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HomeMy WebLinkAboutRESPONSE - RFP - 7052 BENEFITS - TRANSPLANT INSURANCE'A-SEGAL THE SEGAL COMPANY 5670 Greenwood Plaza Blvd., Suite 425 Greenwood Village, CO 80111-2499 T 303.714.9900 F 303.714.9990 www.segalco.com August 13, 2009 City of Fort Collins, Purchasing 215 North Mason, 2°d Floor Fort Collins, CO 80524 Re: Request for Proposal for Benefits - Transplant Consulting Services Dear Purchasing: We are pleased to submit this proposal to provide the Benefits - Transplant Consulting Services as described in Request for Proposal (RFP) for the City of Fort Collins (City) Bid Number: 7052. The format of this proposal complies with the RFP response requirements. The following pages present the details of our proposed consulting services and highlights the credentials and experience of the team of professionals that we have assembled for this engagement. We understand that all proposals shall remain subject to initial acceptance 90 days after the day of submittal. Our proposal is intended to be fully responsive to your request. We would welcome the opportunity to meet with the City to answer any questions or to discuss our proposal. We appreciate your consideration for this important assignment. Sincerely, Linda J. Semmer Benefits Consultant The Segal Company /cz Enclosures Sincerely, Theresa O'Shea Vice President, Marketing Services BCS Insurance Company • 11 • Transplant Coverage Except for kidney and cornea transplants, which are covered by the City of Fort Collins Group Health Plan, covered transplants are provided through a pooled trust. Individual group experience is not available. The City pays 100% of premiums for this coverage. All employees and dependents enrolled for coverage under The City of Fort Collins Group Health Plan are also enrolled for this separate transplant coverage. Summary of Benefits Payable Lifetime Maximum: $2,000,000 per person per covered transplant procedure Covered Services: Heart, Heart/Lung, Lung (single and double), Liver, Pancreas, Kidney/Pancreas, Small Intestine, Autologous Bone Marrow Transplant, and Allogeneic Bone Marrow Transplant Covered Services Paid at 100% of eligible expenses Organ Procurement Max: Cadaveric, $35,000 per transplant benefit period Living, $65,000 per transplant benefit period Bone Marrow, $25,000 per transplant benefit period Immunosuppressants: Covered at 100% Transportation Maximum: $10,000 per transplant benefit period (up to $200 per day for Lodging and meal expenses) Private Nursing Care: $10,000 per transplant benefit period Circulatory Assist Device : Covered at 100% for registered heart transplant candidates Hepatic Assist Device: Covered at 100% for registered liver transplant candidates Complications/Expense related to Disease/ Cause of Transplant: Covered at 100% Re -transplantation: Covered up to Plan's maximums BCBS is willing to duplicate the current benefit program with the noted enhancement in the organ procurement maximum. '�SEGAL s ALPHABETICAL INDEX (http://www.naic.org/committees_e_app_blanks.htm) ANNUAL STATEMENT BLANK • Analysis of Increase in Reserves During The Year Analysis of Operations By Lines of Business Asset Valuation Reserve Default Component Asset Valuation Reserve Equity Asset Valuation Reserve Replications (Synthetic) Assets Asset Valuation Reserve Assets Cash Flow Exhibit 1 — Part 1 — Premiums and Annuity Considerations for Life and Accident and Health Contracts Exhibit 1 — Part 2 — Dividends and Coupons Applied, Reinsurance Commissions and Expense Exhibit 2 — General Expenses Exhibit 3 — Taxes, Licenses and Fees (Excluding Federal Income Taxes) Exhibit 4 — Dividends or Refunds Exhibit 5 — Aggregate Reserve for Life Contracts Exhibit 5 — Interrogatories Exhibit 5A — Changes in Bases of Valuation During The Year Exhibit 6 — Aggregate Reserves for Accident and Health Contracts Exhibit 7 — Deposit -Type Contracts Exhibit 8 — Claims for Life and Accident and Health Contracts — Part 1 Exhibit 8 — Claims for Life and Accident and Health Contracts — Part 2 Exhibit of Capital Gains (Losses) Exhibit of Life Insurance Exhibit of Net Investment Income Exhibit of Nonadmitted Assets Exhibit of Number of Policies, Contracts, Certificates, Income Payable and Account Values Five -Year Historical Data Form for Calculating the Interest Maintenance Reserve (IMR) General Interrogatories Jurat Page Liabilities, Surplus and Other Funds Life Insurance (State Page) Notes To Financial Statements Overflow Page For Write-ins Schedule A — Part 1 Schedule A — Part 2 7 6 30 32 35 29 2 5 9 10 11 11 11 12 13 13 14 15 16 17 8 25 8 18 27 22 28 20 1 3 24 19 53 E01 E02 INDEX ALPHABETICAL INDEX ANNUAL STATEMENT BLANK (Continued) Schedule A — Part 3 E03 Schedule A — Verification Between Years S102 Schedule B — Part 1 E04 Schedule B — Part 2 E05 Schedule B — Part 3 E06 Schedule B — Verification Between Years S102 Schedule BA — Part 1 E07 Schedule BA — Part 2 E08 Schedule BA — Part 3 E09 Schedule BA — Verification Between Years S103 Schedule D — Part 1 E10 Schedule D — Part 1 A — Section 1 S105 Schedule D — Part 1 A — Section 2 S108 Schedule D — Part 2 — Section 1 E11 Schedule D — Part 2 — Section 2 E12 Schedule D — Part 3 E13 Schedule D — Part 4 E14 Schedule D — Part 5 E15 Schedule D — Part 6 — Section 1 E16 Schedule D — Part 6 — Section 2 E16 Schedule D — Summary By Country S104 Schedule D — Verification Between Years S103 Schedule DA— Part 1 E17 Schedule DA — Verification Between Years S111 Schedule DB — Part A— Section 1 E18 Schedule DB — Part A— Section 2 E18 Schedule DB — Part A— Section 3 E19 • Schedule DB — Part A — Verification Between Years S112 Schedule DB — Part B — Section 1 E19 Schedule DB — Part B — Section 2 E20 Schedule DB — Part B — Section 3 E20 Schedule DB — Part B — Verification Between Years SI12 Schedule DB — Part C — Section 1 E21 Schedule DB — Part C — Section 2 E21 Schedule DB — Part C — Section 3 E22 Schedule DB — Part C — Verification Between Years S113 Schedule DB — Part D — Section 1 E22 Schedule DB — Part D — Section 2 E23 Schedule DB — Part D — Section 3 E23 • INDEX2 ALPHABETICAL INDEX ANNUAL STATEMENT BLANK (Continued) Schedule DB — Part D — Verification Between Years S113 Schedule DB — Part E — Section 1 E24 Schedule DB — Part E — Verification Between Years SI13 Schedule DB — Part F — Section 1 SI14 Schedule DB — Part F — Section 2 SI15 Schedule E — Part 1 — Cash E25 Schedule E — Part 2 — Cash Equivalents E26 Schedule E — Part 3 — Special Deposits E27 Schedule E — Verification Between Years SI16 Schedule F 36 Schedule H — Accident and Health Exhibit — Part 1 37 Schedule H — Part 5 — Health Claims 39 Schedule H — Parts — 2, 3, and 4 38 Schedule S — Part 1 — Section 1 40 Schedule S — Part 1 — Section 2 41 Schedule S — Part 2 42 Schedule S — Part 3 — Section 1 43 Schedule S — Part 3 — Section 2 44 Schedule S — Part 4 45 Schedule S — Part 5 46 Schedule S — Part 6 47 Schedule T — Part 2 Interstate Compact 49 Schedule T — Premiums and Annuity Considerations 48 Schedule Y — Information Concerning Activities of Insurer Members of a Holding Company Group 50 Schedule Y — Part 2 — Summary of Insurer's Transactions With Any Affiliates 51 Summary Investment Schedule S1011 Summary of Operations 4 Supplemental Exhibits and Schedules Interrogatories 52 • INDEX3 No Text ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • SUMMARY INVESTMENT SCHEDULE Admitted Assets as Reported Gross in the Investment Holdin s Annual Statement 1 2 3 4 Investment Categories Amount Percentage Amount Percentage 1. Bonds: 1.1U.S. treasury securities ----.--------------------------------- .............. ..-----_-_----_.-------------------- 7,739,240 ----------------5,137 -------------------7.739,240 ...........................5.137 1.2 U.S. government agency obligations (excluding mortgage -backed securities): 1.21 Issued by U.S. government agencies..._..............................._.._.....___...__-_3,663,751 ..........................2.432 -------------------3,663,751 ..........._-.2.432 1.22 Issued by U.S. government sponsored agencies........... - ____ .............. _0 ...........................0.000 ------....__-_0 ................... __ 0.000 1.3 Foreign government (including Canada, excluding mortgaged -backed securities) .......------------------------------- ----_....__.......... -- _ __..... ............... - _D _........ 0.000 ................................D ................. 0.000 1.4 Securities issued by states, territories, and possessions and political subdivisions in the U.S.: 1.41 States, territories and possessions general obligations .............. ...................7.022,907 ..........................4.661 ....................7,022,907 ............ _4.661 1.42 Political subdivisions of states, territories and possessions and political subdivisions general obligations ...................................... ............... ........__.._._D ...........................0.000 --------- --- _________.D ..................... ._._0.000 1.43 Revenue and assessment obligations .... ------------------- _-______... ............... ._._._......-...D ......._.._.._......._0.000 ......------------------.__ ----- ....._...________0.000 1.44 Industrial development and similar obligations . _.._............................D ........... 0,000 ..................................D ................. 0.000 1.5 Mortgage -backed securities (includes residential and commercial MBS): 1.51 Pass -through securities: 1.511Issued orguaranteed byGNMA_._...._...._...._______--- ------------------- J763,582............... --- __-.1.171 ...................1,763,582 .........._._-1.171 1.512Issued orguaranteed byFNMA and FHLMC..___.___... ............... ..30,884,846 ................_.._._20.499 .................30,884,846 ......__..20,499 1.513 All other ------------------------------ -------------------------------------------------- --------------- --- --0 ............._...._0.000 --------------- - _.._D ............. 0.000 1.52 CMOs and REM Cs: 1.521 Issued or guaranteed by GNMA, FNMA, FHLMC or VA.. 6.953,351 ......................_.4.615 ................_6.953,351 .................. 4.615 1.522 Issued by non-U.S. Government issuers and collateralized by mortgage -backed securities issued or guaranteed by agencies shown in Line 1.521.______ . .. .......................___.....0 .................._....._0.000................. ____ __.......D -............_.._____0,000 1.523All other _..-------------------------- ...-------...--------...._........_......------..._..._.31,930,771 -------------------21.194 ..-..._._31,930,771 .........................21.194 2. Other debt and other fixed income securities (excluding short -tens): 2.1 Unaffiliated domestic securities (includes credit tenant loans rated by theSVO) .... -. _....... ........... ....... ..._.. ........-._................................39,206,964 ................. 26.023 39.206,964 ............. .-._26.023 2.2 Unaffiliated foreign securities ......__._..._............_................... ------------- __3,646,077 ........................... .........._._._3,646,077 ...........................2.420 2.3Affiliated securities _.._...-------------------------------------------------------------- ....._..........................D .............. ____0.000 ..................................D ....... 0,000 3. Equity interests: 3.1 Investments in mutualfunds ...................................................... _........................._..._--_--_-___D .......................... 0.000 ._._.--- ---- ..-_---- ------ 0 ............................ 0.000 3.2 Preferred stocks: 3.21 Affiliated ............................... _...-..._.................._......---- ........._.--_-_-_-___0 ........................ 0.000 _D .................... .0.000 3.22 Unaffiliated ...................... D ............ 0.000 - - - D ...................0.000 3.3 Publicly traded equity securities (excluding preferred stocks): 3.31 Affiliated _._D ......_.._...._......._0.000 __D ...........................0.000 3.32Unaffiliated ............................... ..------ ------------------------------------------- ....................... ..........D ................-----0.000 ----------------------------------D ...__..._.. -0,000 3.4 Other equity securities: 3.41Affiliated .._...................... ...--.......------- - - - --------------_------._....__D ........... 0.000 ........................... 0.000 3.42Unaffiliated_.__............................................................. .._..._.._....._...............................D .........._........... .................. - -0 ................. 0.000 3.5 Other equity interests including tangible personal property under lease: 3.51 Affiliated-------- ................ .... __-_.... .................................. D ............ _.____0.000 .............0.000 3.52Unaffiliated..............................._--------------------------------------- ----------------- _.._-----0 ................ .......... .000 _._....._.. D ................ 0,000 4. Mortgage loans: 4.1 Construction and land development..-... - .................... ............... ......._.. ... ...._.....D ------------ 0,000 ._ ......................... ..... .0 ............. - ......_0.000 4.2 Agricultural ..................... ........ ..............................................._.........._......_..._...D............. _.._ __0.000 ------------------------------.__D ............ .............. 0,000 4.3 Single family residenfial properties............................................................... ............................_.....0.............. .._------_0.000............... .....-D ........................... 0.000 4.4 Multifamily residential properties................................._------._..--------------- ...._______0 .................... 0.000 ................... .............. D............. .._____0,000 4.5Commercial loans ------------------------------------------------------------ _............-------- ------------------------------- _-.O ...........................0.000 ....._.._--._....._....._...-D ---........--------0.000 4.6 Mezzanine real estate loans - _ .._0 ......_...................0.000 5. Real estate investments: 5.1 Property occupied by the company..................................... ... .................. ..D ..._..................- 0.000 .........................0.......... ....______ ,000 5.2 Property held for the production of income (including $-.................................. D of property acquired in satisfaction of debt)............_......_-_-_._...D ---------------- 0,000 ...............................-..D ........._...............0.000 5.3 Property held for sale (including $ D property acquired in satisfaction of debt)... - - -............_ ............._.................. ........................D ............... -- D.000 --------- _..D ................... ---0.000 6. Contract loans ..... .................. 183,703 .._.......................0.122 ..............___._183,703 7. Receivables for securities --....................... ...---.............._._.--_...................._...._......._._...D ............._ -0.000 ...................._.._...D ....._... -- ._......0.000 8. Cash, cash equivalents and short-term investments ........................................ ........ .........17,667,787 ....._..__...._......11.727-------------_..17,667,787.................... ...._11.727 9. Other invested assets................................._........._.._......______. 0 1 0.000 1 0 1 0.000 150,662,979 1 100.000 1 150.662,979 1 100.000 10. Total invested assets 1 S101 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company SCHEDULE A - VERIFICATION BETWEEN YEARS Real Estate 1. Book/adjusted carrying value, December 31 of prior year..-.. --- _......----------------------------------------------------------- ..............._......................_._.............._...__ ._...... .............. ...________ 0 2. Cost of acquired: 2.1 Actual cost at time of acquisition (Part 2, Column 6).....__.................. ._________.._------------------- ................... .............._.................. 0 2.2 Additional investment made after acquisition (Part 2,NO .... 0 .............____.____._0 3. Current year change in encumbrances: _ 3.1 Totals. Part 1, Column 13..........__..______-___--......... ._ ... .........................._.................._...........__._...______0 3.2 Totals, Part 3, Column 11 .....__........._.._ ........................_...................._._..............._.........._._...__......_......_.._..............._____..0 .. ._.............._.._......._..0 4. Total gain (loss) on disposals, Part 3, Column 18._..___.._............-._______...................._...._._._........................................................ ._._____.._...... ......................... ........... 0 5. Deduct amounts received on disposals, Part 3, Column 15 ...------------ ........... 6. Total foreign exchange change in book/adjusted carrying value: 6.1 Totals, Part 1, Column 15_.............._...._......_.........._..................._.................................................................._..._............________...0 6.2 Totals, Part 3, Column 13------------- .............................. ...__.........._............... 0 ............------------_0 7. Deduct current years other than temporary impairment recognized: 7.1 Totals. Part 1, Column 12-------------------------------------------------- ..._ _ ____.._0 7.2 Totals, Part 3, Column 10---------------------- .............................. -----__.................... --------------................................................................................ 0 ............ ._--------.0 8. Deduct current year's depreciation: 8.1 Totals, Part 1, Column 11...................... ............ ...._.____..__._.._......................... ...................................... ._....._....._...................________0 8.2 Totals, Part 3, Column 9.....__ .......................____.0............................. 9. Book/adjusted carrying value at the end of current period (Lines 1+2+3+4-5+6-7-8)_.._._._._._........................ ._._........._...._._............._..........._.........0 10. Deduct total nonadmitted amounts..-----------------._................._..----._.....................---------------................_.------------0 11. Statement value at end of current period (Line 9 minus Line 10)....................... ................................ .._.._......_.................. _______.0 0 • SCHEDULE B - VERIFICATION BETWEEN YEARS Mortgage Loans 1. Book value/recorded investment excluding accrued interest, December 31 of prior year 2. Cost of acquired: 2.1 Actual cost at time of acquisition (Part 2, Column 7) 2.2 Additional investment made after acquisition (Part 2, Column 8).................... 3. Capitalized deferred interest and other: 3.1 Totals, Part 1, Column 12, ................ .............._._...........N-0b 3.2 Totals, Part 3, Column 11_............._...._......................._4. Accrual of discount......................__......._ 5. Unrealized valuation increase (decrease): 5.1 Totals, Part 1, Column 9........................... ..._.......................... ..__..._.._..........._.... D D 5.2 Totals, Part 3, Column 8.._......._.........._..........._.........................._............................_......._....._._........__..._.....................0 ..... D 6. Total gain (loss) on disposals, Part 3, Column 1B............................................................... _.._........_...._._........._.........__...._.................._.._- _-___......... ............ ...................... D 7. Deduct amounts received on disposals, Part 3, Column 15._....................................................... _....__................................... __........................_........._.D 8. Deduct amortization of premium and mortgage interest points and commitment fees_.........._....._..............................___..._........ _..........._.....__.._._....D 9. Total foreign exchange change in book value/recorded investment excluding accrued interest: 9.1 Totals, Part 1, Column 13............------------- ----------------------------- ....----- ---- __------ ............................. 0 9.2 Totals, Part 3, Column 13, ...................................................... .......................................0 ........... 10. Deduct current years other than temporary impairment recognized: 10.1 Totals, Part 1, Column 11 ........... .............................................................. .......... .._...._......__._..0 10.2 Totals, Part 3, Column 10................................................... ._____................................................._._____...__._....._........_.............._........0 .._.... D 11. Book value/recorded investment excluding accrued interest at end of current period (Lines 1+2+3+4+5+6-7-8+9-10) D 12. Total valuation allowance ................ .............. ._______......._................................_........._..______.__......._............._._...__.._____........_.................._......_........._..._..________0 13. Subtotal (Line 11 plus Line 12)................... ._..._...... ........................ ................... .............. ....._..........._..D 14. Deduct total nonadmitted amounts.................__..--------.......--..------------__.._..-------......._..---...._.__--....._...._...----.............................-----...._...._..D 15. Statement value at end of current period (Line 13 minus Line 14) ....... .._................_...D S 102 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company SCHEDULE BA - VERIFICATION BETWEEN YEARS Other Long -Term Invested Assets 1. Book/adjusted carrying value, December 31 of prior year. ............... _----------------------------- __.._------------------------------ _--- ----- ......._....._..._....._____....._.................0 2. Cost of acquired: 2.1 Actual cost at time of acquisition (Part 2, Column 8)_.._...................... .._..._..__....................._..._........................_..............._____.____._.........._0 2.2 Additional investment made after acquisition (Part 2, Column 9).___..................... __..................... __ ................................... 0................................. _0 3. red interest talized other: ................................ 3.2plTotals, Partr3, Column 12nd _ _.._N-0..............0 N ...__........._....._..........04. Accrual o(discount_..............._.....__..............._...._.................._........................_ ................................... 5. Unrealized valuation increase (decrease): 5.1 Totals, Part 1, Column 13-------__-_-.................................................................._........................................_....._--__-------....._....__0 5.2 Totals, Part 3, Column 9..........................---- ...-............................. .................................................................................. ................................... ....................................0 6. Total gain (loss) on disposals, Part 3, Column 19............................... _.__-------------------------- __..........._._.............__....._................._....... _ - ___............. _0 7. Deduct amounts received on disposals, Part 3, Column 16............... ......_----------- 8. Deduct amortization of premium and depreciation _----------------------------------- ......................................_____..........._........_------ ------------------------- 9. Total foreign exchange change in book/adjusted carrying value: 9.1 Totals, Part 1, Column 17-------------- ................................ _0 9.2 Totals, Part 3, Column 14 ....................... ._.__-,__-.............................................................. ........... ..........-------------------------- ._..-__ ................................... 0 ..._.......................... __ 0 10. Deduct current year's other than temporary impairment recognized: 10.1 Totals, Part 1, Column 15 ......._.................................._.................................................................................._...............0- 10.2 Totals, Part 3, Column 11------------------------------------------ .—----------------------------------------------------------------- ..........------------------------------------ 0-.............. ..................... 0 11. Book/adjusted carrying value at end of current period (Lines 1+2+3+4+5+6-7-8+9-10) .... 0 12. Deduct total nonadmitted amounts...__......................................_......................._.............................._.________ ...................... .._-- ------------------------._ ------------------ 13. Statement value at end of current period (Line 11 minus Line 12). ................................_........................_..........._............—.___---..............._......._-__........._...._- _..._0 SCHEDULE D - VERIFICATION BETWEEN YEARS Bonds and Stocks 1. Book/adjusted carrying value, December 31 of prior year,.-, ................ ,_.._._..____..__......_.................. ................. 136,557,625 2. Cost of bonds and stocks acquired, Column 7, Part 3____ ............ ............_._.__.__..__..................... ________35.657,453 3. Accrual of discount _________....._._.._..............................._........._......____________................._..............._.......................... ___-___..._.__227,918 4. Unrealized valuation increase (decrease): 4.1 Column 12, Part 1_......_............._............................................................_..........._..-_-__...........................__.._0 4.2 Column 15, Part 2, Section 1 - 0 4.3 Column 13, Part 2, Section 2...-----...----------------...------.._......................................._........-------------_._.......__........_.—__._....._.._........._0 4.4 Column 11, Part 4-_—......_.._..........._.._.._...._................._........____.._.-._.......................... ...._....._0....._...........................0 5. Total gain (loss) on disposals, Column 19, Part 4-------------------- ............. ............_----------------------------------------- ._................ ..._....._.__.____.....----------------------- _______......._320,021 6. Deduction consideration for bonds and stocks disposed of, Column 7, Part 4.__.......__-. ..........__....._.------------- 36,650,893 7. Deduct amortization of premium.---_.....--.............................................. ----------------..-------------------------------------------------------- ------------------._....----......--------.. 488.521 8. Total foreign exchange change in book/adjusted carrying value: 8.1 Column 15, Part 1 0 8.2 Column 19, Part 2, Section 1................................................................. ... .... ...._......._......_......_............................._._._..._----...............A 8.3 Column 16, Part 2, Section 2---------------------- .-----------.................. ....................................... ------------......._...........---..... -------------------------0 8.4 Column 15, Part 4....................................................... ........................................ ..._............................. 0 ..._..._._....__._......._0 9. Deduct current year's other than temporary impairment recognized: 9.1 Column 14, Part 1............_.....__._............_---------------. _. ............................ .....1,647,727 9.2 Column 17, Part 2, Section 1....................... ...._-_--___..........._..._._..................................._..._—................................. _--__--..--------------------- 0 9.3 Column 14, Part 2, Section 2............_.._._............................................._.__----------------------------------------- ................ .. 0 9.4 Column 13, Part 4_ ........................164,384 2,812,111 10. Book/adjusted carrying value at end of current period (Lines 1+2+3+4+5-6-7+8-9)___..__................._......................_ .................. ____..... 132,811 ,492 11. Deduct total nonadmitted amounts............................................................. ...._._............................................._.-._. .........._....0 12. Statement value at end of current period (Line 10 minus Line 11)... _.................132.811.492 • S 103 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company i • SCHEDULE D - SUMMARY BY COUNTRY Lono-Term Bonds and Stocks OWNED December 31 of Current Year 1 2 3 4 Book/Adjusted Description Carrying Value Fair Value Actual Cost Par Value of Bonds BONDS 1. United States.,.-,_,,__,_, � .................. 13,166,574 ____........_14,476,129 .................13.307.595 ___._......12,762.500 Governments2. Canada.._-.........................._....--......................_D _-_.._.................----D _------..................._D -------..............D (Including all obligations guaranteed 3. Other Countries 0 0 0 0 4. Totals 13,166,574 14,476,129 13,307,595 12,762,500 by governments) States, Territories and Possessions 5. United States .................... __.............7,022,907 .--------.---------6,944,711 -------------7,108,078 ...................6,880,000 (Direct and guaranteed) 6. Canada _ ------------------------ ..-------- _....................D ...................D ...................................D ...................................D 7. Other Countries 0 0 0 0 8. Totals 7,022,907 6.944,711 7.108.078 6.880.000 Political Subdivisions of States, 9. United Stales--------------------- __----- ............... ........0 ----------------------------------0 ----------------------------------0 .....--...--..--.......--.........0 Territories and Possessions 10. Canada ........................... -----------------------0 ........................._..... D .............. 0 ............ __0 (Direct and guaranteed) 11. Other Countries 0 0 0 0 12. Totals 0 0 0 0 Special revenue and special assessment obligations and all non -guaranteed 13. United States ........... ......_.......----------- 37,838,197 -----------------38.950.949 ._.....37,866,899 ____..__..38,047,382 obligations of agencies and authorities of 14. Canada ... .......---------___-------------------------- .--- __D _--_ _ ----.--------------.0 ---..._....._.._...............D ...................................0 governments and their political subdivisions 15. Other Countries 0 0 0 0 16. Totals 37,838,197 38,950,949 37,866,899 38,047,382 Public Utilities (unaffiliated) 17. United States .................... __._..........1.482.385 ....................1,463,158 ...........1,501,132 ..........1,475,000 18. Canada .................... - ._.-.. D --- ..--.......--..D ..........................D ----------------------------------D 19. Other Countries 39.986 42,011 39,960 40,000 20. Totals 1,522.371 1,505,169 1.541,092 1,515,000 Industrial and Miscellaneous and Credit Tenant 21. United States ..............69,655,351 -------------62,111,719 .................70,020,783 -----------------71,527,016 Loans (unaffiliated) 22. Canada_.............__._.._..............._..600,701 _----- ....._541,365 ___ .............. 601.335 -----------------------590,000 23. Other Countries 3,005,389 2,592,941 3,016.168 2,990,000 24. Totals 73,261,441 65,246,025 73,638,286 1 75,107,016 Parent, Subsidiaries and Affiliates 25. Totals 0 0 0 0 26. Total Bonds 132,811,490 127,122,983 133,461,950 134,311.898 PREFERRED STOCKS 27. United States---.----...---- ...........................D ------------------------_._..._-D ___-__ - _ D Public Utilities (unaffiliated) 28. Canada ..........__....___...._ ._................_......._.._D .. ----._._._.----------------0 _------------------------_---. D 29. Other Countries 0 0 0 30. Totals 0 0 0 Banks, Trust and Insurance Companies 31. United States ....... ... __ ._._D .................0 _.._..._.......................0 (unaffiliated) 32. Canada ............ ..------- ------........----......--..-D .--....._..............-----0 -------........... ___ -0 33. Other Countries 0 0 0 34. Totals 0 0 0 Industrial and Miscellaneous (unaffiliated) 35. United States.................... ..................................0 ..................D ...-.................--...........0 36. Canada .............. _------- --------------------------0 ............D -------------------------------0 37. Other Countries 0 0 0 38. Totals 0 0 0 Parent, Subsidiaries and Affiliates 39. Totals 0 0 0 40. Total Preferred Stocks 0 0 1 0 COMMON STOCKS 41. United States ------------- ___ -- -----------------------------------D ------- ..............._...D -----------------------------------0 Public Utilities (unaffiliated) 42. Canada..._ ......................... ___-._...................... 0 .............................._-D .................D 43. Other Countries 0 0 0 44. Totals 0 0 0 Banks, Trust and Insurance Companies 45. United States..... --- -----------------------------__D .................D ------------------------------- _A (unaffiliated) 46. Canada ................ . __-__........................ D ............................... _0 ...................D 47. Other Countries 0 0 0 48. Totals 0 0 0 Industrial and Miscellaneous (unaffiliated) 49. United States .......__ ................................_0 -------------------0 ..........--.............___ 50. Canada ............._........ ...................... 0 ----_...--._........_....D .._..-----.......--........_.0 51. Other Countries 0 0 0 52. Totals 0 0 0 Parent, Subsidiaries and Affiliates 53. Totals 0 0 0 54. Total Common Stocks 0 0 0 55. Total Stocks 0 0 0 56. Total Bonds and Stocksl 132.811.490 1 127.122.983 1133,461.950 S104 • • Ll T m a E 0 Q u e- C R Z O N C N fr' J V ) W Li V� m W r Q LL r 0 CD N CCD I.f� N N IL W W W m J 0 LL r � z W rL r V a CO) N a mt0 I M ooOoo M qq q o 00 q qoo A q qo, 1 Q o rn qqq, q, o- oaa m l�H o 0 A m00000w o00000o o o ------- ------o N00000- ry o o N U m I I o `o_ as w C U m o 0 CoD o A w A y �o �d o0 o 0 0 00 0 0 0 -000 o ry o 0 0 d _ U D F q f w Y o oo ca m F U q q q o o •- o 0 0 0 0 0 0 qqqoo n g q q q q o 0 o g q q q o M Q m - qoo O g q q qo.- m "d C ° at c M q, q q q- o Q o rn N - ' Y o a H w cMD L 0 c N c 0 lz w J m C a c 2 w m N A � O O C w O C c a 0 F ci 0 0 % a `o m c N Z w w E w � L « E 0 > 0 a c m � N w Ky UUUUU U F-o UUUUU U f-:; UUUUU U V- 2 = UUUUU U H A N N N N two N u UUUUU U H « N M O O O A Q •- •- •- «« N M R N O A (V N N N N N N N N M O N (D A th (h th M M M M 0 r N M R N cq A O O C R R O O y r N t7 < h tD A h N N E iD N d N N V N S105 • d w J S 106 • 1. Do you agree to provide services to all employees/dependents enrolled as of December 31, 2009? Yes. 2. Will you agree to replicate each of the current plan's provisions? If not, please list the specific provisions you will not replicate, along with the reason you elect not to replicate the provision(s). If you do not identify those specific provisions you cannot replicate and you are selected as the City's vision services administrator, you may be required to make the necessary adjustments in order to achieve replication. Otherwise, your selection may become void. Yes. 3. What is your monthly administrative fee, expressed in terms of dollars per month per employee? 0 Monthly Administration fee, per employee per month is $0.20 • 4. For each geographic area in which you have a network applicable to employee population, provide the following information: See below: 5. Most recent participating provider directory and summary of the number of participating providers in each of the applicable areas (physicians, specialists, institutions, etc.). Also provide the website where provider information can be found. LifeTrac Network Map and Program Reference Grid are included in Section 9. 7�-SEGAL • y � RR Rqo o �- 0 Oggq qo qo •-go,gqo•- 0 o a o rn 0 0o rn C m 0 > o rn v oqo N n q o 0 y n y pam �' xx xxxx xx V o Z Q m � v E U Z000o � p d J m Eo `o IL - z N _ Ey t i o o` o q q` I+ � � � � o �rnrn o o mugiNO .-gggqo •- _ i N Hi V O> W °_ > d J �qo o r �qo NN �qp N VV M op ggqqqoqo .. O N N a ud' -dsa w 0. Q N _ q 0 oa O N d EmovRoo �ggqoM Mgvgorn o,RRq Ro qO o 1 - -cN d R O N W N 0 ~ e_m° t0 v m a S U C m �m OqO O� �ggor 000goo gq.gqqO qO OU �L� Z E C N N?N - W 2 % O N 9 C V d m : m aaa° N U_ r O cn O c a Z n 'C t rn oOgovOM v �n mggo Mco rngoco RRq R Ro qo o O >.�>. N a F'Ili`2 Va Mo 9 q N tO N vl ^M^ '' �. MOl � ° o: N q N N _ m Y > u> E - - n > cy 00 Rqo^oho �RRRO,o rnN E c E r J q q q N m O O m O C m O E U J f E i e o o o s a a o 0 o 0 N �' N O c -i m N N N gO m N N N N a N N N m m m m m m m o c c m m A m m V U V V V V V Vm Vm Fo J J�Cg v v v m 9 9> V 0 0 �p 60666 c; O m m N �N f N . ~ N M a u) ( O r m O) :2 Mi,-i d U- S107 • • • N Z O r U W CO Q r Q a W J D 0 W 2 U U) N q00 qq qq q00 00 0o qoo qq qq qoo qq qq qoo > y �a`m ya qo oq o00 oR 90 oOr 90 00 �v o a- M O f' r Ud omm o0 00 00o coo 00 o 0 oocp 0 0 o0 00 000 0 oN vo cooN 0 o `o LLa` q qq qq Roo cOR qR c o qR qq Roo qoo MR EO a 0 F dplm r � m O J O _ p 0 m U W N o O O O O W C ] qq qq qoo rq qq qor � qq, Rq qoo qco q N > D m oC d O U _ `O o F i qq RR qo- q0 OO qoo qo NO o 10 U1 O N N C d O N U a b qq qq q00 qo q0� qq qq q q o0 d ] d } r } O O m O0 qR qq qoo MO RR ROM Oq qq oogi cpj Ao 0 E }q m �L a O ° 3 b � qq qq qoo o, Mq q Ro- qq q0 qoo q� �q O m N O _ _ a dL C O p Q N qq oq qoo qq qq qoo RR OO qoo Or -_q O " } f :F iK i 'H iU m:< m0 mm'¢ _m ` 'm SY i iY 'n ❑ i0 ;Y �O 'LOL, �Y i❑ iY �Y :Y ! ]Y Q fn (nQ :Q!G fAQ i0 tnQ Io ;dw i0 w i ;vw !w 0 ,, a m ',dw w ;vw iw d im im¢, ¢0ima C¢7 ImQ Ua' ~ w ! w� ''KwIx n 10 2 •a '¢o '2 62 'a0 ia2 'i i f �` m m2V KW� K i i(WI:O m=rnm W mot0 m NW i mmWF mmWF NWO 2W rnm iWX� WN m0 2U mi w( b: r 0L w b!dmW�F rw i0 2 F a n w0 ' m m :iF ew OR o O p :U) pa' :U �(A :(nU my gym NW y CNN :U G : W N W NVl iVl ._ W N �Ny OW N OU o0ya :Ccl :V°a o�0a 'vw9 JOtJU_N-o Nay ] p 2 m 7 a d p N C_ m N 2 Q N O qJ` Q N L". Htn i00imOOF 7 N f 7 Q N N N 0 N t p r (V N N 0 2mi00im00� N m Q t7 N t7 0 I' l 19 r M t7 �mfOOi N t h Q Q Q Q Q mOOH' N m r Q Q Q NU) Oico N M Q O (O r N N i0 S 108 • • O C q q q q o q q q q O o q o q q q q o o L _ m a` m _ �a q R R R o R o R R o q q q q O o n ) O o 0 0 0 o t0 o 0 0 0 m 0 o c! o O o rn o o`_ LLa m q q q q o q M R q o o O O o R o U m M 0 0 0 a mt2q g � a Vl U O a a c m m w R R O o o O m q o o q q q q o a m am 3 N > q q q q o q m q o q 0 q q R R q 0 m o' a O 0 m w - - - - q q R o ro m H 0 'O R RR RO q 90 R R RR DO 3 ' v C O O t m a O Olzt R C1R RO R q m q0 R R R R q o a_ O O c. O O r w w m Q iQ(niQN o' w 'w a !w !w O A Q QN :m i0 :OW m ;O :OW O :m :(7 !UW u h iK :a� m w itr :try O w •. it :ow 0I y �Q Q(n m m Qfn r an d _QN m F- m F iU0 !F i UO KOCIW m w : m w W Y m w W Y m y W Y A OI 0 W 2 U m y ! i m i O W z U o y y ! 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W :N '',Q N U W y N OwlU InW Q y N i N :N U ',W N N InvN Q fnQ ¢ t%1Q ¢ lnQ .:Q :O N¢ :O g F ; D m : m m m a m m D m m a d0 :U W !C7 vW iU o vw iUWa o 'm6 i0¢' imp !(¢.7 im0 iUa' irn ;m0 iU !N itriIx ?m U U'W O U i i i WZ y c WZ o Nm m wx O J Cp ZW AN �WN iU J N O W : C DOK O Y W N O 0 d N 91 i O O O D W O] W :2 O 0 0 y iU �(N/1 m �K �U ''Ni7'' m FAN ;U a o m m A C a e e jN m m io !Q a` o,y qy� '0 5 V D iUD p C ODUD U c C Oa UU V D > UUU U p jOtJ CNJCNN^py��C�HC m cam'=tzocm'c m^��mJ�J��m�-^._ D dt D 0 Emma cadZ' no NN 2ma'c',,^cD M th ?=Nio0i00�.��-Ni�Oi�Or-J;o=miDOi�OF3�A=Ni00i00�JJ ��N l7< O 0 0 0 0 r W 0 0 0 0 F �N t7 V NtDrm ^ ^ F �N [hO N N N N NtOr mm N N N N N N FAN q j M C? M T N(Or to W M V (2 [SI N • • • V/ Q `U Z W 2W `I r W m Z O ILL U_ 2 `W 1 Q 0 W J D W 2 t� N d Q o 0 0 a w m q `m m E cti o 0 0 0 0 0 0 0 d E w v m fQ 0 m c d E O � >c m d d c 0 N fll d O H C d E d C E C t N N � � N C O) O N m � C y � y d c J a m d o d A o O `o o E u � c m m u � a ! 0 o a n E m a c `m > v u n y n t > w o a > c o a w c EN CC_TV U ` d U O j y N o D r d N C C a > c o ` _ N > o a O Q m 7 H O O H O m O (cn (d I: m 6 O N ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • E • Schedule DB - Part A - VBY NONE Schedule DB - Part B - VBY NONE Schedule DB - Part C - VBY NONE Schedule DB - Part D - VBY NONE Schedule DB - Part E - VBY NONE Schedule DB - Part F - Section 1 NONE Schedule DB - Part F - Section 2 NONE Schedule E - Verification NONE Schedule A - Part 1 NONE Schedule A - Part 2 NONE Schedule A - Part 3 NONE S112, S113, S114, S115, S116, E01, E02, E03 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • Schedule B - Part 1 NONE • Schedule B - Part 2 NONE Schedule B - Part 3 NONE Schedule BA - Part 1 NONE Schedule BA - Part 2 NONE Schedule BA - Part 3 NONE E04, E05, E06, E07, E08, E09 .7 • • o97oo7777 7777$: S I b8888g ------ o-m-Qo-- -- ssssaasagggggasaaaasagag�,�g��m i 888 o 86; 8 o oo8�i888mo SJ000000 A a8��888�8�{�RN8�S=&m'88 eo�r' is o - N - w� LsQg1w' rU_ r ogNN r « gym .-ads N�Nro�- vri r(o r'riNr�NONri ojr �Ne m'ad El, _mqY m� < '�iw x�..a w�<cv P�mm��mrym���� E10 o+ri�mmm�Nr'N�mri ai ai .dm o_ r'N N.�ri .H ri .-fv .-idmmmmaiv -R--m --- -- --oo o m mm m m m mom m o mo m m m m om • • �mm<sc�� a�'s�9�2i� oa -- iig=gig ���mA�A as��i os�j��gQ��o�m m;ryS o Sm - - - - -hrym �`.2 E K Y meet T;�� .E E 0 ee mP F,e�oo� w ss�s�a ���oo�as�astaaS as o^ s�s�a�os�s.as. . ... . . . . . . .. . . �s sas Vs - cU F oti _Q LLW V CI w � o o m � o o V U 99 9 9 9 9 9 999 999 99 999 9 9 9 9 m o =- m §gym e goo,j2 3 &1 Q o2o o� nC moo - o--$--- --- - -- ma mS�mA�m Q�e7�-m --ry$Sn S,N c m�^=�a inn Vim^ e��ms�a�oo��� a msn�� � $r---------- -m S�u�m �.giM1 v�simo - _o o m L ; f ;� ��as�s�seae���a��Rss000$�os��a��m�aasee�$�emaaa�ar���NN��R�� ��F--iymo Y' `ad800c5o o a�a'o oSoo� oS oSSo�o s'o ------xooe��eee _� QU U u! 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For each network, describe the specific measures used by your organization to monitor participating provider access. Provide the most recent corresponding statistics available for: Provider to member ratios Average waiting period for an appointment Not applicable. 7. What percentage of your providers has limited their practice to current patients? ,Not applicable. 8. Please describe your credentialing procedures. Currently, there are 86 facilities listed in the LifeTrac Network representing over 700 transplant programs. There are 70 facilities that offer one or more Select programs. When a transplant center is identified as a candidate for inclusion in the LifeTrac Network, the contracting staff works to secure a contract. Once contracting • negotiations are underway, the LifeTrac Data Coordinator requests RFI data from the transplant center. LifeTrac uses the standard United Network for Organ Sharing (UNOS) RFI for solid organ programs and the standard American Society for Blood and Marrow Transplantation (ASBMT) RFI for bone marrow/stem cell programs. The Data Coordinator compiles the data and submits it to the LifeTrac Sr. Quality Management Consultant for review. The Sr. Quality Management Consultant performs a review that includes, but is not limited to: - Accreditations and memberships (Joint Commission, UNOS, NMDP) - Volume - Survival - Waiting time - Transplant team stability - Patient continuum of care process Site visits are also part of the evaluation process, and they are conducted every three to five years. At the site visit, LifeTrac talks to key members of the transplant team, including but not limited to: Medical Directors, Surgical Directors, and Transplant Coordinators. LifeTrac also tours the inpatient and outpatient treatment areas and talks with key staff in these units, such as Nurse Managers and Clinical Educators. -7�-SEGAL • • T C A a E 0 V d C L 3 N C w J r V I.L m W Q a LL I Go in O N W a J w Q W LL1 I.n 0 U LL o N o m o a iN �� 8 80 0 0 �I�� oo� ��mga��e�e:�Hm ���oxmHa� S �H��ei3��i�3;�Ri�'�� �SiQ ���� �'n�n ;'Yin •�c1�8`�K�S'.^ ,^nm o�RH'o, Z Z;2 �ga w m wagv o eryv vs ryo 0 O f LL W U m E c AV d U U o.q gGC4�lGCG9gqq�lqqoG9qA 49A�lOgGo. �l4G�lA 4�lgAA�i N o _ u c _ �-----------o-o��m�a--------------------m-------o--- �a��� mete^��mPa�,a���s���;���a^gym - - m��o -�a� o mo����$� C oHHHHHsaHHaHHaesHHHc;ssHsaHSHSHHHoHooHggo$HgHgHHHHoHgggH 0 c BP2 ows '����Y �°�^'o G33"u-3- -titi-n='e.�'oo��ee^��m.��m`�^'���88 L j LL �?F �;Ha0s0HHa��ttHatsssat�ris�ssHHsigH�a�m,�8�8i�rHi �mH�sS,HB oRgio wammS�^m2oo a�oomoY�mi 6R-i8RaeniieaH8�e w`$a�inLL �8888�8x,H 88 o�mo o$x'o S888o e�m-i o§go Y, am�g eg�zomL4me gm�zRmR - -m° Mesa"<:F1.a��� �$,� Psi �,� �e em 2� Q�_ 0 wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww z- 0 8 Z3 3: =6 1 iE w. 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J 'p mass ��a amo -- .a-rn--nh-_ nHn-ri tF"'wegjATvvP,n=ry_ - - - - - - - U � c rnU �W m U C r'3R-o-Ho m--n-S3 C> f UQr; u;~gEP m o0 0 $ r E $ u 0-0 UG - >A_---_--- --- - - - - --- . - -- - - - - - - �� _ C o �Ea i � UQ 0 ] o u moo_„ u nao����o�mma= Q' Oa m> 9 m V.=i u^i�m m o�N mry^Im.-, ry'u"i -: u�,� - - -NN^.N mryv •v, �. �`I� -m.N N"mi.m v', ry" - `: u4. P `.I m. Y ova mm - - "o �a--- -� ens a _o m o 0 o ooe m - u^.-, ^.m m �0 0 ^ _ a 0 ad8 i .... INN E14 For programs currently in the LifeTrac Network, the clinical RFIs and contract financial performance are reviewed on an annual basis. LifeTrac utilizes data reported by the transplant programs in their annual RFIs. This data presents their entire experience and allows for larger samples and improved reliability. We routinely review patient survival, graft survival, wait time, and lengths of stay. The survival data for solid organs is risk adjusted, while the hematopoietic cellular programs report unadjusted survival data. Credentialing criteria is developed by the LifeTrac Program Review Committee (LPRC), and the members are listed below: ➢ Richard Watt, Medical Director, MD, FACS ➢ Lori Lewis, Manager, Clinical Consulting, RN, MA, CRRN, CCM, CMT ➢ Susan McKevitt, Sr. Quality Management Consultant, RN, MS, CPHQ ➢ Shawn Schwartz, Vice President of Operations ➢ Gary Miles, Vice President of Networks Recommendations made by the LPRC must be approved by the President of LifeTrac, Bonnie Anderson. The Sr. Quality Management Consultant continually monitors trends in transplant clinical outcomes. Her feedback, as well as feedback from the other members of the LifeTrac Program Review Committee (LPRC), is used to formulate potential • changes to the program clinical guidelines on an annual basis. The individuals involved in this process are listed above. LifeTrac periodically seeks feedback from transplant team members of the programs participating in the LifeTrac Network with regard to criteria as well as for trends in clinical practice. • With regard to new facilities joining the network, a site visit will be conducted if we are considering programs for Select status. Follow-up site visits occur every three to five years. At the site visit, LifeTrac talks to key members of the transplant team, including but not limited to: Medical Directors, Surgical Directors, and Transplant Coordinators. LifeTrac also tours the inpatient and outpatient treatment areas and talks with key staff in these units, such as Nurse Managers and Clinical Educators. 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B� ��.�«�g4as�t-^�.g432232<.�°&'&m&'�m&'�m&'��m m �58�8m8RRm ���aaaS8i 8i��53= E14.3 rl � « � E TIT- -_ -Z 2\RR9flm;7; , ! 2`Q7t ¥,5 !:_#4Rem*' m2 m9 ; =7 :\\\:: ` )\\:; \)\\) 0 )! ) !((\\\!!\((R77@ SE \ \!\\\\$ \\\ © mEl !!m ,iiiia !!§;!%2 &&& §§§ '\ 9 - / e=,)fliff)!a!: iq E15 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • SCHEDULE D - PART 6 - SECTION 1 Valuation of Shares of Subsidiarv. Controlled or Affiliated Companies 1 2 3 4 5 6 Do Insurer's 7 8 Stock of Such Company Owned by Insurer on Statement Date 9 10 Admitted Assets NAIC Include NAIC Valuation Intangible Company Method Assets Code or (See SVO Connected Alien Purposes with Holding Description Insurer and of Such Total Amount of CUSIP Name of Subsidiary, Controlled or Identification Procedures Company's Such Intangible Book/ Adjusted 1/1.of Identification Affiliated Company Foreign Number Manual)Stock? Assets Car in Value Number of Shares Outstandin 1999999 Totals 0 0 XXX XXX Amount of insurers capital and surplus from the prior period's assets included therein: Total amount of intangible assets nonadmitted EDP, goodwill and net deferred tax SCHEDULE D - PART 6 - SECTION 2 $ 0 $ 0 1 2 3 4 Stock in Lower -Tier Company Total Amount of Owned Indirectly by Insurer on Intangible Assets Statement Dale Included in Amount 5 6 CUSIP Name of Company Listed in Section 1 Which Shown in Column 7, 1 % of E16 0 / E 0 k k k � § � � E17 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company Schedule DB - Part A - Section 1 NONE Schedule DB - Part A - Section 2 NONE Schedule DB - Part A - Section 3 NONE Schedule DB - Part B - Section 1 NONE Schedule DB - Part B - Section 2 NONE Schedule DB - Part B - Section 3 NONE Schedule DB - Part C - Section 1 NONE Schedule DB - Part C - Section 2 NONE Schedule DB - Part C - Section 3 NONE Schedule DB - Part D - Section 1 NONE Schedule DB - Part D - Section 2 NONE E18, E19, E20, E21, E22, E23 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • Schedule DB - Part D - Section 3 NONE Schedule DB - Part E - Section 1 NONE E23, E24 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • SCHEDULE E - PART 1 - CASH 1 2 3 4 5 6 7 Amount of Interest Amount of Interest Received Accrued Rate of During December 31 of Depository Code Interest Year Current Year Balance JPMor an Chase Bank. N. A.__.....__...___................._.Chic o, Illinois__.._..............._......... _...._. ........0.000 ......_..____163,142 _____________0 _____.....3.543,051 XXX 0199998 Deposits in O depositories which do not exceed the allowable limit in an one de sitm See Instructions - en depositories %X% %%% 0 0 0 %XX 0199999 Totals - Open Depositories 2 HX 163, 142 0 3, 543.051 %XX 0399999 Total Cash on Deposit X. %XX 163.142 0 3,543,051 XAX 0499999 Cash in Com an 's Office X%% %%% %XX %%X 1 0 X%% 0599999 Total Cash X%% I XX% 1 163,142 1 0 1 ,543,051 %%% 1. January__.___13, 377,151 4. April ...._......___. ------------1,134, 132 7. July _.................. 9,479,471 10. October...... ... t2,234.623 2. February.._-..— .--.-..---... 13.807, 936 5. May.--- ............. ...--..._......_ 9.277.266 8. August...................................9, 441,161 11. November...... ................_11.069,826 3. March 11.348.461 6. June 14,127.494 9. SeDtember 13,451.566 12. December 3.543.051 E25 • • T C W O. O V Z w c J a > N C _ w J CY co w m= U- Q 0� N N F— wN w Q a o w U. w z J w F w J U U) z z a w z O z E26 A site visit is required before final approval of any new Select transplant center programs. We feel strongly about the on -site visits because we gain knowledge that is not available through the data. For example, it is through conversations so with physicians that we gain an understanding of how well the transplant team communicates together. Perhaps this may seem trivial to some, but we believe that if a transplant team is not functioning well as a team, there is greater likelihood of safety errors and less likelihood of continuity of care. As another example, we find it helpful to see the physical space to answer such questions as whether the rooms are clean. A bonus of these visits is that we hear first-hand some of the clinical trends occurring — new devices, new protocols, etc. This helps us understand whether the transplant center is conservative or aggressive in their approach to patient selection and patient care, and also helps us prepare for changes in contracting to support the changing clinical trends. During our last re -accreditation survey, The Joint Commission reviewed our program review guidelines and processes and commented to us that they view LifeTrac on -site visits as an extension of The Joint Commission's visits to hospitals. Based on their feedback, we have now incorporated more emphasis regarding quality and safety into our visits and interviews with hospitals. The process for re-credentialing is similar to the initial credentialing. For programs currently in the LifeTrac Network, the clinical RFIs and contract financial performance are reviewed annually. Clinical site visits for LifeTrac programs have been conducted every three years. Beginning in 2008, we began • to focus more attention on programs that had undergone change and had declining performance. Any targeted programs may be visited more frequently, while the stable, high performing programs may be visited less frequently (but at least every 5 years). 8. What type of reimbursement/payment methods is used to reimburse participating providers? Please provide a breakdown by method of review. The LifeTrac Network was created to assist our clients in controlling catastrophic healthcare expenses by making available fixed -fee arrangements for organ and bone marrow transplant services at leading medical centers. Before adding any transplant center to our network, we perform a rigorous review of the transplant center and their programs. Initially, we look for those facilities that are leaders in transplantation with a proven dedication to this field. More specifically, we look for facilities that offer multiple transplant programs, have active research programs, and meet established LifeTrac criteria. Panels of transplant experts from around the country helped establish and maintain these selection criteria. Currently, the LifeTrac Network is made up of over 80 of the leading adult and pediatric transplant facilities in the country. LifeTrac looks to contract with those facilities that truly understand the costs 41 associated with transplant care. LifeTrac has elected to focus our contracting efforts on cost predictability and aggregate cost effectiveness. To accomplish -�-SEGAL io ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company SCHEDULE E PART 3 - SPECIAL DEPOSITS 0 • • Deposits For 1 2 The Benefit of All Policyholders All Other Special Deposits 3 4 5 6 Type of Purpose of Br"mri.sted Fair ..Adjusted Fair States Etc Deposits Deposits C in Value Value Carrying Value Value 1. Alabama. .... .. AL _____ .... .............................. .. 0 _.._ - 0 ............ 0 _ _._ ....0 2. Alaska ... . AK ._. _ _ ____ .... ....... _._ ___ ________ _ ___ ....... 0 __ __ ___-___ 0 ... 0 .._ ..._0 3. Arizona ------------------------------- Az ....... _____......... ................................................................... ............................... 0 ..........................0 ................................ ................----__O 4.Arkansas ..................... AR...... ._._0.__-_-- Life Insurance..._.__...._ ................ __0 ______.____.._....0 .....................120,042 ................... 163,837 5.California ...................... CA..__ _....._ ............ _0 _-___--__._..........0 ...............................0 ............_........_._..._0 6. Colorado ----------------------------- CO. -------------------- .......................................... ......................... ............................... 0 ......................___._0 -__................ ...._.._O _______.____...........0 7.Connecticut ------------------------- CT..__ ....--------------- ............................................................ ._.......__........................0 ..............................0 .._......._......_...__._0 .._..___ -__0 8.Delaware ............................ DE...... _____. -------- .................................._....................... ......................................0 .._..........................0 ......._.._..............._0 _..........._-_-_-__0 9. District of Columbia ..._....._. DC ..... .._.._.----- .............. 0 ............. .._..____ _.0 _._.._...................._0 ____-__-_--_______0 10. Florida ._............................. FL. .......................... _..........................................................._._. ................................0 ............................... ..._......._.........._.._.0 ......_-__-_--__-____._0 11. Georgia -------------------- ...........GA.._.. _-__B__ Life Insurance._..__. --- ___________ _.__.....................A ___ _.._______.0 ...._..............155,118 ------ ............. 157.767 12, Hawaii ..................... __.._ HI ____ ...._..._...__....._ ......------------------ ..............."' -'- - --'- _... _...................._...... 0 ..._...._..________ 0 __.__. ................ __0 __________._._.....0 13. Idaho ----------- ...................... ID......_ .................... .................................................................. ...............................0 ......................... 0 ..._............_......__.0 .....___.__.____-___0 14.Illinois-------------------- ------------ L.._....__...B.......... Life Insurance ........................................... .................. 1,635,168 .................J,713,273 ................................ ............_..-__--_-_0 15.Indiana.._............... ............IN_..._..._..__......__..._..._........................._..._._..__-_______._._._...__....._._..._._.. 0 ........... ..'--______0 __._.. ................ .....0 _.____.._.............. 16.Iowa.................................. IA ........ .................... ................................................................... ............................... 0 ................................0._............................0........... ....._----__._0 17.Kansas ............................... Ks...... _ ..................... .._.___--_----_0 ................................0 ...............................0 18. Kentucky KY...... .........................._..0 .._.._..__..............._D ._............................0.................... .._------ 0 19.Louisiana ............................ LA ....._ ..------------------ ................................................................... ............................... 0 ...................0 ................................ ......................__..._O 20. Maine .__..........._.......... ._... ME.___ .................... ................................................. .............."" ...._....................... ............._....__......_0 ---------- ...........__.___-' _____0 21. Maryland ............._.........._.-MD- .................... .................................................................. ............................... 0 ..................._........_0 ............................... .................__.___._._0 22, Massachusetts. ........... .MA.__..........__......_ ___ ..........._.......... ......_......._....___._................................... 0------------ ........__._..._0 _0 ...._.____________.___0 23. Michigan ................._....._... MI _._. ..........................0 ......._......_........_.._0 ......._._........_......_ 0 .......__---____-___0 24. Minnesota --------------------------- MN _._. ........................_._..O __..___.__...............0 ...............................0 ................_._...._..._0 25.Mississippi .......................... MS...... ----------- _.................................................................................._........._..0 _..._._......................0 ................................0 ................_..........__0 26.Missouri .............................. MO._.__-___-___.._ ___ _.._.............. ....."-'._-_-__-_-----'----"---......._..._......0 ._.__..._.._______ 0 .___._... ................. _0 '_________.._.._.._..0 27.Montana----------------------------- MIT ...... .............. ................................................................... ... ................................ 0 ........................._...._0 _._.............._........._0 ......._0 28.Nebraska ___...................... NE.--- ..............................0 __...____ .............. 0..............................-0 ................................0 29.Nevada_...................... _ ...._ NV _ - - .._.._._._.........._.._.............._...._.........._............_._...._.. -_._....................... 0 ........................ ..... 0. ..........................._.. 0 ..... _........_0............_ 30. New Hampshire ................... NH ...... ... ................ ........................................_._....._...._.................................._.....0 ____.____.__.._.._..0 ................................0 -------------- ................. 0 31, New Jersey ......................... NJ ....... ____-_____._ .................... __.._..........._._.......0 ............ 0 _................._.._....__0 .._._..._.._-__.-____0 32. New Mexico............_..._. NM.__ __..0.......... Life Insurance .......... ......._....._............._0 ...__ - 0 _.___..............104,741 __ 106,780 33. New York ............................ NY ...... _ _.............._......._._0 ............... 0 ........................0 .._._........_.._.-_._._0 34. North Carolina --------------------- NC...... ____B......... Life Insurance, ---------- .__..___..._._. ...__.....__............_ 0 ..__________0 ............... 411,439 462,196 35. North Dakota ....................... ND _.... __-___-__._.. ............................. ._.._.__---_-__-____-___ _._._...................._0 ............._.'--'--"'0 ...........0 _..._..__-_--__-_-'-0 36.Ohio................................... OH.......____ - _ _ ........... .._.............._._____._0 _.__......................._0 .....__. _-_--_____._0 37.Oklahoma .................. _....._ OK..._ ........._..._.._ .........._............................ ............................._........................... 0 ......................_......_0 .................... ....------------ .------------ _0 38. Oregon ------------------------------ . OR. ......_..................................._....._......_.._._.._..__......._. ........_......._.........._0 _._____-________0 ........................_......0 _________.._....._..0 39.Pennsylvania ....................... A ..._. _ _ ..._........._............._0 ___._-___-____-___0 ....._................_....._.0 _______-_--____..__.0 40. Rhode Island_ ..................... RI ....... _. ___................___ ..... 0 .......... __..0 ............_.__.........._0 _.....__-_--____-___0 41. South Carolina ------------------ ..SC._.....__B...___ Life Insurance..._ ..............._..................................._...............0 ........................ 0 ......._._......._150,357 ................ 151,611 42. South Dakota ...................... SO _._ ...............................0 ._............................0 ......................0 ............................._0 43.Tennessee .......................... TN...... ................................0 _-_-__-_--______..0 ................. _0 .__..______..__......0 44. Texas._ .............................. TX ....._ ........._.......... ............................................................ O _______-____ O ......_.._............_..._0 -------------- - D 45. Utah ___ ..................._._... UT __ ._ .................._..........0 .._..__-_-._____ ...... 0................... _0 .............0 46. Vermont .. VT .._ _ .. .. .. .. .......... 0 ___ _ 0 . . ... ..... .... .0 ___ _ _ _ 0 47, Virginia .... VA ._ _ .. .. _. _ ... _ ................ 0 ___ 0 _ _ _ _.. O _ _ __ 0 48. Washington .. WA... _ _ _ ___ _ _ .... 0 _._- 0 ........................0 .................. ._0 49. West Virginia .......................WV..... .......... ............. ....."O __..___-_--_______ 0 ........... ..._. _. ______-___0 50.Wisconsin ........................... WI....... _ .....................0 ................... .----------- 0 ........................0 ........................0 51.Wyoming ............................ WY_... ............._...............0 ......_......_.._...........0 ................................0 _.._........._............. 52. American Samoa.................AS...... ...._......_....._--- ......0 ......_...__................ . .............................. .0 _.._..______.___....0 53. Guam --------------------------------- GU..............._............._......_..............................._......._...._................................._.0 ....___--_-____...._..0 ..__..._.._.. ........... .0 ---0 54. Puerto Rico ......................... PR ...... ......... B---------- Life Insurance............_....._.....__.._.._.._. .........._..........._.....0 ._..._....._.__.__..0 ._..._....._...._740.587 _........_......_696.693 55. US Virgin Islands ................. VI ....._.._.._._.......... .................................. 0 ___0 .........._..........._..._ 0 ...............................0 56. Northern Mariana Islands _... MP ..._ . ..................... ----------------------------------- _.....__.._.____.__._._ .._......................_._0 ......._.........__._...... 0 ......................0 ._......_...._.._........_0 57.Canada------------------------------- CN------ ----- '-""___.................................................................... ................................ 0 ......___...... _............ 0 .......................__...0 __._________-___..0 58, Aggregate Other Alien..._..__ OT. ........%XX......_ .._....._.................._%XX .............. ................ ................................ 0 .._-___-_--__-____ 0 ------------- 0 ..............._...._._.. _0 59. Total %XX XXX 1,635.168 1.713,273 1,682,284 1,738.884 DETAILS OF WRITE-INS 5801. ...................._............................ ......_....... ........_...._............................................ ..................._....._0 0 - ___................__.0 ......._..._.__-__..._0 5802. .__....._............._..._...._....._...._......_..._..__..............._._........._................._.................._ . ..............................0 _..._-__-____.__.0 ___.___-_--_____--O 5803. ............................ ............0 ............_._...._........0 ..............................D ----- - 0 5898. Summary of remaining write-ins for Line58 fmm overflow page............ __-_XXIL_..._ ._._..................XXX..._...._....._..._....... ...............................0 ...._........__........_....0 ...................... ____0 __-______-_______0 M99. Totals (Lines 5801 - 5803 + 5898)(Line 58 above) XXX X%X 0 0 0 0 E27 this, LifeTrac has chosen to contract for transplant services in three phases: pre - transplant, transplant, and post -transplant. Within each phase — pre -transplant, transplant, and post -transplant — LifeTrac includes as many services and supplies as possible. The pre -transplant phase is defined as the period beginning with evaluation, and ending when the transplant episode begins. This period in most cases begins with an admission, and ends when the patient is discharged or transferred to rehabilitation. The post - transplant period also covers as many services and supplies as possible and ends one year from the discharge date. Our research has shown us that from the point of evaluation until the one-year post transplant visit occurs, the majority of the charges incurred by a patient happen during the transplant phase. Since predictable pricing is our goal, we strive to obtain all-inclusive case rates for a predetermined number of days for this phase with fixed per diems for outlier days. In those instances where the transplant goes better than expected, we have negotiated a clause with the majority of our facilities that allows for a guaranteed minimum discount. LifeTrac has been in the transplant business since 1988. Since that time, there have been a variety of approaches employed by various organizations to build their own transplant networks. Today, many payors focus on percentage savings. This may cause payors to lose sight of the cost of care. Some networks set case rates artificially low with a minimum reimbursement guarantee (floor). This gives the false impression that there will be significant savings to the payor who accesses those rates. In fact, these types of payment arrangements generally result in the payor reimbursing the provider at the floor and not really capitalizing on the fixed case rate methodology. Most of our contracts do not contain charge - based floors. In the contracts that do contain such provisions (primarily pediatric hospitals), we strive to set realistic case rates and set floors as close to the transplant center's cost as possible. While LifeTrac is constantly looking at new methods for maintaining and building our network, we have not wavered from our belief that getting the patient to the right transplant center, at the right time, and for the right cost is ultimately what is most important. 10. In addition to routine reimbursement and any withholding provisions, can your providers increase the total reimbursement received from your plan, e.g., by provider incentive programs? If so, please explain. M • '�SEGAL �1 11. If provider discounts are used, state the basis of the agreement. Are discounts based on provider charges or actual cost of service? 0 LifeTrac Network Providers submit claims as "billed charges" to LifeTrac. LifeTrac then reprices the claims according the rates and terms in place for that transplant program before forwarding claims on the payor for payment. 12. Is there a formal committee that sets quality assurance policy and review the outcome on a regular basis? LifeTrac uses the same staff and processes for the management of quality assurance issues as for any other program review decision, as described earlier in this RFP. Susan McKevitt, Sr. Quality Management Consultant, is responsible for implementing quality assurance processes. The transplant center/program is contacted and requested to respond in writing to the incident. The LifeTrac Program Review Committee (LPRC) reviews the response. Depending on the nature of the incident an ad hoc meeting may be called. The Sr. Quality Management Consultant, the assigned Clinical Consultant, and, depending upon the severity of the issue, the Medical Director, work together to define a corrective action plan and monitor the transplant center. If a corrective action plan is not appropriate for the situation, the program may be moved to supplemental status or may be terminated. 0 . 13. Do you capture all utilization data? We maintain detailed records of all claims submitted. 14. What claims experience and utilization reports are available? If there is additional cost, please specify. Reports can be generated based on a specific format if provided by the City of Fort Collins. Unless there is a special request, there is not additional costs associated with the reports. 15. Describe patient satisfaction surveys that you perform. Not applicable. • '�SEGAL 12 16. Do you have an agreement that prohibits providers from billing or collecting from patients more than the designated coinsurance or co - payment in the plan design? LifeTrac require inclusion of the following language is its Provider Contracts, "Provider will not balance bill the Patient, Payer, LifeTrac or LifeTrac's affiliates for any additional amounts. However, Provider may bill the Patient for services not covered by the Patient's Benefit Plan and for any deductibles, coinsurance and copayments for which the Patient is financially responsible. In no other event, including but not limited to nonpayment by Payer, Payer insolvency, or breach of any agreement, will Provider seek compensation from, or take any recourse against, a Patient or person acting on a Patient's behalf for Health Services." If an insured/patient chooses not to use a Lifetrac facility, BCS staff will negotiate the Lifetrac rate with the facility chosen so that the insured/patient is not balanced billed for eligible services included in the negotiated rate. 17. Please describe your method for calculating renewal rates. BCS considers both the individual experience of groups as well as the behavior of the entire block of business when approaching renewal rate action. We take into account the likely impact of new clinical techniques and technologies. Adverse experience experienced at the group or block level is not considered indicative of adverse trend. 18. Do you provide a toll -free number for employees to call with questions on claims, plan provisions or requests for dentist referrals? Yes — the toll free number for transplant claims is: 1800.768.4375. 19. Do you provide a care line that employees can call with questions about proper levels of care? See the answer to question 18. I ], 7�-SEGAL 13 20. Will you provide a dedicated Representative for the City's Human Resources Department with telephone and email contact information? 40 Yes. Alice Johnson, Transplant Analyst, Claim Administration & Compliance Direct Phone Number 630 472 7742 email address: ajohnson@bcsigroup.com Doris Knazze, Manager Claims Administration &Compliance Direct Phone Number 630 472 7757 email address: dknazze@bcsigroup.com Theresa M. O'Shea, PAHM, CHC, Vice President, Marketing Services Direct Phone Number: 630.472.7738 Email address: toshea@bcsigroup.com 21. Will you provide COBRA services? M 22. Can your Firm certify compliance with HIPAA Health Information Security and privacy regulations per attached Exhibit A? Yes. 23. What is your organization's financial rating (e.g., Best & Co., S&P)? BCS Insurance Company's A.M. Best rating is A- (Excellent). • '�SEGAL 14 Services to Be Provided In addition to the plan provisions set forth in the attachments, the City has specific vendor requirements needed to support its day-to-day operations. 2.1 Specific Requirements 2.1.1 Account Management The account executive and service representative(s) will deal directly with the City. This environment requires the account management team to: a. Be able to devote the time necessary to the account, including being available for frequent telephone and on -site consultations with the City. Proposers who are not committed to serious account service will not receive serious consideration; BCS understands and will comply. b. Be extremely responsive; BCS understands and will comply. c. Be comprised of individuals with specialized knowledge of the proposing company's: • Claims and Eligibility Systems • Provider Networks (where applicable) • Systems Reporting Capabilities • Claims Adjudication Policies and Procedures • Administrative Services Contract Wording • Standard and Non -Standard Banking Arrangements • Relationships with Third Parties BCS understands and will comply. d. Be thoroughly familiar with virtually all of the proposing company's functions that relate directly or indirectly to the account; BCS understands and will comply. • 7SEGAL 15 CITY OF FORT COLLINS PROPOSAL FOR BENEFITS TRANSPLANT CONSULTING SERVICES August 13, 2009 Linda J. Semmer Theresa O'Shea Benefits Consultant Vice President, Marketing Services THE SEGAL COMPANY BCS INSURANCE COMPANY 303.714-9928 630.472.772.7738 Isemmer@segalco.com toshea@bcsigroup.com Copyright 02009 by The Segal Group, Inc., parent of The Segal Company and its Sibson Consulting Division. All rights reserved. e. Act on behalf of the City in "cutting through red tape." This facet of account management cannot be emphasized enough — the account management team must be able to effectively advance the interests of the City through the vendor's corporate structure. BCS understands and will comply. 2.1.2 Enrol lment/EligibiIity The City will provide initial enrollments electronically or on paper. The initial enrollment and updates will be provided directly to the selected vendor by the City. The selected vendor will perform direct eligibility certification to providers and verify coverage as a part of the claims management and adjudication process. A quarterly reconciliation between payroll and eligibility will be required of the selected vendor. BCS understands and will comply. 2.1.3 Fee Administration • Transplant coverage will invoice the City. The City may calculate the fees/premiums payable on a monthly basis and will submit these fees directly to the selected vendor. BCS understands and will comply. 2.1.4 Customer Service The selected vendor must have as its primary focus efficient and effective processing of all inquiries. Satisfactory customer service will include prompt, courteous and accurate responses to the City and employee inquiries regarding claim submissions, applicable provider networks, plan design and provisions, etc. A toll free number should be available for eligibility certification and claim submission inquiries. Vendor will provide the City with contact information specifically for the use within the Human Resources Department — name, phone number, email address. A back-up contact will be provided as well. BCS understands and will comply. • -'�"SEGAL 16 2.1.5 Financial Accounting On a monthly basis, the selected vendor must provide an accounting reconciliation of any "central bank" accounts utilized. The selected vendor must provide a quarterly written report detailing all administrative expenses charged outside the Administrative Services Agreement. The selected vendor must present a report detailing and justifying proposed fees for the coming year by September 1st of the preceding year. BCS understands and will comply. 2.1.6 Right to Audit The selected vendor must agree to allow the City, or its representative, the right to audit all claims, applicable provider credentialing, financial data and other information relevant to the City's account. BCS understands and will comply. 2.1.7 Data and Management Information Reporting The selected vendor must provide monthly paid claim summaries and detailed claim listings, preferably in Excel format or through a secure website. The vendor(s) must also provide its standard reporting package. Ad hoc reports will periodically be requested. Enrollment, claims and premium/fee information must be accurate and supplied in a timely manner upon request. Please describe your online claim reporting and look -up capabilities that will be available to the City. BCS understands and will comply. 2.1.8 "No Loss/No Gain" for Covered Employees It is critical that there will be no loss of coverage for any employees. Therefore it is required that your proposal waives any "actively at work," "dependent confinement," or any other rules that would prevent 100% continuity of coverage for any employees or dependents that are currently covered under the plans. BCS understands and will comply. • '�SEGAL 17 • • Claims are processed within 30 days or less provided all relevant information is received at the time of the initial submission. 7�-SEGAL 18 • • Audited financials for BCS are included in Section 9. The cost for the Organ and Bone Marrow Transplant program effective January 1, 2010 is $10.89. This is for an 18-month benefit period and it includes the prescription drug benefit with Bio Scrip. This is only a 12 month rate — BCS will not do a two year rate. -. 7�-SEGAL 19 Items Included with Proposal (As indicated on the Checklist included in Section III). These items should be indexed in the order listed on the checklist with a copy of the index included in this section. Please see the responses to Section 7. CHECKLIST OF ITEMS INCLUDED WITH PROPOSAL Yes No Description of Item X Proposal for Transplant Coverage Included in Section 5 of this proposal X Signed Business Associate Agreement Included in Section 3 of this proposal X Signed Proposal Compliance Letter Included in Section 2 of this proposal . X Signed Plan Design Confirmation Included in Section 5 of this proposal X Completed and Signed Questionnaire(s) Included in Section 6 of this proposal X Transplant Network Access Analysis (if applicable) LifeTrac Network Map and Program Reference Grid is included in Section 9 of this proposal. X Proposed Implementation Timeline for the City. As the incumbent, there would be no need for any reenrollment or implementation of the program that employees already have. X Audited Financial Statements and/or Department of Insurance filings for the past two years (Only if requested by the City) Included in Section 9 of this proposal. X Provider "Report Cards" used to provide feedback on clinical and non -clinical performance measures Currently, there are 86 facilities listed in the LifeTrac Network representing over 700 transplant programs. There are 70 facilities that offer one or more Select programs. -7�-SEGAL 20 When a transplant center is identified as a candidate for inclusion in the LifeTrac Network, the contracting staff works to secure a contract. Once contracting AM negotiations are underway, the LifeTrac Data Coordinator requests RFI data from the transplant center. LifeTrac uses the standard United Network for Organ Sharing (UNOS) RFI for solid organ programs and the standard American Society for Blood and Marrow Transplantation (ASBMT) RFI for bone marrow/stem cell programs. The Data Coordinator compiles the data and submits it to the LifeTrac Sr. Quality Management Consultant for review. The Sr. Quality Management Consultant performs a review that includes, but is not limited to: - Accreditations and memberships (Joint Commission, LINOS, NMDP) - Volume - Survival - Waiting time - Transplant team stability - Patient continuum of care process Site visits are also part of the evaluation process, and they are conducted every three to five years. At the site visit, LifeTrac talks to key members of the transplant team, including but not limited to: Medical Directors, Surgical Directors, and Transplant Coordinators. LifeTrac also tours the inpatient and outpatient treatment areas and talks with key staff in these units, such as Nurse Managers and Clinical Educators. For programs currently in the LifeTrac Network, the clinical RFIs and contract • financial performance are reviewed on an annual basis. LifeTrac utilizes data reported by the transplant programs in their annual RFIs. This data presents their entire experience and allows for larger samples and improved reliability. We routinely review patient survival, graft survival, wait time, and lengths of stay. The survival data for solid organs is risk adjusted, while the hematopoietic cellular programs report unadjusted survival data. X Copy of your Policy Assuring Member Satisfaction N/A X Samples of all Standard and Optional Reports you are proposing to provide on an account specific basis Reports will be provided on an as needed basis and the format must be outlined. X Copy of your Banking Services Agreement As the Incumbent, The City of Fort Collinspiready has our Banking Services Agreement on file. X Copy of your Customer Satisfaction Survey N/A X Copy of your Administrative Services Agreement or Insurance Contract that will be in effect January 1, 2010 As the Incumbent, the City of Fort Collins already has a copy of the Insurance Contract for the program on file. 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U a m a� E C�C7 aci y Z a io �= ca CD �S�cnvOcn w o p � a E a- wU o ¢ = a> uai c Co V c E `m °� a`> 0 2 w fB = aci Cj "a-m 2 :° m m o m e : ac 0 0 cn w � m aw p ��U o�"> a�. 2. U: ® 0 E �SU co 0"`�-aU cD D a) no- cn E m 02 0 0 en QQ a> `o �:� V Fu o cn c r a�L cno6UUU cn- c` o 0 0._ 0 cn" o m� E Q U aci Y Fa o >U= f0 =m o0 2 O> cn 0 -2 o= wu $ o w 0 :O 0Q fn ¢ 0 c o c-a.�. 0 0-FuU c c o U o owa Qa E-` 0 CD > o aD cn O c o U S= _ E o o 0 0 o a� 0 E 3 t N o c6 a o �e o a� a> a> p a> > o N n� O c c tF 0 m -0 o c = 2 .> 0 cn >, c U >. N >, o v c.> 2 p 3 o o� c m _ cn E c •` �- X•` cn.� i2 Jd cn�QOli c0�� - Co o O7 cc� cU==O �� c c2 a�i 4� N L i co c c L "c ip E "c� n m U U U O a� cYi .> n ocu ` N 0 L) > 0 CL O 70 C `o 0 cn p 0 7 U L O C a) cB ca a) o L o O _ L p O J Qc ) <�a� Q� UciJJ(ntn»> UHW2 cl¢ 0(D 1L2���Cl) UZa —UJZ � z No Text LifeTrac® Network Program Reference Guide • The LifeTrac® Network (LifeTrac) is a national network comprised of a select group of the world's leading transplant facilities that perform solid organ and stem cell transplants. Accessible to 30 million lives nationwide, LifeTrac serves HMOs, TPAs, major insurance companies, and employer health plans. C7 • A = Adult Children's Hospital of Alabama (Birmingham) p p p University of Alabama Health System (Birmingham) AIP A A Alp a/P Alp alp A A A Ma o Clinic Scottsdale A A A A A A A A Phoenix Children's Hospital (Phoenix) P P P P University Medical Center (Tucson) Alp a a a/p a/P alp alp A/P A/P A/P University of Arkansas (Little Rock) a a a a a a a City of Hope (Duarte) A/P A/P A/P Loma Linda University Medical Center (Loma Linda) A/P a a a/p a/P a/p a/p a/p Lucile Packard Children's Hospital (Palo Alto) P p P P P P P P Scripps Green Hospital (La Jolla) a a a a a a a Stanford Hospital & Clinics (Stanford) A a A A a a A A A U.C.L.A. Medical Center (Los Angeles) A/P A A/P A/P A A/P A/P A/P U.C.S.D. Medical Center (San Diego) A a a a a A A A U.C.S.F. Medical Center (San Francisco) A/P A A A/P A A A/P A/P A/P Rocky Mountain Blood and Marrow Transplant Program Denver A A A The Children's Hospital / Denver (Denver) P p P P p P University of Colorado Hospital (Denver) A a a A A A A a a a • . Alfred I. duPont Hospital for Children (Wilmington) Georgetown University Hospital (Washington, D.C.) p p p p p p a a a alp alp Washington Hospital Center (Washington, D.C.) a a a a . Jackson Memorial Hospital (U of Miami) (Miami) BrJward General Medical Center (Ft. Lauderdale) A/P A A/P a A/P A/P a a a H. Lee Moffitt Cancer Center (Tampa) a a a Mayo Clinic (Jacksonville) A a a A A A A a a a Tampa General Hospital (Tampa) alp a a a a a Shands Hospital at the University of Florida (Gainesville) Alp A A a/P A/P A/p A/P A/P A/P ... Northside Hospital (Atlanta) A A A Piedmont Hospital (Atlanta) A a a A Children's Memorial Hospital (Chicago) P P P P P P Loyola University Medical Center (Chicago) A a A A A A A A Northwestern Memorial Hospital (Chicago) A A A A a A A A A Clarian Health = Indiana University/Methodist HospitattRiley Hospital for Children (Indianapolis) A/P A A I A/P A/P A/P A A/P A/P A/P Indiana Blood and Marrow Transplantation (Beech Grove) a a a University of Iowa Hospitals (Iowa City) Alp a a a a/p Alp Alp A/p Jewish Hospital (Louisville) University of Kentucky Chandler Medical Center (Lexington) A a a a a a a a a a a a a a a University of Louisville Hospital (Louisville) a a a Ochsner Clinic Foundation (New Orleans) A/p a a Alp Alp Johns Hopkins Hospital (Baltimore) University of Maryland Medical Center (Baltimore) A/P a a a/p Alp a A/P A/P A/P a/p a a a a a a a a Brigham and Women's Hospital (Boston) A/p A A See Dana -Farber for HCT programs Children's Hospital Boston (Boston) P P P p P P p Dana -Farber Cancer Institute (Boston) A A A Massachusetts General Hospital (Boston) Alp Alp A a Alp A A Tufts Medical Center (Boston) a/p a/p a a a P = Pediatric All programs listed here are contracted with LifeTrac for transplant services. "Select" programs are indicated by uppercase, bold-faced type and meet specific clinical criteria. "Supplemental" programs are indicated by lowercase, regular typeface. For additional criteria information, call us at (800) 968-8722. Facility and program changes may occur, and they should be verified prior to making specific patient referrals. (Continued on back) LT7003 (7/2009) • City of Fort Collins August 13, 2009 Letter of Introduction Section 1 — Executive Summary .............................................. 1 Section 2 — Proposal Compliance Letter ................................. 2 Section 3 — Business Associate Agreement ............................ 3 Section 4 — Checklist of Items included with Proposal ............ 4 Section 5 — Plan Design Confirmation ..................................... 6 0 Section 6 — Questionnaire Reponses...................................... 7 Section 7 — Performance Guarantees ................................... 18 Section 8 — Financial Exhibits ................................................ 19 Section 9 — Items Included with Proposal ............................. 20 ➢ LifeTrac Network Map and Program Reference Grid ➢ Copy of Audited Financial Statements • -�-SEGAL 4 University of Michigan Medical Center (Ann Arbor) Abbott Northwestern Hospital -Allina (Minneapolis) Hennepin County Medical Center (Minneapolis) a/P A A A/P AIP A A A/P A/P A/P a A a a Mayo Clinic (Rochester) AIP a a Alp Alp A A Alp Alp Alp University of Minnesota Medical Center, Fairview (Minneapolis) Barnes Jewish Hospital (St. Louis) AIP A A Alp alp Alp Alp A AIP AIP AIP A a a A A A A A A A St. Louis Children's Hospital (St. Louis) p P P P P P P P Nebraska Medical Center (Omaha) Memorial Sloan-Kettering Cancer Center (New York) AIP A A AIP AIP Alp A/P Alp A/P Alp A/P Mount Sinai Hospital (New York) AIP a a A/P alp alp a a Alp Alp Alp Strong Memorial Hospital (Rochester) A a a a A A A A Duke University Medical Center (Durham) Alp A A alp A/P Alp Alp A/P A/P AIP • Cincinnati Children's Hospital Medical Center (Cincinnati) Cleveland Clinic (Cleveland) P A A A P Alp p p A/P A P A P A P A Nationwide Children's Hospital (Columbus) P P P Ohio State University Medical Center (Columbus) -- - - - - - - - - - - - - - - - - - - - - - - - - - -- James Cancer Hospital (Columbus) a --- a ----- a ---- a -- --- a --- a -- --- ----- a ---- a ----- a Oregon Oregon Health & Science University Solid organprograms- - - - HCT programs - Northwest Marrow Transplant Program = OHSU/Doembecher Children's Hospital/Legacy Good Samaritan (Portland) A/P a alp A/p Alp Alp Alp Children's Hospital of Philadelphia (Philadelphia) P P P P P P P P Medical University of South Carolina (Charleston) a a a A a a a a Methodist University & Le Bonheur Children's Hospital Solid or2an2roq_rams------------------ HCT programs - UT Blood & Marrow (Memphis) aP - -- a ----- - a-- Alp -- --- --- -- --- ----- a ---- a ----- a St. Jude Children's Research Hospital (Memphis) Vanderbilt University Medical Center (Nashville) Alp a a Alp a/P P Alp P Alp P Alp Baylor All Saints Medical Center (Fort Worth) A a a A Baylor University Medical Center Dallas A A A A A a A A A Children's Medical Center of Dallas (Dallas) P p M.D. Anderson Cancer Center (Houston) A/P A/P A/P St. Luke's Episcopal Hospital (Houston) a A a Texas Children's Hospital (Houston) p P P P P P P P Texas Transplant Institute (San Antonio) A a a a a A/P A/P A/P University Health System - San Antonio (San Antonio) alp alp 1 a UT Southwestern St. Paul Hospital (Dallas) a a a University Health Care Salt Lake City) A A a a A A A University of Virginia Medical Center Charlottesville alp a a Alp alp Alp Virginia Commonwealth University Medical Center Richmond Alp a a alp Alp Alp Alp Alp Seattle Children's Hospital Seattle Seattle Cancer Care Alliance = Fred Hutchinson/Children's Hospital/ University of Washington Seattle P P p P A/P A/P A/P University of Washington Medical Center (Seattle) a a a a a a a Children's Hospital of Wisconsin (Milwaukee) Froedtert & the Medical College of Wisconsin (Milwaukee) p A a a p a P P A P p a a A A University of Wisconsin Hospital & Clinics (Madison) a/P A A A/p A A A/p Alp Alp • A=Adult P=Pediatric All programs listed here are contracted with LifeTrac for transplant services. "Select" programs are indicated by uppercase, bold-faced type and meet specific clinical criteria. "Supplemental" programs are indicated by lowercase, regular typeface. For additional criteria information, call us at (800) 968-8722. Facility and program changes may occur, and they should be verified prior to making specific patient referrals. LT7003 (7/2009) LifeTrac Network • 11100 Wayzata Blvd., Suite 350 • Minneapolis, MN 55305 • (800) 968-8722 or (800) YOU-TRAC • www.LifeTracNetwork.com No Text 8 0 9 8 5 2 0 0 8 2 0 1 0 iiiii iiiii 0 LIFE AND ACCIDENT AND HEALTH COMPANIES —ASSOCIATION EDITION ANNUAL STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2008 OF THE CONDITION AND AFFAIRS OF THE BCS Life Insurance Company NAIC Group Code 0023 0023 NAIC Company Code 80985 Employer's ID Number 36-2149353 (Current Period) (Prior Period) Organized under the Laws of Illinois State of Domicile or Port of Entry Illinois Country of Domicile United States Incorporated/Organized 09/22/1949 Commenced Business 11/17/1949 Statutory Home Office 2 Mid America Plaza, Suite 200 Oakbrook Terrace, IL 60181 (Street and Number) (City or Town, State and Zip Code) Main Administrative Office 2 Mid America Plaza, Suite 200 Oakbrook Terrace, IL 60181 630-472-7700 (Street and Number) (City or Town. State and Zip Code) (Area Code) (Telephone Number) Mail Address 2 Mid America Plaza, Suite 200 Oakbrook Terrace, IL 60181 (street and Number or P.O. Box) (City or Ti wm, State and Zip Code) Primary Location of Books and Records 2 Mid America Plaza, Suite 200 Oakbrook Terrace, IL 60181 630-472-7700 (Street and Number) (City a Town, state and Zip Code) (Area Code) (Telephone Number) Internet Website Address www.bcsigroup.com Statutory Statement Contact Pamela Ann Gordon 630-472-7719 (Name) (Area Code) (Telephone Number) (Extension) pgordon@bcsigroup.com _ 630-472-7788 (E-mas Address) (FAX Number) OFFICERS Name Title Name Title Howard Francis Beacham III # President, Chairman & CEO Henry Alan Carpenter # Secretary, General Counsel & SVP Susan Ann Pickar # Treasurer & Senior Vice President OTHER OFFICERS David John Jacobs # Senior Vice President Robert Jerry Krueger Executive Vice President Dale Edward Palka # Senior Vice President Sandra Kay Strutz Assistant Corporate Secretary DIRECTORS OR TRUSTEES Howard Francis Beacham III # Henry Alan Carpenter # Robert Jerry Krueger Raymond Frederick McCaskey State of ............... .................. .Illinois., ............... ___....,----.- Countyof......--.............. ........ Du Page-- ............. ................. as The officers of this reporting entity, being duty sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated. above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures Manual except to the extent that: (1) state law may differ, or, (2) that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their Information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulato in lieu of or In dition to the enclosed statement. Howard Francis Beacha III Hen Susan Ann Pickar President, Chairman & CEO tary, Genera Counsel & SVP Treasurer & Senior Vice President a. Is this an original filing? Yes ( X ) No ( ) Subscribed and sworn to before me this P P If no, 02nd day of Februa , 2009 LARY ) FFICIAL SEAL" 2. State tlamendment number �v MARIA T. ARREZ 3. Number of pages attached M is Arrez, Notary Public PUBWSTATEOFILLINOIS October 03, 2009 10J2200® 0 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • Is ASSETS Current Year Prior Year 1 2 3 4 Net Admitted Assets Net Admitted Assets Nonadmitted Assets Cols. 1 - 2 Assets 1. Bonds (Schedule D) 132,811,486 ----------------------------------D .._.._-.-_._132.811,486 .................136,557,622 2. Stocks (Schedule D): 2.1 Preferred stocks ................................................ .................. .............................D ...................................0 ............. ................................_A 2.2 Common stocks ._.....- ---------------.........D .--------------_..._D .....---_._.....----.......D .............. _0 3. Mortgage loans on real estate (Schedule B): 3.1 First liens ..................__._-- ----------- --------------..................-------------------------- --- -- --__-___-.._.......D ...._..._--_____-__-_..D .............---.....-----------.0 _...----------------------------- 3.2 Other than first liens ............................................................ .------_-----._-.......D .....-----------_......D ._---- -------...............0 ....................... .D 4. Real estate (Schedule A): 4.1 Properties occupied by the company (less $-------------------------------0 encumbrances) .................. ---------................... ------------------------ ................................................ ----------..D ......................... 4.2 Properties held for the production of income (less $- ---------------------------------- encumbrances) --------------------------------------------- .......---...-----------._..D .............------------------ ...................................0 ...._.... D 4.3 Properties held for sale (less $ -----------------------------------0 encumbrances)----........................----........._...................................._..0 ................................... .----------------- ----_.._.._D 5. Cash I$ 3,543,051 , Schedule E - Part 1), cash equivalents ($ __.............................. D , Schedule E - Part 2) and short-term investments ($ 14.124.736, Schedule DA)................................... ......._.__._.17,667,787 ................................_.D .................17.667,787 ----------- ._18,704.859 6. Contract loans (including $...._..........................._0 premium notes) ...._.................183.703 .................. ........................183,703 -----------.._____195.779 7. Other invested assets (Schedule BA) --........................................................... ----------.._------._..0 ........... ..................................D -------------------0 8. Receivables for securities-..-_. ____ ._._........................................................ ................................... D -----------------------------------D .............-._.__-_____A .................._.........D 9. Aggregate write-ins for invested assets................................... 0 ...................................D ------------ 0 ................................D 10. Subtotals, cash and invested assets (Lines 1to9)..._._._...---------------------------- --__-_--__150,662.976 _..........._....._------- _D ...............150,662,976............ -_155,458,260 11. Title plants less $ D charged off (for Title insurers only�----.._......._..............----------------------..._..---- - ................... -------------------------------0 ------------------0 .......- _D ...............................0 12. Investment income due and accrued................................................................ .. ........ ........... 1,015,940 ..................................D---------- -._--_1,015.940 ..............1,053.754 13. Premiums and considerations: 13.1 Uncollected premiums and agents' balances in the course of collection ............_...23,348,787 ........................170,516 ------------------23,178,271 .................34,135,363 13.2 Deferred premiums, agents' balances and installments booked but deferred and not yet due (including $------------------ 2,118,949 earned but unbilled premium) ............................................ ...................._.....---------- -------__......2,118,949 __D ._._......_..._2.118,949 ...................2,888.549 13.3 Accrued retrospective premiums-..__...............__.------............................. _-______---------.....A ----..................-----...--A -----------0 -0 14. Reinsurance: 14.1 Amounts recoverable from reinsurers...._.................................................. ......... .......... 1,196,821 ................_.....177,115 .......__1,019,706 .......................966,363 14.2 Funds held by or deposited with reinsured companies_.._...._.................._._......._........90,451 ........................48,949 ......_._._41,502 ....................... 171,294 14.3 Other amounts receivable under reinsurance contracts .......................... ------- ---------------904,777............. ...........197,633 ..._707,144 ........................495,487 15. Amounts receivable relating to uninsured plans ---------------_-- --------------------------� �-_�_��----�--------......--D ----------------------------------n .............. ._..._--..._....D ....._................. D 16.1 Current federal and foreign income tax recoverable and interest thereon..... ...D - ___0 ----------------------------------0 -----------_.____-____0 16.2 Net defamed tax asset..... ._- -------------------2,040,071 ___.1,086.549 _.._..._..._.__. 953,522 ..............-958.705 17. Guaranty funds receivable or on deposit . .................................D __ 0 18. Electronic data processing equipment and software...........................................D ...._--_--_-_-- -- _------------------ ---------- ..D ................. 0 19. Furniture and equipment, including health care delivery assets ($ _--.-.... __.............. D )-............................................................. ----------------------------------0 ..._...._..... ------------ ..._.. -- _._........D ...................................0 20. Net adjustment in assets and liabilities due to foreign exchange rates.............._____..................D ......----------------------------0 ............... ............. ........... ........_D 21. Receivables from parent, subsidiaries and affiliates .......____ ................................_...------........._.__15 ........._------------------.....D ..__.._________....15 ..................................0 22. Health care ($--------------------- ............. D ) and other amounts receivable__.. ..................................D -_-...0 ... ------------------------------- 0 23. Aggregate write-ins for other than invested assets .......................................... . _.._1,301,097 .......... ...................._441,056 .----------------------860,041 .......................773.961 24. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 10 to 23) .............._............... .................182,679,884 ....___.2,121,818 ..._........._180,558,066 .............._196,901,736 25. From Separate Accounts, Segregated Accounts and Protected CellAccounts ................... ..........._--........_...................--- -------------'A -'--......----..................D ....----- -- ____- _ -_.D ..._.................._....._..0 26. Total Lines 24 and 25 182.679,884 2.121,818 180,558,066 196.901,736 DETAILS OF WRITE-INS 0901........................................... - - ........ ..... D .._._.. - D ............--.................D ..... D 0902. -- ----_.._............._0 ..................................D ......._..._..----...-----.D 0903.__.-......................---------................__ ..--------......-------.D D D D 0998. Summary of remaining write-ins for Line 9 from overflow page ...................... -------------D ...................................0 --- --- -- ------ ...................................0 0999. Totals Lines 0901 through 0903 plus 0998 Line 9 above 0 0 0 0 2301. Other Accounts Receivable-------- ___..__._..7,223 ._....._._....._.__..3,556 ------------- _..____3.667 ......---------------------3,713 2302. Unappl ied Claim Payments... --- ..... ............. -------------....._----------------- .............. 856,374 ......... . --------------0 ........ .._...856,374 ..................__770.248 2303. Prepaid Expenses ___..437,500 ----------------------437,500 D D 2398. Summary of remaining write-ins for Line 23 from overflow page .................... ......... ......................... D __ , -.._D ._ ............................... D.............. _-__-_-_-_- 9 2399. Totals(Lines 2301through 2303 plus2398 Line23above 1,301,097 441,056 860,041 773,961 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • is LIABILITIES, SURPLUS AND OTHER FUNDS 1 2 Current Year Prior Year 1. Aggregate reserve for life contracts $ 12,693,408 (Exhibit 5, Line 9999999) less $.._.__._.......................D included in Line 6.3 (including $ ---------- _____-____._ D Modco Reserve) _._.-_............__....... ..................12,693,408 .................. 11,1SM% 2. Aggregate reserve for accident and health contracts (Exhibit 6, Line 17, Col. 1)(including $ ......__- _-____..........D Modco Reserve) .................................. - - ....... - ................._.... - - ............... ........ ......41,417,973 42,130,978 3. Liability for deposit -type contracts (Exhibit 7, Line 14, Col. 1) (including $ ......................._..___0 Modco Reserve) ...................................... A ...................................0 4. Contract claims: 4.1 Life (Exhibit 8, Part 1, Line 4.4, Col. 1 less sum of Cols. 9, 10 and 11)___..............................._............_........................... -__._... 1,377,278 ______...... 1,687,833 4.2 Accident and health (Exhibit 8, Part 1, Line 4.4, sum of Cols. 9, 10 and 11) .................... .--- ............................. ._...._........32,861 ,195 .._._._.......42.974,154 5. Policyholders' dividends $ -D and coupons $ .....______..._........... 0 due and unpaid (Exhibit 4, Line 10) .......--_D ----------..- .............D 6. Provision for policyholders' dividends and coupons payable in following calendar year ­estimated amounts: 6.1 Dividends apportioned for payment (including $ ..................---_.___0 Modco).............. .- ---- ----------------------------- ................................. 0 .................... D 6.2 Dividends not yet apportioned (including $....._------._------._---------.0 Modco)........................................................ ...._ ._............................... 0 ............................... D 6.3 Coupons and similar benefits (including $ A Modco)...................................................................... ..................D ....................0 7. Amount provisionally held for deferred dividend policies not included in Line 6.......................................................................... .................0 -------------------D 8. Premiums and annuity considerations for life and accident and health contracts received in advance less $ __.__------------------------- D discount; including $ .......................... 15,375 accident and health premiums (Exhibit 1, Part 1, Col. 1, sum of Lines 4 and 14)- - -------------------------15.375 9. Contract liabilities not included elsewhere: 9.1 Surrender values on canceled contracts -----------.__.._0 D 9.2 Provision for experience rating refunds, including $...................................0 accident and health experience rating refunds.................. ......................._...._.................................................................. .--- --- _._..------..._.._------....._. --- .._._....._............D ._..._..._.__....._.........D 9.3 Other amounts payable on reinsurance, including $ ..................6,844 assumed and $ .._.__---- ....._.0 ceded ...........................6,844 .......................284,937 9.4 Interest Maintenance Reserve (IMR, Line 6) ___......_....3,193,394 ...................3,609,838 10. Commissions to agents due or accrued -life and annuity contracts $ ---------------193,573 accident and health $ 199,524 and deposit -type contract funds $ ....._---__-_____......_D-------------------------------------------- ._...._.._.- _--_..._............ 393,097 -._-_- ...... ..._575,853 11. Commissions and expense allowances payable on reinsurance assumed_...................................................... _......._..._ -------------------- 1.205.449 .......................839,978 12. General expenses due or accrued Exhibit 2, Line 12, Col. 6 ..................2,657,323 __----- ......3,323.238 13. Transfers to Separate Accounts due or accrued (net) (including $ .... D accrued for expense allowances recognized in reserves, net of reinsured allowances)................................................................... .............D ..................................A 14. Taxes, licenses and fees due or accrued, excluding federal income taxes (Exhibit 3, Line 9, Col. 5)._._......._........._.....___ _____........... 832,747 -----------------------834,100 15.1 Current federal and foreign income taxes, including $ 0 on realized capital gains (losses). ... .......................205,320 __.............. 5,731 ,903 15.2 Net deferred tax liability _ ...._...._.._..................0 ------------------------ ._ D 16. Unearned investment income..................................................-----------___-----____..._.-..-.-...--------._......._....................._...._......_..._.-----------._.D ----------.......--------D 17. Amounts withheld or retained by company as agent or trustee................._....._......_....................._...._------..__------..__.__..___ ...........................3,344 18. Amounts held for agents' account, including $._.._--------------------------- 0 agents' credit balances _.___ ---- .................................. .................................. -D ______.............._0 19. Remittances and items not allocated ---____--___-------------------------------------------------------- .--.... ........................718,318 -.--_.........-.691,368 20. Net adjustment in assets and liabilities due to foreign exchange rates............................... ....................... .... .. ............................___0 _____.._.................0 21. Liability for benefits for employees and agents if not included above........................................... _........................... --- ........................ .. D --------------------0 22. Borrowed money $ - ___ ............ 0 and interest thereon $ _________._......_.._.0 .- -- --.____ ---------- ......._._ -_........................... ..D ................D 23. Dividends to stockholders declared and unpaid..........__..._........._----------------------_-----------............................ _.__0 .............D 24. Miscellaneous liabilities: 24.1 Asset valuation reserve (AVR, Line 16, Col. 7)- . _..... ._---------------------- 0 ._................... 402,058 24.2 Reinsurance in unauthorized companies. _ ...._.................257,175 .............789,812 24.3 Funds held under reinsurance treaties with unauthorized reinsurers .................. .........._......__..._._....................................._.._.............._..........D .._............................_0 24.4 Payable to parent, subsidiaries and affiliates..._.................._............_.............--------.--.- ................... 2, 012, 320 .__---..........1,312,839 24.5 Drafts outstanding ---------------------------------- ___--- 24.6 Liability for amounts held under uninsured plans ................................................... _......._...._...._...._............._.._.................. --- --- ._...................... 0 ................................. 24.7 Funds held under coinsurance........... ...________._........_.........._..... ______--........_........D .................._........._...D 24.8 Payable for securities ............ ....----------------................................ ..-------.._...................... .934,948 ................D 24.9 Capital notes $ ........................0 and interest thereon $................ ................ ...0------------------------------------------ -_.._..._....-............._D ----------------------0 25. Aggregate write-ins for liabilities ............. ...... 45,922 11.324 26. Total liabilities excluding Separate Accounts business (Lines 1 to 25) 100.831,430 116.355,180 ................................. __...__...__................ D 27. From Separate Accounts statement _............._..... 28. Total liabilities (Lines 26 and 27) _-------------------------- 100,831,430 116,355,180 29. Common capital stock -._ ............ .._ ......... __ .........2,500,000 _________2,500,000 30. Preferred capital stock ...............D .._.._.._------_.._---------- 31. Aggregate write-ins for other than special surplus funds_..............................__._._.........................._......._...._..............----.__ ..................................D __.___._.._.......__..D 32. Surplus notes ..... - ..........._.................... 0 ------------------------ D 33. Gross paid in and contributed surplus (Page 3, Line 33, Col. 2 plus Page 4, Line 51.1, Col. 1)----------------------------------- _ _______ _..1,126,255 ...................1 ,126,255 34. Aggregate write-ins for special surplus funds _ ................................. - 0 ---------------D 35. Unassigned funds (surplus)-_---------------------------------------------------------- --.------------------------------------ ._._--.............. .------------ ._ .._---...._...76,100,381 ............._..76,920,301 36. Less treasury stock, at cost: 36.1 ...................... ..__-.__0 shares common (value included in Line 29 $ ----------------------------0).._............................. _.. --------------------------------- D .............D 36.2 .__._........................... 0 shares preferred (value included in Line 30 $ .................................. ....................... .................... D................................ ._0 37. Surplus (Total Lines 31+32+33+34+35-36) ( including $ D in Separate Accounts Statement) ............... 77,226,636 78,046,556 79,726,636 80,546,556 38. Totals of Lines 29, 30 and 37 (Page 4, Line 55)__._._______ .......... ------------------- ------------------------- _............................... .- 39. Totals of Lines 28 and 38 (Page 2, Line 26, Col. 3 180.558,066 196,901,736 DETAILS OF WRITE-INS 2501. Sundry Liabilities....__...........__ .............._--6.922 _______-__......1,324 2502. Funds Held Under Deposit Accounting..--.._ ........................._....... - ----------------------- .. ...............................................39,000 ----- 10,000 2503...................._-..__...._.....-...........--------- -------------.........._.A .._..........._--....__-. D 2598. Summary of remaining write-ins for Line 25 from overflow page ................................................ ....................... . ...... .---------------- .........B ............................... ...0 2599. Totals Lines 2501 through 2503 plus 2598 Line 25 above 45,922 11,324 3101. ......._._.-._...............D .....----------................D 3102. 3103. ... .. ____...._............................._.._.._._........_...__.._...............................-_.._ .............D ..............0 3198. Summary of remaining write-ins for Line 31 from overflow page._.............._...._._....................._...._...._...__........_.-------------._.0 ---------------------------------.D 3199. Totals Lines 3101 through 3103 plus 3198 Line 31 above 0 0 3401. ............................ ..__......D .._---.........._.............D 3402.---- .._....----.------------------- ------------'...............--................-----................_.._...-----.._...._._........----------------------.........-------- -----.........................D ..------...................... 3403. ....... .. - -_........_....................__................... .........._.D 0 3498. Summary of remaining write-ins for Line 34 from overflow page ..................................................... ..............................-.._......................D -----------0 3499. Totals Lines 3401 through 3403 plus 3498 Line 34 above 0 0 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company is 0 SUMMARY OF OPERATIONS 1 2 Current Year Prior Year 1. Premiums and annuity considerations for life and accident and health contracts Exhibit 1 Part 1 Line 20.4 Col. 1 less Col. 11 __200,941,353 207 617.506 2. Considerations for supplementary contracts with life contingencies --------------- .._.____-.................._................._...._...--------------- ..... 1,071,122 ...........__378,328 3. Net investment income (Exhibit of Net Investment Income, Line 17)._._._......_.._._..__.............................................................. .................. ....................6.527,461 4. Amortization of Interest Maintenance Reserve (IMR, Line 5)._....----------------- _-_________-_---------- ......._._................................. ._...............__504,260 .........__._.__538,252 5. Separate Accounts net gain from operations excluding unrealized gains or losses .................................... __._------------ ............. ._------------------ 0 ..................................9 6. Commissions and expense allowances on reinsurance ceded (Exhibit 1, Part 2, Line 26.1, Col. 1)..._.......... .......................... ......._.____3,994,958 ................ _4,578,905 7. Reserve adjustments on reinsurance ceded ..........._...___________.........._ --------- .......__.___...._..........D 8. Miscellaneous Income: 8.1 Income from fees associated with investment management, administration and contract guarantees from Separate Accounts............. ----......... .....- ............ .....---------- -- .-...._.............................. ..D ----------------------------A 8.2 Charges and fees for deposit -type contracts................................................................................................................................................................. ..................................D 8.3 Aggregate write-ins for miscellaneous income ....__.______.._............... -.._.________...._.....------------------------------------------------- 10,983 2.002.066 212,753.681 221.642,518 9. Totals (Lines 1 to 8.3) ...................4,293,619 10. Death benefits --------------------------------------------- .................. ...................... ...--............_..._.......4,104,502 11. Matured endowments (excluding guaranteed annual pure endowments) ................................................ _.-_.------------ ----------- _ .___...........0 ....___ _____.._......0 12. Annuity benefits (Exhibit 8, Part 2, Line 6.4, Cols. 4 + 8) ___ ...................... ...._...._.______........._.......................... .................... .... ..._......_........._.._...D ......------------._.............D 13. Disability benefits and benefits under accident and health contracts ------------------------------------_._--------- _.._____ 164.969,233 _...._.......142.301,091 14. Coupons, guaranteed annual pure endowments and similar benefits .._.._......_...._-___............................................................... ..................................A ................................_.D 15. Surrender benefits and withdrawals for life contracts......................._................................................_.....__._.............. ... ..._.540,176 ..........._.. 1.042,049 16. Group conversions ------------ ........................ .--------------------------- ___ ----................. --------------_.__------------------------------------------------------- ---------------------- --...D .------.._..-----------D 17. Interest and adjustments on contract or deposit -type contract funds ------ ._ ..... ....................... D--------------------- __....._. D 18. Payments on supplementary contracts with life contingencies.............._......-............-..-..........-......-..._...........__.._............._..................._.........._...0 -------------------------0 19. Increase in aggregate reserves for life and accident and health contracts. 1,801,761 24.570,416 171,415,672 ...............172,207,175 20. Totals (Lines 10 to 19) ............. .......----.....----.......--......_._....._..._.._...................._...........---- ............. 21. Commissions on premiums, annuity considerations, and deposit -type contract funds (direct business only) (Exhibit 1, Part 2, Line 31, Col. 1) _ - - - -- - --...................... -------............................. ._-----------.......................................................... .._......._..__2,995,777 ................ _.4, 201, 721 22. Commissions and expense allowances on reinsurance assumed (Exhibit 1, Part 2, Line 26.2, Cal. 1).................................... .................... 3,939,684 ...................2,801,088 23. General insurance expenses (Exhibit 2, Line 10, Columns 1 , 2, 3 and 4)............................................ ._.___------------------ ...__. _ __27,704,988 ..........___26,600,038 24. Insurance taxes, licenses and fees, excluding federal income taxes (Exhibit 3, Line 7, Cols. 1 + 2 . 3) .................................. ................... .2,807,106 -------------------3,184,865 25. Increase in loading on deferred and uncollected premiums --........----......._.._--_.-__---._.__..............-_........_............_......... --------------- ...._...._.-...D ....-..._-----.................D 26. Net transfers to or (from) Separate Amounts net of reinsurance....................... ................................... .----- --- _.--------------------- -------- ... D ............._______-_.D 27. Aggregate write-ins for deductions ----------------------- --._--_--_.......................... ----_........................................................... 78,900 1_663,622 28. Totals (Lines 20 to 27) . - -- - - .............. - .................. -- -...------.............---------------------------- 208.942,127 210,658, 509 3,811,554 .......10.984, 009 29. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 28) _..__._............. 30. Dividends to policyholders --- ---- - -------------------------------- -----_..._.._....------------------------------------------------------------------------- ---------- 0 0 .................... 3,811, 554 ------------ 10,984,009 31. Net gain from operations after dividends to policyholders and before federal income taxes (Line 29 minus Line 30)............. 32. Federal and foreign income taxes incurred (excluding tax on capital gains) 143,365 3.354.878 33. Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses)(Line 31minus Line 32)......._._... -------------------------- ....._.....-........................................................... ........---3,668,189 .................7,629.131 34. Net realized capital gains (losses) (excluding gains (losses) transferred to the IMR) less capital gains tax of $------------------------(72,834) (excluding taxes of $ ..........................47,295 transferred to the IMR).. 2.554,372 302.688 1,113,817 7.326,443 35. Net income Line 33 plus Line 34 ........ CAPITAL AND SURPLUS ACCOUNT 36. Capital and surplus, December 31, prior year (Page 3, Line 38, Col. 2).................. ... .................................. ._........_............._.. 80,546,556 76.385,000 ........ ...._._-_1,113,817 ................. _7,326,443 37. Net income (Line 35)----------------------------------------------------------- .................................................... 38. Change in net unrealized capital gains (losses) less capital gains tax of.$. ----------------------------------- D--- _--________-- ----------------------------------- 0 -------------_._._._15,773 39. Change in net unrealized foreign exchange capital gain (loss)---------------------------------------------------------------- ...._---------- ----- _.D ........... D 40. Change in net deferred income tax _ ........................... - .... _. .. --- ... .. 869,556 - _ _(9,728) 41. Change in nonadmitted assets - ......................... - - ---- .. --(1,433,216) --- 27,553 42. Change in liability for reinsurance in unauthorized companies --- --- --- . - -_- -- ---_-- 532.637 (789.812) 43. Change in reserve on account of change in valuation basis, (increase) or decrease (Exhibit 5A, Line 9999999, Col. 4) ... -.. 195 229 ..... - __ - _ _D 44. Change in asset valuation reserve ----------------------------------------------------------------------------- -----_........'---'.......................---..._._..._.----......._........_..... 402,058 -------------------------91,323 45. Change in treasury stock (Page 3, Lines 36.1 and 36.2 Col. 2 minus Col. 1)........._._..._...._........_...D ..................................D 46. Surplus (contributed to) withdrawn from Separate Accounts during period _.................... ------- --- .--- __---------- ..........................0 47. Other changes in surplus in Separate Accounts statement ......_-------------------------------- ._................................_._................_........... ----------------------------------D ..................................0 48. Change in surplus notes D ........ D 49. Cumulative effect of changes in accounting principles _.......... ---------- ......................................................... _.......------- .... D ............................ 0 50. Capital changes: 50.1 Paid in ----------------------------------------------------------- ------------.............-----..............------------------...----...............--.D 0 50.2 Transferred from surplus (Stock Dividend)---------- ------- --- .____._......_D ..................................0 50.3 Transferred to surplus..._................._..................................................................................___.................._..___.........._...._..........------.....-.-..__.......D ...._........-----.___ D 51. Surplus adjustment: 51.1 Paid in...................................................................... .......................................�--�-._...... -....................................................... ...._........_..._..............D .........-----........._........0 51.2 Transferred to capital (Stock Dividend) ...._-------------__............................................................. ._......-.__......._............. .......... _D -----------_.-.-.--...__._0 51.3 Transferred from capital_..._..._....._....._.._._._...................._...........__.............D ..................................D 51.4 Change in surplus as a result of reinsurance__................................................................. ....__........._ ------- -- ..._D ............................ -.0 52. Dividends to stockholders ..._._.._................................ ____.___..__..........._..._._.._...._.._...................._..._.................__(2,500,000) ..................(2,500,000) 53. Aggregate write-ins for gains and losses in surplus 0 1 0 819,919 4 A61.552 54. Net change in capital and surplus for the year (Lines 37 through 53)-------------------------------------------------- 79.726.637 80, 546, 552 55. Capital and surplus, December 31, current year Lines 36 + 54 (Page 3, Line 38 DETAILS OF WRITE-INS 08.301. Settlement of Business Dispute ._.._........._...._.............. D ...................2,000,000 08.302. Other income .............. ' - ._.........................._......................................_......._............. ...._........._.._.... -- ------ 10,983 ...........................2,066 08.303................._......_...__........_.........................__................................__________.._......_..............._..................................._.............._........D ............................._...0 08.398. Summary of remaining write-ins for Line 8.3 from overflow page D ......._.....______----- D 08.399. Totals Lines 08.301 through 08.303 plus 08.398 Line 8.3 above 10,983 2.002.066 2701. Interest Expense _D -------------------1.663,622 2702. Miscellaneous Expense -------------------------------------------------- .....-----------------------. -- - -'- ........_....._........................._.....------------.. ._78,900 ...............................0 2703....._.............-----------------........_.._------_....................._......_.------------.._._._- --------------_.........D .._._...------------_D 2798. Summary of remaining write-ins for Line 27 from overflow page ...................... _.__-...................................................... .--..----._.__........... 0 ...._ D 2799. Totals Lines 2701 through 2703 plus 2798 Line 27 above 78,900 1 1.663.622 5301. 5303. ..............--------____.........._......_-....---...---............._................._.....---.........D ...................._-..........D 5398. Summary of remaining write-ins for Line 53 from overflow page_............._......................_...............------------_------.__--- ------------------ -_............0 5399. Totals Lines 5301 through 5303 plus 5398 Line 53 above 0 0 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • 0 CASH FLOW 1 2 Current Year Prior Year Cash from Operations 1. Premiums collected net of reinsurance ----------------------- ............._-______........_--................................__........_.._........................... --------------_213,935,273 ................203,236,229 2. Net investment income .............. .------------._.............. ......---..---------------------- ................. ....------------......_.......-----------...................6,521,160 ----------------6,770,638 3. Miscellaneous income 3,799.483 5,882,652 224.255,916 215,889,519 4. Total (Lines 1 through 3)------------- ---------- - ---............--------------------------- - - ...........- -- 181,325, 995 ...............154.667,127 5. Benefit and loss related payments -----.......................................---.......---....------._----__. --------------------- ---................. 6. Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts.____.__-__............._.....__._____ ..................................0 .......--------------------------- 0 7. Commissions, expenses paid and aggregate write-ins for deductions ------------------------------- ............._.....---------- ................... ........ _............... 38,002,754 ___.36,254,173 8. Dividends paid to policyholders-------._.-------------------------------------------------- --------------------- ------.............................. ----------- ..................................D ..............................._.D 9. Federal and foreign income taxes paid (recovered) net of $ ____...............523,954 tax on capital gains (losses)_..____... 5.644.408 1 299,999 224,973,157 191.221.299 10. Total (Lines 5 through 9) 717.241 24.668.220 11. Net rash from operations (Line 4 minus Line 10).............._....._...._.................... Cash from Investments 12. Proceeds from investments sold, matured or repaid: 12.1 Bonds. --.............................................. .... ... ............ ----- ............ .......................... -- -__...34,500,553 -- .__27,541.620 12.2Stocks... ...................... .----------------------------------------------------- ...................2,150,340 ...........15,567 12.3 Mortgage loans ................................ ._.......................... ....______............................................................ ............................ ...._ -__._...._........_.__._.D ______..___._.._._... D 12.4 Real estate. ........................................ ................_............................ ......... ........... ........... ...-__--0 .................0 12.5 Other invested assets....... -_- _ ____................ ._.. _.....__._................... .D ............9 12.6 Net gains or (losses) on cash, cash equivalents and short-term investments ........_.__.----------------------------------- ___.._..................._._.................D -------------------_D 12.7 Miscellaneous proceeds ------__... --------------------- --------------------- .............._..............----------__.._...................._.------_ - 934.948 464.265 .................. 37,585.841 .................28,021,452 12.8 Total investment proceeds (Lines 12.1 to 12.7)------------- ................... .......... ......................................................... 13. Cost of investments acquired (long-term only): 13.1 Bonds -- .................... __ -.................- ................................. -- ......... - - ...... ........33,688,690 .................41,858,043 13.2Stocks . .... ................. - - ..........- ..--........._........_.........._._..._..._.._............_.. _ ...1,968,763 .....-- ...............0 13.3 Mortgage loans ............................................................... ....._______........_......_..._........_._...._......................_.............__.............__--------.............0 ............... ................... D 13.4 Real estate .................... ........................................................ _____._.-------------------------------------------------------------------------------------- ----------._D -_-___.._--_--.........__.0 13.5 Other invested assets ........._--------............ .....------------------------------------------------------------- .._---------- ....._...................... .....----- ........................ 0 .....----------..............0 13.6 Miscellaneous applications ...................... ---------- ............__ 0 4 35.657.453 41.858.047 13.7 Total investments acquired (Lines 13.1 to 13.6)_._.__....._._........................_..._..._............_._.._..............._.........._....___. 12,076 248.071 14. Net increase (decrease) in contract loans and premium notes ...._.....__......_...........__________.......................... _...__...__ .._ 1,940,464 13,588,524 15. Net cash from investments (Line 12.8 minus Line 13.7 minus Line 14)_ .............__..............________._...................._.____ Cash from Financing and Miscellaneous Sources 16. Cash provided (applied): 16.1 Surplus notes, capital notes __..-_---.._---------- ................................................... .............................................. ................................... 0 ..............................0 16.2 Capital and paid in surplus, less treasury stock .................... _____-___ .......... _.._..-_____.............................. ....__-______ ...............................0 ..................................0 16.3 Borrowed funds................._....................._........_....._............._._____.._................._____._.__............------------......__.__.._ ...............................D ----------------------------------D 16.4 Net deposits on deposit -type contracts and other insurance liabilities ........... __._......................_-D ____._..................... 0 16.5 Dividends to stockholders --------------- .---------- .----------------------- ._._______.............._.________........................._.... _ ______. ....................2.500,000 ....................2,500,000 16.6 Other rash provided(applied)_--------------------------------------------------------- ..--------------------- ..---..--._.-----_-__ ................ ....._.___----_- 239,701 3,210.884 2,260.299 5,710,884 17. Net cash from financing and miscellaneous sources (Lines 16.1 to 16.4 minus Line 16.5 plus Line 16.6)......_.._.__ RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 18. Net change in cash, cash equivalents and short-term investments (Line 11, plus Lines 15 and 17).........................__------------. _.._.._..._...(1,037,076) ______._...5,368,812 19. Cash, cash equivalents and short-term investments: 19.1 Beginning of year.. __----------------------------------- .................................................._............ ........... ... .18,704,859 -- -13.336,047 19.2 End of ear Line 18 lus Line 19.1 17.667.783 18,704,859 • • • a. >Cl) a LV E Z 0 a m N LL O w /A J W H U Z m W J x } LL W 0 O O O w O a W }9 W F W 0 a o LL O z LL m O W Q J z Q z Z a Q a CIA cl� g8000s 8 - _IN- _ go E E78 E a ; a� g 8cg go o iov 2J m E'A8 - =c o8i�o�g a�n'g •� 8m_ - ^LL - E d -m c o� m� c" E12 .3-°c8=-6-cmm ^nrFm_ aJ�a E. -0 u _m o f 8 E E o E m Q o' ;m _v �v `ma a ma8mc Hcm_ v_- yam it'�`m rya gEg$u rnU¢gt>>�gN vEra `-' E �Em m��ajyw- nE -c �m aEaEc-m--�.-_ -°� iE- iE p 0o p 0 a V ZQNUK Em m m'60°f Q OUu°i c7Ea � FV UIS E z Q H2v�ZJ �ila i • 0 0 T C Ca LLJ G L=L V r d ' ^ c� v c Z 7 N C D w Q J V Lu m w 2 W U- LLJ O (n co 0 LLJ 0 N a Z w — >- LU LU � Q 0 o LLI LL z U z w Z 2 LL O 7 z �. z J a Q Z Q q q q R q o q m - XX X x 00 m J O m JJ 9 C r N U o' R q R q R R u> E.9 nU y m j m ¢ q q q R q q o o q x R R O a' 9 y c m _ R R q o _ q q R R m (0 N q q q R R R R q q o 0 0 q R R q a 2 m A co m b g m i o E K N I I c 01 T c m 0 c 'a m c co° ¢ C c c O m O V m m a_ 9 Cn U U 5 Z, Z O y d o N a L U n N o W tOl c m C c J `om J c a m m E m n a 2 o `: 3 m m m d o d m v m m n o a E o m N m U m N N N D m y C Z m •- m N 1p l0 O L ti P L6 tD h O N m 6 m O m C N Cl l O m P LO 7 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • 0 EXHIBIT OF NET INVESTMENT INCOME 1 2 Collected Earned DuringYear Durin Year 1. U.S. Government bonds .. - _ 577.648 577,874 1.1 Bonds exempt from U.S. tax -----_......_._............................................................... _.-----._.--------............--------------- (a)............................ 19,563 --_-19,563 1.2 Other bonds (unaffliated)....------------------------------------- _..__-__._................................____.._..................._..._................. (a) ............. .___5.757,509 ............ 1.3 Bonds of affiliates....._.._. (a) ----------------------- _._.........D 2.1 Preferred stocks (unaffiliated) .......................... ._.._ ................_._-_..___.. (b)._...._............_._......_...0 ....................___..-__.....0 2.11 Preferred stocks of affiliates__________..........._................................._..............._......._..._....._ (b)-..........._......_......._......0 _............................_.....0 2.2 Common stocks (unaffliated)-------------------------------------------------------------------- ....-----------__..__..........------------- . ..................------6.039 .......... .----------- ----- .6,039 2.21 Common stocks of affiliates -.-.0 .....................................0 3. Mortgage loans. .......... (c) ---- .... -__..D ..... - - -.---._-_.__.0 4. Real estate............................................................. ..............._...._............._ (d)........._........_._.._._......D ............_.__...._.__......0 5. Contract loans, ------------------------------------------------------------ ..................... --73,106 ...... ............13,106 6. Cash, cash equivalents and short-term investments ............... _..__._.-__-_--_._....................... .................. (a) -------------___ _-_-451,210 ..................._.._415,839 7. Derivative instruments_......__.........-------...........------------..._............._....---------.-------------........._....._..------ (0..................................... D ...._....--------------- 0 8. Other invested assets ---......................................................................... -......................... ..---------_._ ...................---------...D ..........__.-----___-._0 9. Aggregate write-ins for investment income _ _ _ _ 10. Total grossinvestment income 1 6,825.075 .6,787,261 11. Investment expenses .---------- ..._..... ......... .......- -- ----- ------ --------- - - ...._.... ------- - .._. (g)--.... -----551.688 12. Investment taxes, licenses and fees, excluding federal income taxes ...._......._......__._..._..........__ ........................_......................... (g).....__------..............4,568 13. Interestexpense---------------------------_..............------...............---......---.......------------------..(h)--------------....----------..0 14. Depreciation on real estate and other invested assets ..._.__.-.__.__..... O............................_....._0 15. Aggregate write-ins for deductions from investment income_....._....__................................................................................................... ..__._____._ ................ ._._.__._------ 0 16. Total deductions (Lines 11 through 15) ..........................556, 256 17. Net investment income (Line 10 minus Line 16) 6.231.005 DETAILS OF WRITE-INS 0901.------------------------.._...-----..................................-------------.......------------------------._..---._............- -------D --..........._......--..........D 0902.........__.......----------......_ ................_--..------.._.......-----....---. - .._............._....._.._.......0 ............----.................D 0903.---------._...................................................................... .._-__------......................... ..---------------------------------------------------- ................ -0 ...........--.......__..........0 0998. Summary of remaining write-ins for Line 9 from overflow page ......................................................... ...._. --------------------..--0 ---------- 0999. Totals Lines 0901 through 0903plus 0998 Line 9, above 0 0 1501. -------......._.._.............0 1503. 1598. Summary of remaining write-ins for Line 15 from overflow page ...............-....-----....................... ._.._..____--_-_-_---.................._..... --- ..--- .....--- ..._....-...........--.---...._ ..... D 1599. Totals Lines 1501 throw h 1503 lus 1598 Line 15, above 0 (a) Includes $ ..............227,922 accrual of discount less $ ..............488,517 amortization of premium and less $ .............. 128,968 paid for accrued interest on purchases. (b) Includes $ ........................ 0 accrual of discount less $ ....._..._..._..._---0 amortization of premium and less $ .........................0 paid for accrued dividends on purchases. (c) Includes $ .........................0 accrual of discount less $ .................__----D amortization of premium and less $ _ 0 paid for accrued interest on purchases. (d) Includes $ .._............. .. D for company's occupancy of its own buildings; and excludes $ D interest on encumbrances. (a) Includes $ ------------------------0 accrual of discount less $ --------------------0 amortization of premium and less $ ____._._.._..... 0 paid for accrued interest on purchases. (f) Includes $ D accrual of discount less $ D amortization of premium. (g) Includes $ D investment expenses and $ D investment taxes, licenses and fees, excluding federal income taxes, attributable to segregated and Separate Accounts. (h) Includes $ D interest on surplus notes and $ ____...............D interest on capital notes. (i) Includes $ D depreciation on real estate and $ 0 depreciation on other invested assets. EXHIBIT OF CAPITAL GAINS (LOSSES 1 Realized Gain (Loss) On Sales or Maturity 2 Other Realized Adjustments 3 Total Realized Capital Gain (Loss) Columns 1 + 2 4 Change in Unrealized Capital Gain Loss 5. Change in Unrealized Foreign Exchange Capital Gain Loss 1. U.S. Government bonds ---........................................ -- ---------------------20,695 ..--------------...._._0 ........................20,695 ---.......-------------_D ..................................0 1.1 Bonds exempt from U.S. tax ______ ........................... . 0 ......----------------------------0 _ 0 (unaffiliated) 1.2 Other bonds (una ........---------- ................117.748 .--------- 2,812,112 - ( ) ..._........... 2,694,364 . ( ) ........----------------0 ...............-------......0 1.3 Bonds of affiliates ..............._..._- ------ _------------------------- ----.....------------------------ 0 .......... .._................... 0 _......_..._-...-----.._.....D ...........----...._..--.._._..0 ...............----___._._0 2.1 Preferred stocks (unaffiliated) --------------------------------------- ............ __9 .._.........................._..0 ................_...__..___.D _...___......_.._...........0 ..................................0 2.11 Preferred stocks of affiliates ___- _ _...........__............_ _-_...._......._..............0 ..................................D ..._...-___._._............0 .................._..............0 ..... D 2.2 Common stocks(unaffiliated)-------..........----------------- ....................... 181,576 _--_--__--__-----.._.._..0 ........-----.........181,576 ___0 .................................. _..._...........................0 2.21 Common stocks of affiliates- ..................................0 ________.........._._9 ..................................0 _....______.___._.._D ..........................._.....0 3. Mortgage loans ............................... ..__................._.__._........_..............___.0 ..........0 ................ .................. 0 ...-_-_-__-____.._D ...................................0 4. Real estate------------------__--__-__.._._....._............-- --------........._.._0 .......----.....--............0 _-_--__-___-........_0 ..._.._.........................D .......___-_--_____-__ D 5. Contract loans 0 ---......_.._.........0 .._..._.._..........._........D .........__.......... -...0 ........._........ -..... D 6. Cash, cash equivalents and short-term investments ..___._----------------------- 0 .............................a ---------- .................D ............_-..___-..__.0 .................................. 0 7. Derivative instruments ......................................... _-_-____-_--.........._..0 ...._.__.._.....-----........0 ..___-___-_____--._0 ................................. D .. D 8. Other invested assets. .. .............._.._..............0 .....___...___......... .--0 -------------- ._--------------- 0 --...---------------._D _......_-.........----........0 9. Aggregate write-ins for capital gains (losses) ............. ................. 0 ..................................0 .._..__......_..._........_0 10. Total capital qains losses 320,019 2,812,112 2,492,093 0 0 DETAILS OF WRITE4NS 0901._..._..._........._....................._-____.....___.........._......................................_..0 ____-__-___.........._.0 ..................................0 0902. ....................- ----...._..._............-----0 - ----- __-- ------_..----...0 ..........................._.....0 0903.---.._.._---..............--------------------..-_.._...---......--- ----...-----......---_...._D .-...----......._...............D ......---------------_D 0998. Summary of remaining write-ins for Line 9 from overflowpage ........... -.......................... --------.................. 0 .._...............------......D ...............0 ---------- ....................-.....0 0999. Totals (Lines 0901 through 0903) plus 0998 (Line 9, above) 0 1 0 0 1 0 0 0 • 0 'rSEGAL THE SEGAL COMPANY 5670 Greenwood Plaza Blvd., Suite 425 Greenwood Village, CO 80111-2499 T 303.714.9900 F 303.714.9990 www.segalco.com August 13, 2009 City of Fort Collins, Purchasing 215 North Mason, 2"d Floor Fort Collins, CO 80524 Re: Request for Proposal for Benefits - Transplant Consulting Services Dear Purchasing: We are pleased to submit this proposal to provide the Benefits - Transplant Consulting Services as described in Request for Proposal (RFP) for the City of Fort Collins (City) Bid Number: 7052. The format of this proposal complies with the RFP response requirements. The following pages present the details of our proposed consulting services and highlights the credentials and experience of the team of professionals that we have assembled for this engagement. We understand that all proposals shall remain subject to initial acceptance 90 days after the day of submittal. Our proposal is intended to be fully responsive to your request. We would welcome the opportunity to meet with the City to answer any questions or to discuss our proposal. We appreciate your consideration for this important assignment. Sincerely, Linda J. Semmer Benefits Consultant The Segal Company /cz Enclosures Sincerely, Theresa O'Shea Vice President, Marketing Services BCS Insurance Company • • R -NR m CAM �2 Sj§o�Q^ M m^�Q R RR2 m - mien J Ga 0 fA ° O o H- a W c = co - z z a a o z� Q - -ammR 90 mmm �214 L A 2- is 2mom mPma- Ix a � 2 Li_ rn m t a jm a j �T �" Ev $Ea iEamH$ �Bi iw m � Egic :�$ `� ��c10 E$o W iE !E2 E2 E U 8 moa¢i v9 vo¢¢z� as KKz o o r.'¢:`0 m''a D moon �ooVVVV<�Q---��n��°i��� 1i6 a`�tz 1-rvNry I • • d W J a a Q z a m O CU 0 z Q N a z W im LN r Q a m 2 W N Q N O m O J O N m v a m a a' - U � � a 0 � N C .y q q q o G o 0 o R O o 0 r 0 o' ' ' R R R R R q q R R r W _ m N 0 J U z N R R R R R Q R R R Q R R R R O R R CO �- a �- z � O a Nq N q R R q q q q q q o q q R O g 0 5 U z° d Q N m �W Z R q R R o R R R q R o R q g q q o Q O N � O J H N W W a a a Ol 9 ! 7 y1 N Q E ZU c a E y a y 9 E y a E y c! c y O Z Z N O IL r J u "' u "' °' u o f u c _v K fi -- 3 cWi c°'i t m 2U ; UO Uf� O o OmO WO C Cx NJ Z x Z x¢ Z ri c y m N cl N t� 00Q Z O ( Il 16 WQ y2 U N N? a N N N N 2- N N N M t7 C W x O 1 W O - U a 10 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • • EXHIBIT 2 - GENERAL EXPENSES Insurance 5 6 1 Accident and Health 4 2 3 Cost All All Other Lines of Life Containment Other Business Investment Total 1. Rent 70 484 0 _ _ 303 373 0 1 474 331 2. Salaries and wages.......__..._...__...._.._....._......._....._.. ....__-._-__-. 414,749 .........._..............._0 ............_... 1,984,270 .........._.._.............0 ...._........._.....67,796 ..2,466,815 3.11 Contributions for benefit plans for employees . ----------------- .....____-____259, 803 ......_.._.......__...._0 ......._..._... 1,158,.. ..............._............ 0 ..........._.........37.671 ._1156.030 112 Contributions for benefit plans for agents .......... ..._.._-_ ................._0 ._.............._..__.._0 .__....................._..0 .._.._........_...........0 .._._......................0 .............._.._...._...0 3.21 Payments to employees under non -funded benefit plans __ ____......................0 ............_.....__._._0 .._..._....................0 ......_....._._........._0 .. _.... _.. _............... 0 ............................. 0 3.22 Payments to agents under non -funded benefit plans ......... ...._.._-__.._.....0 ......._......_.........._0 ......_............_..._..0 .............................0 _......._..................0 ____.______...0 3.31 Other employee welfare........_.......__....._ ....................... -------------45.407 ..._............_........_0 ._...._..._........184,142 .............................0 ...................7,010 ....................236,559 3.320iher agenlwelfare------------------ .-------------------------------------- _-__._..............0 ............................ 0 ............................. 0 .............................0 .............................0 ..._.._-._____..._...0 4.1 Legal fees and expenses ------------------------------------------------- .___ _ ..._....0 .............................0 .............................0 .................. ...... _... 0 ........................_._0 ___-_____-____._.0 4.2 Medical examination fees ___.._...._............................... ...........____..45.589 ........... _0 .............................0 ............ ..._0 ____.._.............._0 ......_.._-__-45,589 4.3 Inspection report fees ------------------------------------------------------ ................... ..........0 ........._._`.-____0 _.._...................... 0 ._.._.___.______0 .......... _0 .......... _0 4.4 Fees of public accountants and consulting actuaries ......... ................... ._40,460 _.............._-.____.0 ..._............... 169,814 .._._.0 _____._.........._ 1167.......... ........._216, 337 4.5 Expense of investigation and settlement of policy claims ---- ----------------------- 2,134 ............_...._____0 .1,923 .........___________0 __....................._..0 _..............._._.4,057 5.1 Traveling expanses..-___....._ ......................................... .._......._..._... 42.DD8 ........_..__.._._._.__0 _................. 195,213 ............_._..___0 _._.._..........5,908 ...-_-____-__243,729 5.2 Advertising..-, ................. .......................----------- ......................24.633 ....................._.._.-0 _...__...55,316 5.3 Postage, express, telegraph and telephone ..................... . _........_..__.....6.528 .............._.......___0 _______ _ ._...29,273 ..._..._......_....__.._0 ...._.................... 968 ..............._..._36.669 5.4 Printing and stationery ___ .._._............_24,198 ......_.._.._..._.._._.0 _____...........28,359 .....................__....0 ..........................905 .._._........._.._53,462 5.5 Cost or depreciation of furniture and p equipment......._--___ _..........B93 ........................._.0 ........_.............3,661 .............._.............0 .._..........._..._._.137 .4.691 5.6 Rental of equipment ___________..._........._........._..............___._-____21.622 _....._............._.._-0 ......................91,044 ._......._.._._0 ............11,B6fi -------- _.___124,532 5.7 Cosl or depreciation of EDP equipment and sof vare_..._.. .....________._....0 ........... __0 .............................0 ....._.._._.______0 ........... _0 ............_.____._._0 6.1 Books and periodicals_ .......__....__J,276 ......_..._......_.___0 ............._.......30,277 ......._...0 ___....._........ 1,275 _......._....._._ 38.822 6.2 Bureau and association fees._ _____-___._..........0 .............................0 ...._........._------.._..0 .............. _0 ......._..__............_0 ....__-____-______a 6.3 Insurance, except on real estate ....................... .._...-_ ___......37,851 .............................0 ......_...._...... 151,906 .............................0 .......................5,88f ._195,638 6AMiscellaneous losses. .............._.__. __..._................._.0 ............. ____-___0 ..............._..0 ......___-________0 __......___._....__...0 .._.._...._.........__..0 %Collection and bank service charges --------------------------------- ....................... ____________.4, 468 .................... ....... 0 ......................19, 161 ....._..._..._ _ _.0 ___._..._........648 .._..___..._-__ 1 877 6.6 Sundry general expenses ...................._..._......_.............. _._....4, 748 ............................0 ..................... 27,424 ..............._....._._..0 _.._....................683 .26,855 6.7 Group service and administration fees ....................._____ _______.... 1, 348, 771 ..........................._0 ................20,076,867 .............................0 ............................. 0 _._.._____21,425,639 6.8 Reimbursements by uninsured plans ...................... .................0 .............................0 ............. ............... 0 .............................0 .............................0 .... __________....0 7.4 Agency expense allowance _ _ _...___... _.-_._....0 .......... ............. 0 .............................0 ......._..._._.._.._..0 ....._..._........._.._0 ........-___..-_____-_0 7.2 Agents' balances charged off (less $............_.............._....._D recovered)..................------... .........._._............_0 ._..._..............____0 ............0 .._.........._-"-' ____0 ...........0 ........_..._..._......-_0 7.3 Agency conferences other than local meetings .................. .________.............I .............................0 ....._...._..._........._0 ....._..........._........-1 ............................-1 - ......0 9.2 Investment expenses not included elsewhere --------------- ........___._. ............... g ------......------...........0 ._......------............_0 .............................0 ....................380,996 ._____.____ _ 380.996 9.3 Aggregate write-ins for expenses ------------------------- _.._... 138,134 0 659.958 0 11.757 809.849 ____._....2,539,857 .............................0 ...............15,165,131 ................._.._......0 .._................551,fi88 1 a)______28,259.679 10. General expenses incurred _ 11. General expenses unpaid December3l, Prior year......__ -___-____...154,184 ........__.................0 ..................3, 003,949 ............._........._--- 0 .._..........._.....65,105 3,323, 238 12. General expenses unpaid December 31, current year.._..._ ________..209.047 ...................._..._..0 .................2,391,425 .........._....._._......0 _....._..........._56,851 2:657,323 13. Amounts receivable relating to uninsured plans, prior year. ....____.._..._......A .............................0 .............................0 ......_...._...__..._0 ........................... _0 _______________0 14. Amounts receivable relating to uninsured plans, current year 0 0 0 0 0 0 15. General expenses paid during year (Lines 10+11-12- 13+14) 2,584.994 0 25.777, 655 0 559,942 28,922.591 DETAILS OF WRITE4NS 09.301. Consul ling Fees_.._......_.. ............._.... 138,134 ..........................._0 _______........._141,306 .............................0 ...................... 11,757 -----------------..291,197 09.302. Rate Stabilization Reserve Interest..._._ ........................ .... _........0 ......_......------._....0 ....................518,652 ___.............._0 _...........___ 518,552 09.303. ..........._............_ 0 ..._..._...._.....___.0 .............................0 _.._.....___.______0 0 _ 0 09.398. Summary of remaining wnte-ins for Line 9.3 from overflow page................._..__ 0 ..........._...__....__ 0 __........._............-_0 _.....__._________0 ..............0 ........._..................0 09.399. Totals (Lines 09.301 through 09.303 + 09.398) (Line 9.3 above)138.134 0 659.958 0 11.757 809.849 (a) Includes management fees of $ _.._.......____...5,640.137 to affiliates and S...........------------- ._......._D to non -affiliates. EXHIBIT 3 - TAXES, LICENSES AND FEES (EXCLUDING FEDERAL INCOME TAXES) Insurance 4 5 1 2 3 All Other Lines of Life Accident and Health Business Investment Total Real estate taxes.................._.._.................................... ..............._......_..........0 ........................._......_D ........................------.....D ......__.........................0 .......---___--_____0 i1 State insurance department licenses and fees ................... ..._........_..........._95,627 ..........................138,519 .._.................._._.._.__D -______-_____........._0 ..._......._............334,146 3. Slate taxes on premiums - ................_... ..._......_._..........114,259 ..........._......._.2,053.032 ...................................0 ................................... 0 ...__.__________2, 267,291 4. Other stale taxes, incl. $ 0 for employee benefits__-_____.._......._._.._ .................. .........._...._...._-----1.311 ......_------....._........32,112 .._...............................D ................................... 0 ..._._..35,,tO 5. U.S. Social Security lazes.. -. _ .....30,641 ....... ... ..131,265 .._..........................__.D ............._.._._....... 4,568 ...........................166,474 6. All othertaxes ........__ 790 7,510 0 0 8,303 7. Taxes, licenses and fees incurred ........................... 344,668 ........................ ,462,438 ..........................D .............................A,568 .... 2,811,674 B. Taxes, licenses and fees unpaid December 31, prior year .. ..................._..._f01,433 ....._................__725,617 0 9. Taxes, licenses and fees unpaid December 31, current year 99.930 732.817 0 0 832.747 353.171 2.455.29 0 4.568 2.813.OZ1 10. Taxes licenses and tees id Burin ar Lines 7 + 8 - 9 EXHIBIT 4 - DIVIDENDS OR REFUNDS 1 2 Life Accident and Health 1. Applied to pay renewal premiums........_................_____.._.__......_.............._....._...................................... ....................................0 ..........._._._.__.__._-0 2. Applied to shorten the endowment or premium -paying period ........._.__.____.._.._................................. ...................................0 ................._.............. D 3. Applied to provide paid�p additions......._.........................._......._NONE .._ ..__. __ ......._...........___......... _.._..._.._._.._.............0 ................._................D 4. Applied to Provide paid -up annuities_ ...................................._........ .. ... ..........._ 0 0 5. Total Lines 1 through 4". .. .. ... ............................_ .........0 ..................__6Paid incesh._._..._.............._..................._ __........._0 ................._....7. LeftondePosL............................._...._._.......................__... ..__ ..._.........._.._.......... _. .._-'-"'--'--____._.._....0 ................................_.D 8. Aggregate write-ins for dividend or refund options......_...._.....__....._...__.............._....._...........____________------- ..---- ._............_...... 0 0 9. Total Lines 5 through 8 ------._........._............. 0 10. Amount due and unpaid ____...._.............._.................................._........................................._............_.._........_.................................... _....._..........................D ................................... ................................._0 11. Provision for dividends or refunds payable in the following calendar year--_ ._................_.._._.._._0 12. Terminal dividends..............._.__._...__.__......................._0 ...................................0 13. Provision for defamed dividend contracts_______..____......_...._................._....................................__......._............................_._.................._..0 _. D 14. Amount provisionally held for deferred dividend contracts not included in Line 13. _ 0 0 15. Total Lines 10 through 14...................._........................._..____._........................_. ____-_--__..............._0 ................_.._....._.._..0 16. Total from prior year.............___._....___.__...__._..._._.............._..._._...._.................._....................................... 0 0 i 7. Total dividends or refunds Lines 9 + IS. 16 0 0 DETAILS OF WRITE4NS 0801................ ............._....._....._.....0 ....._____________ 0 0803. .................__._...........___.._._._.............._..._............................................................._.............._.........._......__...._.........__............ _._..._....._........_........0 ........_.._..........._........0 0898. Summary of remaining wnte-insfor Line 8 from overflow page ----- _----- _----------------------------------------------------------- .... 0 .........._......................-1 0899. Totals Lines 0801 through 0803 + 0898 Line 8 above 0 0 11 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • • EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS 1 Valuation Standard 2 Total 3 Industrial 4 Ordinary 5 Credit (Group and Individual 6 Group LIFE INSURANCE: 0100001. Group llniversal Life - See Note 30......................_..........._.._... 0100002. Group Conversion- See note 30......................................................... 0100003. GroupLife -See note 30.._...................................... 12,141,735 170,227 ............................ --------.................._.._0 .............._._....._0 ---------------------- 0 -______._..........._.0 __________... 170,227 ___.._........................0 .................... —.0.....................12,141,735 ........_...._....._._..__._0 ....................................0 ..................._.............0 .._........._...........43,447 0199997. Totals (Gross) 0199998. Reinsurance ceded —...-_.......... 12,355,409 187,075 ...........------.............._0 0 ....—______-. 70,227 166,787 ............._.......---.__._0 0 ..._......_...... 12,185.182 20,288 0199999. Totals Net 12,168.334 0 3,440 0 12,164,894 ANNUITIES (excluding supplementary contracts with life contin encies 0299997. Totals (Gross) 0299998. Reinsurance ceded ._--0 0 ............... XXX -------------- XXX --------------- ..._.............._0 0 ....._..___._XXX.._.______ XXX ........... —.0 0 0299999. Totals Net 0 XXX 0 XXX 0 SUPPLEMENTARY CONTRACTS WITH LIFE CONTINGENCIES: 0399997. Totals (Gross) 0399998. Reinsurance ceded _...._........................._0 0 _.................._..........._0 0 .___ . .......................0 0 ....................................0 0 ....................................0 0 0399999. Totals Net 0 0 0 0 0 ACCIDENTAL DEATH BENEFITS: 0499997. Totals (Gross) 0499998. Reinsurance ceded ----- ....................--0 0 ------------ ...--------0 0 ----------------......0 0 ------------------------------------ 0 ............------...--.......0 0 0499999. Totals Net 0 0 0 0 0 DISABILITY -ACTIVE LIVES: 0599997. Totals (Gross) 0599998. Reinsurance ceded ---...-----.....----------0 0 ------------------ -_0 0 ------- .....................0 0 ...................................0 0 .----........-----.............0 0 0599999. Totals Net 0 0 0 0 0 DISABILITY-DISABLLIVES: 0600001. 1970 Interco GrED ou Life WG1 Table a 3.5)L .................................. 1,813,515 ................................__0 _-__-_--__-................ 0 -------------------- ............... 0 ....__............. 1,813.515 0699997. Totals (Gross) 0699998. Reinsurance ceded .....................1,813,515 1,288, 441 ......................_0 0 ____._-_.___.............0 0 ............. ..............._.....0 0 .................... 1,613,515 1,288,441 0699999. Totals Net 525.074 0 0 1 0 1 525,074 MISCELLANEOUS RESERVES 0799997. Totals (Gross) 0799998. Reinsurance ceded .............._.________0 0 ...................................0 0 0 _ ..............._.._._.........0 0 ................._...._.._...._0 0 _......._............_..........0 0799999. Totals Net 0 0 0 0 0 9999999. Totals Net - Page 3, Line 12,693,408 0 3.440 0 12,689,968 12 8 0 9 8 5 2 0 0 8 3 7 0 0 IIIII0 0 1 0 0 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company EXHIBIT 5 - INTERROGATORIES 1.1. Has the reporting entity ever issued both participating and non -participating contracts? - -- - .......... --..-- Yes [ 1 No [ X 1 1.2 If not, state which kind is issued Non -participating ..------------...----_----_....- ------------ ---------_____._....-- -- ._______--_........................... ._.---..._...................................... . 2.1. Does the reporting entity at present issue both participating and non -participating contracts? Yes [ J No [ X 1 2.2. If not, state which kind is issued Non -participating ..................... ...-------..................... ---------._..................................................................................................... ......_..._.._..._. 3. Does the reporting entity at present issue or have in force contracts that contain non -guaranteed elements? Yes [ X J No [ ] If so, attach a statement that contains the determination procedures, answers to the interrogatories and an actuarial opinion as described in the instructions. 4. Has the reporting entity any assessment or stipulated premium contracts in force Yes [ ] No [ X J If so, state: 4.1 Amount of insurance?--------_._ ....................... ..---- -------- ................................................................................................................. .....-....._...$.-------........._........._..D 4.2 Amount of reserve?_ - - ............................ ...........--.................................... ........_........... ................... $ ...................... 4.3 Basis of reserve ._......... -- .. ........................ 4.4 Basis of regular assessments .................._.....................- .............. . ---- .... . ............... ..... --........._..........._.._...--..._...... 4.5 Basis of special assessments ----...._............ .....------.......................-----------...-.....--------...................--._._.......... - - ................ -- .......................... 4.6 Assessments collected during the year.......---- ---_ ._............................... ................--..--........_.......--------.........._..__.... $---------_. ................ D 5. If the contract loan interest rate guaranteed in any one or more of its currently issued contracts is less than 5 % , not in advance, state the contract loan rate guarantees on any such contracts. 6. ------------------------------------------------------- .._.. _...._................ _ - - -....._............... - --I - - ................ - ........................ Does the reporting entity hold reserves for any annuity contracts that are less than the reserves that would be held on a standardbasis?........_.. ------------------------------------_---------------------...-----.....----..-...--..--...--.....-...------...-----......--------._----.._.............. Yes [ 1 No 1 X 1 6.1 If so, state the amount of reserve on such contracts on the basis actually held: _._____ .................______-_...._.........................$..__________._.......D 6.2 That would have been held (on an exact or approximate basis) using the actual ages of the annuitants; the interest rate(s) used in 6.1; and the same mortality basis used by the reporting entity for the valuation of comparable annuity benefits issued to standard lives. If the reporting entity has no comparable annuity benefits for standard lives to be valued, the mortality basis shall be the table most recently approved by the state of domicile for valuing individual annuity benefits:....--- _.-_..................- - -- -- ...._............. - .._..- .........._.... -_........................ Attach statement of methods employed in their valuation. 7. Does the reporting entity have any Synthetic GIC contracts or agreements in effect as of December 31 of the current year? Yes [ ] No [ X J 7.1 If yes, state the total dollar amount of assets covered by these contracts or agreements: .......... .......__.._................................... $_______.__.------..._.D 7.2 Specify the basis (fair value, amortized cost, etc.) for determining the amount ..................... ---............................ ..........__................................. ........................................ 7.3 State the amount of reserves established for this business: ...__---------- ........... .................._........_.._......_._......______.__........._....__$...--_.._........................0 7.4 Identify where the reserves are reported in the blank - .............-- - - ....................-._.- ................. - — .............................. • EXHIBIT 5A - CHANGES IN BASES OF VALUATION DURING THE YEAR 1 Description of Valuation Class Valuation Basis 4 Increase in Actuarial Reserve Due to Change 2 Changed From 3 Changed To LIFE CONTRACTS (Including supplementary contracts set upon a basis other than that used to determine benefits) (Exhibit 5) 0100001, DisabiIit -Disabled Lives ........_--------------------------------------------------------------- 75%ofFacevalue.-......_..-......._.--......3.5£.......--..-.-.-_.-....--..--_.._.--...-.....-_.-._._............195,229 1970 Interco Group Life WOP Table ? 0199999 Subtotal (Page 7, Line 6 XXX XXX 195,229) ACCIDENT AND HEALTH CONTRACTS Exhibit 6 0299999 Subtotal XXX XXX 0 DEPOSIT -TYPE CONTRACTS Exhibit 7 0399999 Subtotal XXX XXX 0 9999999 - Total Column 4 only) 195,229 13 • • q q q q q o q o o g q q O q 0 0 q q q q o q q q q o N a O N q q q q q o q o o g q q O o q q q q o q q q q o m 9 Q m I O O U O N w q q q q q o q o o q q q o q o o-- q q q q o q q q q o � � o — m O q q q q q o q o o g q q o q o 0 0 o q q q q o q q q q o � o N � m m y (Dc q q q q q o q o o g q q o q o 0 0 0 q q q q o q q q q o N � U 0 Z > m y d� q qo qqo qo0 qqqoqoo-- qqqqoqqqqo o m U� m m U o Oq(OON NggoN _� _ qqqqoqqqqo O 9 _ n (7 I I d Oo ggcoo Nrnn N, qq0 o ggOooOQOgo y d 20 H M M CD li a y 2' v ti Z v d v v - - m d m E C o N m o c� ! E � o D im w •. om w Imrn m i cm of y c � N d ' a N CI O O- N � a ` `� >000m c01� 0 3 ! CZ W T ~ W 3t Oho 3o'm m Q 7 wE--m0 is c E— LL.>=�' W c 9E ' m 01 � - a Co �= m OK Z3 o iyo '10o a 'mom p C` m .3 w LL n o C U N O O O 2 c°li N_ O O U tQ O O C O J a y y W N_ d i > o o m i w y v H H JJZ Q j1p Q E E w C1 a a d m rn d a d d 0¢ w' o o o o m 166 0 C� 6 4 6 m r m --- A 0 0 0 m m m m m 0000 - m o Q 2 2 p 14 Ll 0 15 • R g q R R R R R q q R R R R R o o R W ; R R R R R R R R R R R A R R R R R o 0 2 V N U > 9 � C 0! _ O C � c J C (p g o q o 0 o A o ia A, q q- -- R-- q q A R g q q q q q o 0 0 0 0 0 o A A O d J d R R R R q q q q F i d v j D N aN d E m E v d U yNy u y N U y N U d d c c N d c°c c d gi c °c A m � m m m C C d d ❑ d' w Z ❑ 2' K Z ❑ K K Z ❑ of of ❑ K m Z N M O Cl! N N N N M C N V N N N N N N N N t7 M M t7 O Q C R N C E d o 0. L n y d C � ❑ � N N N N - (7 0 Q r a d E O o U w c q � O a o N d S d a � a E i v w m a in <6 t0 a W E U d a d R m d - D y E c a d d - N a � C d N N d C E FA 0 9 15 U d d a 5 d aDi q = O ° d d � ° E d - = o C d f9 D E m 3 a o d a == a m a n E o C9 C L d m _ ODl t J d a d L c d rn a d CU ` A 0 D U Q Yi D E � v w p9 9 C O C d � D � a E T Q E c d U U U D U A � � 16 • • • Cl) V r Z O V `2 r J Q W 2 im Z Q H Z W v U Q Z Q W LL J N w O LL C)C L Q J U Mr W 2 W 0 t � QOQq o,c Qo Q QQQo o qo Q,o y a - _ c �� V d da U m Q 0 C7 ova N, bra o,o oo 0000 0 0000 0000 M=[_•] o °c m n o ccD vi _ _ _ c m o m H m m c m a a o! a m m ;tea iEa!Eo Cy !Ea v m m m m t m a m E 3 E �� i m �' m m c imp fat E!gym to iE im um a i�m "' uu m vo v'mm a mm omm imjOm d mi.m > > m� m m v d d v E 'm a Q�z=T'o x x z od no��z o�T�oxo!z E N Ilie. E m 1 N [7 a E e6 6 6 (O6 C NN Q mJ Q V R V Q Ett0 f0 a N ti O N tp N 17 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • EXHIBIT OF NONADMITTED ASSETS 1 2 3 Change in Total Current Year Total Prior Year Nonadmitted Assets Nonadmitted Assets Nonadmitted Assets Col. 2 - Col. 1 1. Bonds (Schedule 0).................................................................... ...._0 ._.........._-___-...._.............._0 _________...................-___0 2. Stocks (Schedule D): 2.1 Preferred stocks ----------------------------------------------------- ..........__............._________................................................... 0 ................................ .0 2.2 Common stocks_.._.._.........................................._.....__........._................____..__..................__...._.__._.._---- .0 ..............................................0 .............................................0 3. Mortgage loans on real estate (Schedule B): 3.1 First liens .............. ................................................................... ---.........-----_____._.... .0 ._...---------------....._.__0 0 3.2 Other than first liens __ .................................................. ....._........._............._ ......... _--_-__-_--__-..._0 .......... ...-____-_--_- -._-....._--__-0 4. Real estate (Schedule A): 4.1 Properties occupied by the company.__________ ----- .........._...........___..........................._............._............_0 .............................................0 ............................................0 4.2 Properties held for the production of income, _. _____.-_..- .............................................0 ......._-___. _ ....................... 0 -.._..................................... 0 4.3 Properties held for sale--------------------------------------------------------------------------------- --------- ...................... ......................0 ---------- _................................. 0 .............................................a 5. Cash (Schedule-E Part 1), cash equivalents (Schedule-E Part 2) and short-term investments (Schedule DA).........................._............................... ............................................. ............................................D .............................................0 6. Contract loans ....---....--------................. _------...................................................... ......... ......._ _ ___ ------------ .0 ......_........._............ _0 7. Other invested assets (Schedule BA) .................. ..___..............._........-_________.__ ............................................0 ......_..__._____._.............. .0 .................................0 8. Receivables for securities ..._............. .----------------- .______.--.._...._.._..._._.__-._.__.._......__......------_.._------------..._.._0 .............................................0 ........................................ 9. Aggregate write-ins for invested assets .....-------------------------- ----...--------------------- ........----------......._-------_ 0 ..............................................0 ...------------------------------------ 0 10. Subtotals, cash and invested assets (Lines 1 to 9) ---__---......_._........................................_._................._..._...._0 ............................................0 .............................................. 11. Title plants (for Title insurers only). ---------------------------- ............ ................. _ - _ - ........... _0 ___ _____ _______..._..___._0 ...__- - __..._..._.___ 0 12. Investment income due and accrued............................._...._.._......................._..._._.._........'---_________...... 0 ..................... ........................ 0 ......._.__..........._._..........__ 0 13. Premiums and considerations: 13.1 Uncollected premiums and agents' balances in the course of collection ......................... - _---------------- ---`---- - .............. ------ ---------------------------------- 170,516 _.._...221,455 - - - 50.939 13.2 Deferred premiums, agents' balances and installments booked but deferred andnot yet due, ....._------------------- ....._......._..............._-_-____................_.__________..._......................................_.0 ...__--___-_- ___..__...0 13.3 Accrued retrospective premiums............-...__-..................................................._...........---.............--------0 ..............................................0 .........................................0 14. Reinsurance: 14.1 Amounts recoverable from reinsurers .................. ......................................... ........ ............ ____-_____ 177,115 ......................................._..._0----------------------- ......_.(177 ,115) 14.2 Funds held by or deposited with reinsured companies ......................................... .......------------- ...._..._....48,949 ...................................48,949 ............... ............................. 0 14.3 Other amounts receivable under reinsurance contracts ...................... ....._..............------.._ 197,633 .................................202.832 .....................................5.199 15. Amounts receivable relating to uninsured plans ........__..._...._................ ....__...._......_ ..... ...................................__0 ----------- ...._........................... 0 ____.__................... ........... 0 16.1 Current federal and foreign income tax recoverable and interest thereon _ .................._.---------- ------------0 _...._.._..______-.........._..._0 ......._____......._..............._0 16.2Net deferred tax asset ............_...-------------------------------------------------------- ............_._..._._.._........_--------------------1,086,549 ......._.__..__.._...211,810 _.._.._..._..(874,739) 17. Guaranty funds receivable or on deposit ......... ... _.....--...............----..._.....................--------..._............_..._......0 .............................................0 _._..._.......................... ._._.0 18. Electronic data processing equipment and software-._..._ ................. .......... ..____ _..--- --------------- .._-.-.-_____-.-_-_..0 .............. ..._.......................... ........._...----------.................... 19. Furniture and equipment, including health care delivery assets........................................_............_.___............._0 .............................................0 --------------------------------------.0 20. Net adjustment in assets and liabilities due to foreign exchange rates . ...................... ............................................ 0 .._....-...._...__.._._-..............0 ____________......._......_ 0 21. Receivables from parent, subsidiaries and affiliates ..................................................... .. ..................... ....................... 0 ........... _........._.............. ....._0 ____-_____...._.......-____0 22. Health care and other amounts receivable .................. ..............._._-------------- .._ __ ___- ------------ _0 _........................................... 0 .............................................0 23. Aggregate write-ins for other than invested assets ._........................................ ..._..------ --------- _.._.___--__-__441,056 .....................................3,556 .........................(437,500) 24. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 10 to 23)._.---_---_-...._.------------------- -----..................... ..............__-__-_-2,121, 818 .................................688,602 ............................(1,433,216) 25. From Separate Accounts, Segregated Accounts and Protected Cell Accounts.......... 0 0 0 2,121,818 688,602 1,433,216 26. Total Lines 24 and 25 DETAILS OF WRITE-INS 0901.........__...........................__-__...._.._._...... - D 0902. - ...._................._.......-- ........_.....__..... -- .........__._. - - - 0 ..............._.__.................._-.0 ----------- - 0 0903.. ......... _0 0 - 0 0998. Summary of remaining write-ins for Line 9 from overflow page................._-___--...... ------------------..--_-____.___._0 ------------------------------0 .............------------------------_.0 0999. Totals Lines 0901 through 0903 plus 0998 Line 9 above 0 0 0 2301. Other Accounts Receivable --------.._.._..................----..-._....._..............---------...........................................3,556 ....--------------......._3,556....................... ....................... 0 2302. Unappl ied Claim Payments -- .................................................................................... ................. ............................ 0 ...--....- .......-------------------0 ............. .............................. 2303. Prepaid Expenses _____437,500 0 (437,500) 2398. Summary of remaining write-ins for Line 23 from overflow page ................. ..._........._ ...............0 ......._...._ 0 .................... 2399. Totals Lines 2301 through 2303 plus 2398 Line 23 above 441.056 3,556 437,500 18 • • The Western Cost Management Trust (WCMT) is a program committed to directing your organization and its members to high quality, cost effective organ and bone marrow transplant care. Complicated cases, repeated hospitalization and lifelong immunosupression medications make the care of transplant patients a costly medical procedure. Utilizing the expertise, benefits and the facilities of the WCMT program will enable your employees to face these life altering experiences with confidence. '�SEGAL ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS 1. Summary of Significant Accounting Policies A. Accounting Practices The accompanying financial statements of BCS Life Insurance Company have been prepared on the basis of accounting procedures prescribed or permitted by the Illinois Department of Financial and Professional Regulation — Division of Insurance (Department). The Department recognizes statutory accounting practices prescribed or permitted by the state of Illinois for determining and reporting the financial condition and results of operations of an insurance company, for determining its solvency under the Illinois Insurance Law. The National Association of Insurance Commissioners' (NAIC) Accounting Practices and Procedures manual, version effective January 1, 2001, has been adopted as a component of prescribed or permitted practices by the state of Illinois. The Commissioner of Insurance has the right to permit other specific practices that deviated from prescribed practices. The Company does not have any of these practices. B. Use of Estimates in the Preparation of the Financial Statements The preparation of financial statements requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, and expenses. Such estimates and assumptions could change in the future as more information becomes known, which could impact the amounts reported and disclosed herein. C. Accounting Policies Life premiums are recognized as income over the terms of related policies. Accident and health premiums are earned over the terms of related policies and reinsurance contracts. Unearned premium is established to cover the unexpired portion of premiums written, such reserves are computed by the pro rata method. Expenses incurred in connection with acquiring new insurance business (acquisition costs) are charged to operations as incurred. The Company sells group accident and health business with a rate stabilization reserve (RSR) feature. This reserve is included in the aggregate reserve for accident and health contracts on the statement of Liabilities, Surplus and Other Funds. When the underlying business generates an underwriting gain, the RSR increases by the amount of the gain. An underwriting loss reduces the balance. This reserve can be used by the policyholders to stabilize rates charged to the customer. At December 31, 2008, the Company recorded $37,318,836 in the rate stabilization reserve. In addition, the Company uses the following accounting policies: 1. Short term investments are stated at cost, which approximates market. 2. Long term bonds are stated at their amortized value using the scientific interest method. Non -investment grade securities with NAIC designations of 6 are stated at the lower of amortized value or fair value with any unrealized losses recorded as a reduction to surplus. If a security is deemed to be other than temporarily impaired, it is written down to its fair value through a charge to earnings. 3. Common Stocks - Not applicable 4. Preferred Stocks - Not applicable 5. Mortgage Loans - Not applicable 6. Prepayment assumptions for loan -backed securities are obtained from broker dealer survey values or Bloomberg Systems. These assumptions are consistent with current interest rates and the economic environment. The retrospective scientific method is used to value all loan backed and structured securities. 7. Subsidiaries, Controlled and Affiliated Companies - Not applicable 8. Joint ventures, Partnerships and Limited Liability Companies - Not applicable 9. Derivatives - Not applicable 10. Anticipated investment income as a factor for premium deficiency reserves - Not applicable 19 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS 11. Unpaid losses and loss adjustment expenses include an amount determined from individual case estimates and loss reports and an amount, based on past experience, for losses incurred but not reported. Such liabilities are necessarily based on assumptions and estimates and while management believes the amount is reasonable, the ultimate liability may be in excess of or less than the amount provided. The methods for making such estimates and for establishing the resulting liabilities are continually reviewed and any adjustments are reflected in the period determined. 12. Capitalization Policy- Notapplicable 13. Pharmaceutical Rebate Receivables — Not applicable 2. Accounting Changes and Corrections of Errors A. Accounting Changes Other than Codification and Correction of Errors None 3. Business Combinations and Goodwill None 4. Discontinued Operations Not Applicable 5. Investments A. Mortgage Loans None B. Troubled Debt Restructuring for Creditors None • C. Reverse Mortgages None D. Loan Backed Securities Anticipated prepayments for loan -backed and structured securities are used to determine the effective yield of an issue at purchase. Changes in the estimated cash flows of the issue are incorporated when determining the statement value at the end of each quarter and year-end. Prepayments for loan -backed and structured securities were obtained from the broker dealer survey or Bloomberg Systems. These assumptions are consistent with the current interest rate and economic environment. The retrospective scientific method is used to value all loan - backed and structured securities. E. Repurchase Agreements None F. Real Estate None G. Low Income Housing Tax Credits None 6. Joint Ventures, Partnerships and Limited Liability Companies None 7. Investment Income A. Accrued Investment Income The Company nonadmits investment income due and accrued if amounts are over 90 days past due. B. The total amount excluded is $0. ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS 8. Derivative Instruments The Company does not have in derivative instruments. positions 9. Income Taxes A. The components of the net deferred tax asset recognized in the Company's Assets, Liabilities, Surplus and Other Funds are as follows: December 31, December 31, 2008 2007 Change Total gross deferred tax assets $ 2,138,404 $ 1,201,703 $ 936,701 Total gross deferred tax liabilities 98,333 31,188 67,145 Net deferred tax asset 2,040,071 1,170,515 869,556 Non admitted deferred tax assets 1,086,549 211,810 874,739 Net admitted deferred tax assets $ 953.599 $ 958.705 $ The change in deferred income taxes reported in surplus before consideration of non - admitted assets are comprised of the following components: December 31, December 31, 2008 2007 Change Net deferred tax assets $ 2,040,071 $ 1,170,515 $ 869,556 Tax effect of unrealized losses Net tax effect without unrealized losses $ 2,040,071 $ 1,170,515 869,556 Change in deferred income tax surplus $ B62-5u B. Unrecognized Deferred Tax Liabilities Not Applicable C. Current income taxes incurred consist of the following: . December 31, December 31, 2008 2007 Current fax expense on operations $ 143,365 $ 3,354,878 Current fax (benefit) expense on realized capital gains (25,539) 549,493 Current year income taxes incurred $ 117,826 $ 3,904,371 The changes in the components of deferred tax assets and liabilities are as follows: December 31, December 31, 2008 2007 Change Deferred Tax Assets Claim and policy reserves $ 518,106 $ 626,073 $ (107,967) Deferred acquisition costs 298,092 278,085 20,007 Statutory non -admitted assets 362,344 166,877 195,467 Loss adjustment expense 5,829 21,186 (15,357) Other than temporary impairment 954,033 109,482 844,551 Total deferred tax assets 2,138,404 1,201,703 936,701 Deferred tax assets non -admitted 1,086,549 211,810 874,739 Total admitted deferred tax assets 1051 995 99,9893 61962 Deferred Tax Liabilities Investments 30,003 31,188 (1,185) Change in method for reserves 68,330 - 68,330 Total deferred taxliabilities 98,333 31,188 67,145 Net admitted deferred tax assets $ 953,522 $ 958,705 $ (5,183) • 19.2 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS D. The provision for federal income taxes incurred is different from that which would be obtained by applying the statutory federal income tax rate to income before income taxes. The significant items causing the difference are as follows: December 31, 2008 Current income taxes incurred $ 143,365 Change in deferred income tax (869,556) Total income tax reported (726,191) Income before taxes 3,811 ,554 Net statutory capital losses (2,492,093) Total pre-tax income 1,319,461 Expected income tax expense at 34% statutory rate 448,616 Increase (decrease) in actual tax reported resulting from: Change in method for reserves 68,330 Reversal of prior tax accrual (50,000) Interest maintenance reserve (171,448) Capital gains tax 25,539 Tax rate change (21,416) Deferred taxes on statutory nonadmitted assets (195,467) Return to provision adjustments (225,038) Small life company deduction (599,9941 Other (5,313) Total tax incurred $ (726,191) E. At December 31, 2008, the Company did not have any unused operating loss carry -forwards available to offset against future taxable income. The following are income taxes incurred in the current and prior years that will be available for recoupment in the event of future net losses: 2008 $ 399,995 200,,7 2006 2,173173 ,25257 The reporting entity has a total of $0 protective deposits which are on deposit with the Internal Revenue Service under Section 6603 of the Internal Revenue Service Code. F. The Company's federal income tax return is consolidated with BCS Financial Corporation, BCS Financial Services Corporation, BCS Insurance Company and BCS Insurance Agency, Inc. The method of allocation between the companies is subject to written agreement, approved by the Board of Directors. Allocation is based upon separate tax return calculations with current credit for net losses. Intercompany balances are settled once the tax return is completed and filed. 10. Information Concerning Parent, Subsidiaries, and Affiliates A., B., &C Nature of Relationships On January 1, 2007 BCS Financial Corporation merged with BCSI Holdings, Inc. (Holdings) pursuant to laws of the State of Delaware. The common stock of BCS Financial Corporation was converted into common stock of Holdings and all assets and liabilities of BCS Financial Corporation were transferred to Holdings. Pursuant to the merger, Holdings changed its name to BCS Financial Corporation (BCSF). BCSF has 2,340,270 common stock shares issued and outstanding at a par value of $0.01. The Internal Revenue Service issued a private letter ruling stating that the merger and subsequent name change were not taxable events. The Company paid ordinary cash dividends to BCSF, of $2,500,000 in 2008 and 2007. D. Amounts Due to or from Related Parties At December 31, 2008, the Company reported $2,012,320 as amounts due to BCSF and $15 due from BCS Insurance Company. E. Guarantees or Contingencies for Related Parties None 19.3 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS F. Management or Service Contracts and Cost Sharing Arrangements • The Company has a management service agreement with BCSF, where by BCSF provides all insurance management, administrative and advisory services as well as investment management and general office administrative services. G. Nature of Control Relationship Disclosure All outstanding common shares of the Company are owned by BCSF, an insurance holding company domiciled in the state of Delaware. H. Amount Deducted for Investment in Upstream Company None I. Investments in SCA Entity that Exceeds 10% of Admitted Assets None J. Investments in Impaired SCA Entities Disclosure None K. Foreign Insurance Subsidiary None L. Downstream Noninsurance Holding Company None 11. Debt None 12. Retirement Plans, Deferred Compensation, Postemployment Benefits and Compensated Absences and Other Postretirement Benefit Plans A. Defined Benefit Plan None B. Defined Contribution Plans None C. Multiemployer Plans None D. Consolidated/Holding Company Plans BCSF sponsors a defined benefit pension plan and a 401(k) Plan covering substantially all employees as well as a deferred compensation plan for select employees. Additionally, BCSF sponsors a postretirement health care benefit plan. The Company has no legal obligation for benefits under these plans. The expenses of these plans are charged in accordance with the management service agreement. As of December 31, 2008, the Company incurred expenses of $952,523 relating to these plans. E. Postemployment Benefits and Compensated Absences None F. Impact of Medicare Modernization Act on Postretirement Benefits Not applicable. 19.4 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS 13. Capital and Surplus, Shareholders' Dividend Restrictions and Quasi -Reorganizations 1. Outstanding Shares The Company has 25,000 shares of $100 par value common stock authorized, issued and outstanding. The company has no preferred stock outstanding. 2. Dividend Rate of Preferred Stock The Company has no preferred stock outstanding. 3., 4. & 5.Dividend Restrictions Under Illinois insurance regulations, the Company is required to maintain minimum capital and surplus of $1,500,000. At December 31, 2008, the Company's capital and surplus exceeds the NAIC's Risk Based Capital requirements for life and health insurance companies. The amount of dividends that can be paid by insurance companies domiciled in Illinois without prior approval of the Insurance Commissioner is subject to restrictions relating to statutory surplus and net income. The maximum dividend payout that can be made by the Company without prior approval in 2009 is $7,722,664. The Company paid ordinary cash dividends of $2,500,000 on December 8, 2008. Within the limitation there are no restrictions placed on the portion of Company profits that may be paid as ordinary dividends to stockholders. 6. Restrictions on Unassigned Surplus None 7. Mutuals —Total amount of Advances to Surplus not Repaid None 8. Stock held by the Company including affiliates None 9. Special Surplus Funds None 10. Changes in Unassigned Funds The portion of unassigned funds represented or reduced by net unrealized losses is $0 at December 31, 2008. 11. Surplus Notes None 12.& 13. Quasi Reorganizations None 14. Contingencies A. Contingent Commitments None B. Assessments The Company is subject to guarantee fund assessments by the states in which it writes business. Guarantee fund assessments are accrued at the time of insolvency. The Company has no accruals for guarantee fund assessments at December 31, 2008. C. Gain Contingencies None 19.5 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS D. Claims related extra contractual obligations and bad faith losses stemming from lawsuits The Company paid $0 during the reporting period to settle claims related extra contractual obligations or bad faith claims stemming from lawsuits. Number of claims where amounts were paid to settle claims related extra contractual obligations or bad faith claims resulting from lawsuits during the reporting period. (a) (b) (c) (d) (e) More than 0-25 Claims 26-50 Claims 51-100 Claims 101-500 Claims 500 Claims x Claim count information is disclosed per claim. E. All Other Contingencies Various lawsuits against the Company arise in the course of the Company's business. Contingent liabilities arising from litigation, income taxes and other matters are not considered material in relation to the financial position of the Company. The Company has no assets that it considers to be impaired in which an impairment has not been taken. 15. Leases None 16. Information About Financial Instruments with Off -Balance Sheet Risk None 17. Sale, Transfer and Servicing of Financial Assets and Extinguishment of Liabilities A. Transfer of Receivables Reported as Sales None • B. Transfer and Servicing of Financial Assets None • C. Wash Sales The Company has not sold and reacquired any security within a 30 day period of its original sale. 18. Gain or Loss to the Reporting Entity from Uninsured A & H Plans and the Uninsured Portion of Partially Insured Plans A. Administrative Services Only (ASO) Plans None B. Administrative Services Contract (ASC) Plans None C. Medicare or Similarly Structured Cost Based Reimbursement Contracts. None 19.6 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS 19. Direct Premium Written/Produced by Managing General Agents/Third Party Administrators • Types of Types of Premium Fein Exclusive Business Authority Written/ Name &Address Number Contract Written Granted" Produced BC/BS of Michigan 600 Lafayette East Detroit, MI 48266 38-2069753 N Group A&H U', C, CA, B, P $ 104,565,016 Marsh @W orkSo luti ons 1776 Westlakes Pkwy. West DesMoines, IA 50398 13-3109248 N Group Life P 6,243,483 Michigan Education Special Services Assoc. 1480 Kendale Blvd. East Lansing, MI 42856 38-1641634 N Group A&H C, CA, B, P 59,755,865 North American Benefits Co. 530 East Swedesford Road Suite 100 Group Life Wayne, PA 19088 23-2682285 N Group A&H U`, C, R, B, P 12,628,137 All other TPA Premium 7,757,695 20. Other Items A. Extraordinary Items None B. Troubled Debt Restructuring Debtors None C. Other Disclosures None D. Balances Uncollectible for Assets None E. Business Interruption Insurance Recoveries None F. State Transferable Tax Credits None G. Hybrid Securities None H. Subprime Mortgage Related Risk Exposure 1. The Company has indentified securities with the following characteristics as having subprime mortgage risk: a. First lien mortgages where borrowers have a FICO scores less than 650 b. First lien mortgages with loan -to -value ratios greater than 95% c. Second lien mortgages where borrowers have FICO scores less than 675 d. Borrowers with less than conventional documentation of their income and/or net assets and FICO scores less than 650 2. Direct Exposure through investment in subprime mortgage loans None • 19.7 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company NOTES TO FINANCIAL STATEMENTS 3. The following summarizes the Company's investments in securities with underlying • subprime exposure at December 31, 2008: Other -than - Temporary Book Impairment Adju sted Losses Actual Carrying Fair Recognized Investment type Cost Value Value to date Residential mortgage backed securities $ 1,643,144 $ 1,657,745 $ 1,360,521 $ 369,287 Commercial mortgage backed securities - - - Collateralized debt obligations Structured securities Equity investments in subsidiaries Other assets 4. Underwriting exposure to subprime mortgage risk through Mortgage Guaranty or Financial Guaranty insurance coverage None 21. Events Subsequent There are no events occurring subsequent to December 31, 2008 through the date of this filing meriting disclosure. 22. Reinsurance A. Ceded Reinsurance Report Section 1 —General Interrogatories 1. No is 2. No Section 2. Ceded Reinsurance Report — Part A 1. No 2. No Section 3. Ceded Reinsurance Report — Part B 1. Not applicable 2. No B. Uncollectible Reinsurance None C. Commutation of Ceded Reinsurance None 23. Retrospectively Rated Contracts and Contracts Subject to Redetermination None 24. Changes in Incurred Losses and Loss Adjustment Expenses Reserves for incurred losses and loss adjustment expenses attributable to insured events of prior year has increased $3,462,485 as of December 31, 2008 due primarily as a result of development in accident years 2007 and 2006 on accident and health business. 25. Intercompany Pooling Arrangements Not Applicable 19.8 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • C. I ]l NOTES TO FINANCIAL STATEMENTS 26. Structured Settlements None 27. Health Care Receivables None 28. Participating Policies Not Applicable 29. Premium Deficiency Reserve Not Applicable 30. Reserves for Life Contracts and Annuity Contracts The Company primarily writes renewable group term life insurance with premium due throughout the month, which necessitates the calculation of unearned premiums on a daily basis. In addition to reserves for group term life policies, reserves for the Group Universal Life product are based upon the contributions to the cash fund made by the individual insured. The reserves are the actual cash received plus any interest, which is earned on the cash value. The 2008 interest rates were 8% per annum for contributions made in the current policy year and 6% per annum for cash values remaining in the cash fund in subsequent years. 31. Analysis of Annuity Actuarial Reserves and Deposit Liabilities by Withdrawal Characteristics None 32. Premium and Annuity Considerations Deferred and Uncollected Type Gross Net of Loading Ordinary Life Group Life 33. Separate Accounts Not Applicable 34. Loss/Claim Adjustment Expenses $ (699) $ (699) 1,504,520 1,504,520 The balance in the liability for unpaid accident and health claim adjustment expenses as of December 31, 2008 and 2007, was $3,480 and $3,913, respectively. The Company incurred $1,489 and paid $1,922 of claim adjustment expenses in the current year, of which $0 of the paid amount was attributable to insured or covered events of prior years. The Company did not increase or decrease the provision for insured events or prior years. The Company took into account estimated anticipated salvage and subrogation in its determination of the liability for unpaid claims/losses and reduced the liability by $0. 19.9 • 1] • Our signed cover letter signifies proposal's complete adherence with the RFP specifications, except as specifically noted in the appropriate sections. 7�-SEGAL 2 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company GENERAL INTERROGATORIES PART 1 - COMMON INTERROGATORIES GENERAL 1.1 Is the reporting entity a member of an Insurance Holding Company System consisting of two or more affiliated persons, one or more of whichis an insureR--------------------- ------------------------------------------------------------- ............._----........._-------------......--------..................-------------...--- Yes [ X J No [ ] 1.2 If yes, did the reporting entity register and file with its domiciliary State Insurance Commissioner, Director or Superintendent or with such regulatory official of the state of domicile of the principal insurer in the Holding Company System, a registration statement providing disclosure substantially similar to the standards adopted by the National Association of Insurance Commissioners (NAIC) in its Model Insurance Holding Company System Regulatory Act and model regulations pertaining thereto, or is the reporting entity subject to standards and disclosure requirements substantially similar to those required by such Act and regulations? Yes [ X J No [ ] NA [ ] 1.3 Slate Regulating?---------------------------------------------------------------- ......................... _..-------------------------------------- __._._------..._-------------------Illinois_..................._. 2.1 Has any change been made during the year of this statement in the charter, by-laws, articles of incorporation, or deed of settlement of the reportingentity?_.._..............._......-----------.__...-------.............---..................------......_....__.-------..._..._......._.---------------..... .................. ..... Yes [ ] No [ X J 2.2 If yes, dale of change: 3.1 State as of what date the latest financial examination of the reporting entity was made or is being made ...... ....___.____....__...................... ............................. 12/31 /2005 3.2 State the as of date that the latest financial examination report became available from either the state of domicile or the reporting entity. This date should be the date of the examined balance sheet and not the date the report was completed or released. 12/31 /2005 3.3 State as of what date the latest financial examination report became available to other states or the public from either the state of domicile or the reporting entity. This is the release date or completion date of the examination report and not the date of the examination (balance sheetdate) . ....................... __ —------------------------------------------------------------- ..............-_--- _._---- ------- .................... ----- .................... ----- __._.._............ .06/21/2007 3.4 By what department or departments? Illinois, ----------------- __ _ -------------------------- --- -- -- ----------------------------------------------------------------------------- 3.5 Have all financial statement adjustments within the latest financial examination report been accounted for in a subsequent financial statement filed with departments?-. -.__._._._.._....._.----------__----------------------------------.....................-.................................-....-. _........................ Yes [ X J No [ ) NA [ ] 3.6 Have all of the recommendations within the latest financial examination report been complied with?............................................................. Yes [ X J No ( ] NA [ ] 4.1 During the period covered by this statement, did any agent, broker, sales representative, non-affiliated sales/service organization or any combination thereof under common control (other than salaried employees of the reporting entity) receive credit or commissions for or control a substantial part (more than 20 percent of any major line of business measured on direct premiums) of: 4.11 sales of new business? Yes [ X J No [ ] 4.12 renewals? ---------------------- Yes ( X ] No [ 4.2 During the period covered by this statement, did any sales/service organization owned in whole or in part by the reporting entity or an affiliate, receive credit or commissions for or control a substantial part (more than 20 percent of any major line of business measured on direct premiums) of: 4.21 sales of new business? Yes [ J No [ X J 4.22 renewals?-...........................---------._.._----------------- Yes [ J No ( X ] 5.1 Has the reporting entity been a party to a merger or consolidation during the period covered by this statement? .................... Yes [ J No [ X J 5.2 If yes, provide the name of the entity, NAIC company code, and state of domicile (use two letter state abbreviation) for any entity that has ceased to exist as a result of the merger or consolidation. 1 2 3 Name of EntityNAIC Company Code State of Domicile 6.1 Has the reporting entity had any Certificates of Authority, licenses or registrations (including corporate registration, if applicable) suspended or revoked by any governmental entity during the reporting period?__._........................................................................... _._._..._------._............._....... Yes [ ] No [ X ] 6.2 If yes, give full information ._..............._._--_.._- ------------ .......................................................... ___ -- 7.1 Does any foreign (non -United States) person or entity directly or indirectly control 10 % or more of the reporting entity? Yes [ J No [ X ] 7.2 If yes, 7.21 State the percentage of foreign control.................................... --- ----------------------------- .....--- -_------ ------------------- 0.0 7.22 State the nationality(s) of the foreign person(s) or entity(s) or if the entity is a mutual or reciprocal, the nationality of its manager or attorney - in - fact and identify the type of entity(s) (e.g., individual, corporation, government, manager or attorney - in - fact). 1 2 Nationality Type of Entity 20 • • • ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company GENERAL INTERROGATORIES 8.1 Is the company a subsidiary of a bank holding company regulated by the Federal Reserve Board? Yes [ ) No [ X J 8.2 If response to 8.1 is yes, please identify the name of the bank holding company. 8.3 Is the company affiliated with one or more banks, thrifts or securities firmsv ....... Yes [ J No [ X J 8.4 If response to 8.3 is yes, please provide the names and locations (city and state of the main office) of any affiliates regulated by a federal financial regulatory services agency O.e. the Federal Reserve Board (FRB), the Office of the Comptroller of the Currency (OCC), the Office of Thrift Supervision (OTS), the Federal Deposit Insurance Corporation (FDIC) and the Securities Exchange Commission (SEC)] and identify the affiliate's primary federal regulator. 1 Affiliate Name 2 Location Ci , State 3 FRB 4 OCC 5 OTS 6 FDIC 7 SEC 9. What is the name and address of the independent certified public accountant or accounting firm retained to conduct the annual audit? KPMG LLP, 303 East Wacker Drive, Chicago, IL 60601 10. What is the name, address and affiliation (officer/employee of the reporting entity or actuary/consultant associated with an actuarial consulting firm) of the individual providing the statement of actuarial opinion/certification? .............. Bernard E. Hartt, MWM Consulting Group, 20 East Jackson Blvd, Suite 1050, Chicago, IL 60604 11.1 Does the reporting entity own any securities of a real estate holding company or otherwise hold real estate indirectly? Yes [ J No [ X J 11.11 Name of real estate holding company 11.12 Number of parcels involved 0 11.13 Total book/adjusted carrying value_._.______ $ ................... .__..________0 11.2 If yes, provide explanation 12. FOR UNITED STATES BRANCHES OF ALIEN REPORTING ENTITIES ONLY: 12.1 What changes have been made during the year in the United States manager or the United States trustees of the reporting entity? 12.2 Does this statement contain all business transacted for the reporting entity through its United States Branch on risks wherever located? ........ Yes [ J No [ J 12.3 Have there been any changes made to any of the trust indentures during the year? Yes [ J No [ J 12.4 If answer to (12.3) is yes, has the domiciliaryor entry slate approved the changes? ------------ _...______------- ............................................... Yes [ J No [ J NA [ ] 13.1 Are the senior officers (principal executive officer, principal financial officer, principal accounting officer or controller, or persons performing similar functions) of the reporting entity subject to a code of ethics, which includes the following standards? Yes [ X J No [ J Honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and a. professional relationships; b. Full, fair, accurate, timely and understandable disclosure in the periodic reports required to be filed by the reporting entity; c. Compliance with applicable governmental laws, rules and regulations; d. The prompt internal reporting of violations to an appropriate person or persons identified in the code; and e. Accountability for adherence to the code. 13.11 If the response to 13.1 is No, please explain: 13.2 Has the code of ethics for senior managers been amended? Yes [ J No ( X ) 13.21 If the response to 13.2 is Yes, provide information related to amendment(s). 13.3 Have any provisions of the code of ethics been waived for any of the specified officers? ....._..__------------------------------- .......__.___.__.__... Yes [ ] No [ X J 13.31 If the response to 13.3 is Yes, provide the nature of any waiver(s). BOARD OF DIRECTORS 14. Is the purchase or sale of all investments of the reporting entity passed upon either by the board of directors or a subordinate committee thereof?-------------._.------...--------------....................-..........------------------ ..._..................--------------.................-----------......_..__....... Yes [ X ) No i [ 15. Does the reporting entity keep a complete permanent record of the proceedings of its board of directors and all subordinate committees thereof? ........._.--------------............................._...._....------.........._.............._.... Yes [ X J No [ [ 16. Has the reporting entity an established procedure for disclosure to its board of directors or trustees of any material interest or affiliation on the part of any of its officers, directors, trustees or responsible employees that is in conflict or is likely to conflict with the official duties of suchperson?--.......---.................................................. __.............._................---------. Yes [ X ] No [ J 20.1 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company GENERAL INTERROGATORIES FINANCIAL 17. Has this statement been prepared using a basis of accounting other than Statutory Accounting Principles (e.g., Generally Accepted Accounting Principles)?....................................._......_..................................................................... Yes [ J No [ X ] 18.1 Total amount loaned during the year (inclusive of Separate Accounts, exclusive of policy loans): 18.11 To directors or other officers. $________..._...._----- -------f) 18.12 To stockholders not officers.. $._..._._____._ ........ ------------ 0 18.13 Trustees, supreme or grand (Fraternal only) .................. $....__.____.-......_............0 18.2 Total amount of loans outstanding at end of year (inclusive of Separate Accounts, exclusive of policy loans): 18.21 To directors or other officers.. $______._. ....................... _0 18.22 To stockholders not officers...$..____._...........................0 18.23 Trustees, supreme or grand (Fraternal only) ...................... $____________.....__._._0 19.1 Were any assets reported in the statement subject to a contractual obligation to transfer to another party without the liability for such obligation being reported in the statement? Yes [ J No [ X j 19.2 If yes, state the amount thereof at December 31 of the current year: 19.21 Rented from others ........ $------------------- -----------------------0 19.22 Borrowed from others ............. $___________.._._..___ 0 19.23 Leased from others..........__________.........._..$._.___.__...------..._---------_..0 19.24 Other .........$-------------------------------------------- 0 20.1 Does this statement include payments for assessments as described in the Annual Statement Instructions other than guaranty fund or guaranty association assessments? .................. Yes [ X j No ( J 20.2 If answer is yes: 20.21 Amount paid as losses or risk adjustment....... $__ ...................... _.....0 20.22 Amount paid as expenses .............................. $---------------------------------- 86,711 20.23 Other amounts paid ----------- ................................. $_.-_-_-_......._.................... 21.1 Does the reporting entity report any amounts due from the parent, subsidiaries or affiliates on Page 2 of this statement? _ ..____ ........... ....... Yes [ X J No [ ] 21.2 If yes, indicate any amounts receivable from parent included in the Page 2 amount:......__.$-_________._._................0 INVESTMENT 22.1 Were all the stocks, bonds and other securities owned December 31 of current year, over which the reporting entity has exclusive control, in the actual possession of the reporting entity on said date? (other than securities lending programs addressed in 22.3).___._._.._.................... Yes [ X ] No [ ] 22.2 If no, give full and complete information relating thereto: 22.3 For security lending programs, provide a description of the program including value for collateral and amount of loaned securities, and whether collateral is carried on or off -balance sheet. (an alternative is to reference Note 16 where this information is also provide) 22.4 Does the company's security lending program meet the requirements for a conforming program as outlined in the Risk -Based Capital • Instructions? 22.5 If answer to 22.4 is YES, report amount of collateral........................._..._......._............................_..............._....._.....__...__.._..........._.............. ..............._..._............__....._.............._.... Yes [ ] No [ ] $............................................ 22.6 If answer to 22.4 is NO, report amount of collateral ...__......___-------------------------------------------------------------------------- _.._______........._... $................. 23.1 Were any of the stocks, bonds or other assets of the reporting entity owned at December 31 of the current year not exclusively under the control of the reporting entity or has the reporting entity sold or transferred any assets subject to a put option contract that is currently in force? (Exclude securities subject to Interrogatory 19.1 and 22.3)____........................................................................ .__....................... Yes [ X ] No [ j 23.2 If yes, state the amount thereof at December 31 of the current year: 23.21 Subject to repurchase agreements --- _ $___._____..........------------ 0 23.22 Subject to reverse repurchase agreements, ................ $........................................... 0 23.23 Subject to dollar repurchase agreements .._.............. $_____...____......._...._...0 23.24 Subject to reverse dollar repurchase agreements..... $............................................0 23.25 Pledged as collateral .............. $ ...__ 0 23.26 Placed under option agreements .._.__..._._............... $._____________ ......_.._0 23.27 Letter stock or securities restricted as to sale............. $............................................ 0 23.28 On deposit with state or other regulatory body........... $__________ ------ 3,317,452 23.29 Other ....................................... $-----------.........._...........0 • 23.3 For category (23.27) provide the following 1 2 3 Nature of Restriction Description Amount 24.1 Does the reporting entity have any hedging transactions reported on Schedule DB? ...... Yes [ ] No [ X j 24.2 If yes, has a comprehensive description of the hedging program been made available to the domiciliary state? ............. Yes [ J No [ J NA [ X ] If no, attach a description with this statement. 25.1 Were any preferred stocks or bonds owned as of December 31 of the current year mandatorily convertible into equity, or, at the option of the issuer, convertible into equity?_......._...................._.....-------------...................... ._......._.......................... .---- ---------------- .................. Yes [ ] No [ X ] 25.2 If yes, state the amount thereof at December 31 of the current year.......................................................... $................ ................ ..... 0 20.2 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • GENERAL INTERROGATORIES 26. Excluding items in Schedule E-Part 3-Special Deposits, real estate, mortgage loans and investments held physically in the reporting entity's offices, vaults or safety deposit boxes, were all stocks, bonds and other securities, owned throughout the current year held pursuant to a custodial agreement with a qualified bank or trust company in accordance with Section 3, III Conducting Examinations, F - Custodial or Safekeeping agreements of the NAIC Financial Condition Examiners Handbook? ... ...____ ........_.............._............... ____ _........ Yes [ X ] No [ ] 26.01 For agreements that comply with the requirements of the NAIC Financial Condition Examiners Handbook, complete the following: 1 Name of Custodians 2 Custodian's Address The Northern Trust Company ------------------- __........_._............ 50 South LaSalle Street, Chicago, IL 60675..........._---- 26.02 For all agreements that do not comply with the requirements of the NAIC Financial Condition Examiners Handbook, provide the name, location and a complete explanation: 26.03 Have there been any changes, including name changes, in the custodian(s) identified in 26.01 during the current year? Yes [ ] No [ X ] 26.04 If yes, give full and complete information relating thereto: 1 Old Custodian 2 New Custodian 3 Date of Change 4 Reason 26.05 Identify all investment advisors, brokers/dealers or individuals acting on behalf of broker/dealers that have access to the investment accounts, handle securities and have authority to make investments on behalf of the reporting entity: 1 Central Registration Depository Numbers 2 Name 2 Address 109875 .........._.___ Asset Allocation Management ....................... 30 North LaSalle, Chicago, IL 60602..._.. 106595.......... .---------------------------------------------------- Wellington Management.. ----------- _._______ 75 Stale Street, Boston, MA 02109_._.__-- 940 Sothwood Blvd, Incline Village, NV 104751----------- Zazove.....................................----------.._...... 89454------------------ ...__-.. ___ __..................... .. 27.1 Does the reporting entity have any diversified mutual funds reported in Schedule D, Part 2 (diversified according to the Securities and Exchange Commission (SEC) in the Investment Company Act of 1940 [Section 5 (b) (1)1)?_......_............._.Yes ( j No [ X ] 27.2 If yes, complete the following schedule: 1 CUSIP # 2 Name of Mutual Fund 3 Book/Achusted Carrying Value 27.2999 TOTAL 0 27.3 For each mutual fund listed in the table above, complete the following schedule: 1 2 3 4 Amount of Mutual Fund's Name of Mutual Fund Name of Significant Holding Book/Adjusted Carrying Value from above table Of the Mutual Fund Attributable to the Holding Date of Valuation 20.3 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • GENERAL INTERROGATORIES 28. Provide the following information for all short-term and long-term bonds and all preferred stocks. Do not substitute amortized value or statement value for fair value. 1 2 3 Excess of Statement over Fair Value (-) Statement (Admitted) or Fair Value Value Fair Value over Statement + 28.1 Bonds.... .................................... ------------------------------146,936,225 .................................141,300,079 ....... ..... .(5,636,146) 28.2 Preferred stocks., 0 _._..........................._._-.-_— __ 0 ..........................0 28.3 Totals 146,936,225 141,300,079 5,636.146 28.4 Describe the sources or methods utilized in determining the fair values: 29.1 Have all the filing requirements of the Purposes and Procedures Manual of the NAIC Securities Valuation Office been followed? Yes i % ] No ( ] 29.2 If no, list exceptions: OTHER 30.1 Amount of payments to trade associations, service organizations and statistical or rating bureaus, if any?,,,- . ...................$......................18,947 30.2 List the name of the organization and the amount paid if any such payment represented 25 % or more of the total payments to trade associations, service organizations and statistical or rating bureaus during the period covered by this statement. 1 Name 2 Amount Paid A. M. Best Coapany.- - —.------------------------------------------------------------------------------------------------- -------------------17,400 31.1 Amount of payments for legal expenses, if any? _------_._.............................. .........................................._................................_._.-----$ -----------........_..------------0 31.2 List the name of the firm and the amount paid if any such payment represented 25 % or more of the total payments for legal expenses during the period covered by this statement. 1 2 Name Amount Paid 32.1 Amount of payments for expenditures in connection with matters before legislative bodies, officers or departments of government, if any?....$_______...._....................0 32.2 List the name of the firm and the amount paid if any such payment represented 25 % or more of the total payment expenditures in connection with matters before legislative bodies, officers or departments of government during the period covered by this statement. 1 2 Name Amount Paid 20.4 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company GENINTPTI - Attachment 28.4 BCS Life Insurance Company's custodial bank provides the Company with the fair market vaue of the security. A • description of its methods follows; Interactive Data Services, Standard & Poors, and Lehman are all sources for U.S. Treasuries, Corporates, Governments, and Collateralized Mortgage Obligations; Standard & Poors is a primary source for Municipals; manual pricing is provided by Bloomberg, Prudential American Securities, Everett Thatcher & Associates, Brokers, and Investment Managers. E • 20 - Attachment ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company GENERAL INTERROGATORIES PART 2 - LIFE INTERROGATORIES 1.1 Does the reporting entity have any direct Medicare Supplement Insurance in force? Yes [ X J No [ ] • 1.2 If yes, indicate premium earned on U.S. business only ........... _......_..... ......._.............._.....................................____._______________...... $ ................... 1,704 1.3 What portion of Item (1.2) is not reported on the Medicare Supplement Insurance Experience Exhibit? ...........__..___.___.__...-_........_.._. $ ................_.... 0 1.31 Reason for excluding .............................. ......................... ..._.______________.__..._........... ._......___.__........._....._....................._.._..... 1.4 Indicate amount of earned premium attributable to Canadian and/or Other Alien not included in Item (1.2) above . ...................................... $ _...._........__________...0 1.5 Indicate total incurred claims on all Medicare Supplement insurance._...._._...................................................__.._____________..-__._... $ ..__.____.____._.._......._0 1.6 Individual policies: Most current three years: 1.61 Total premium earned _____-___-___--_-__-_..... $-------------------------------------- _ 0 1.62 Total incurred claims .............................._ ............. $........_..-..______ .......... 0 1.63 Number of covered lives ......... ............. ...................... All years prior to most current three years: 1.64 Total premium earned ------------------------------------------- $1,704 1.65 Total incurred claims -__.....$.................................. ___ _...0 1.66 Number of covered lives.-. ... ................................. 1.7 Group policies: Most current three years: 1.71 Total premium earned -._--- ..----- ............................. $.......... ..-....-..----- ------------------ 0 1.72 Total incurred claims -------------------------- $ ...................... 0 1.73 Number of covered lives., __ --------------- -------........ .....__.. ....... ............... 0 All years prior to most current three years: 1.74 Total premium earned -__.._...__..__-.....-- $ ....................... 0 1.75 Total incurred claims ............................................. $........... ........_--__-_--_____.0 1.76 Number of covered lives _________________ .............................................. 0 2. Health Test: 1 2 Current Year Prior Year 2.1 Premium Numerator $ .................189,901.526 $ ................172,789,852 2.2 Premium Denominator $ ................200,941.353 $ -----------207,617,506 2.3 Premium Ratio (2.1/2.2) ............... __....._ 0.945 _-.._ .................... 0.832 2.4 Reserve Numerator $ ...............37,380,801 $ ..................98,755,212 2.5 Reserve Denominator $ $ • ..................51,031,018 ..................60,583,253 2.6 Reserve Ratio (2.4/2.5) ............ _ .......... 0.733 ..................0.805 3.1 Does this reporting entity have Separate Accounts? Yes [ J No [ X ] 3.2 If yes, has a Separate Accounts statement been fled with this Department?_______________--------------------------------------- Yes [ I No [ ] NA [ X J 3.3 What portion of capital and surplus funds of the reporting entity covered by assets in the Separate Accounts statement, is not currently distributable from the Separate Amounts to the general account for use by the general account?............................................................. $ ...................... 0 3.4 State the authority under which Separate Accounts are maintained:_..________________._............._............._......_...._..._........._....._............... 3.5 Was any of the reporting entity's Separate Accounts business reinsured as of December 31? ....... Yes [ ] No [ J 3.6 Has the reporting entity assumed by reinsurance any Separate Accounts business as of December 31? Yes [ ] No [ ] 3.7 If the reporting entity has assumed Separate Accounts business, how much, if any, reinsurance assumed receivable for reinsurance of Separate Accounts reserve expense allowances is included as a negative amount in the liability for "Transfers to Separate Accounts dueor accrued (net)? .................. -------------- ...................................... -----__.--------- ......._.......................... ...................................................... $.............................. .._.--._.0 4.1 Are personnel or facilities of this reporting entity used by another entity or entities or are personnel or facilities of another entity or entities used by this reporting entity (except for activities such as administration of jointly underwritten group contracts and joint mortality or morbiditystudies)?.._._.._.___________..__._............................. _..______-__..-__.._...._...._.............. ................_..__......................_._._....._----------- Yes [ X I No [ ) 4.2 Net reimbursement of such expenses between reporting entities: 4.21 Paid: ................................................... $.............----...........5.640,137 4.22 Received: ..................... ........._.......... $........... ___ ......._.________ 0 5.1 Does the reporting entity write any guaranteed interest contracts?.............................................................. .._......----------------- Yes [ I No [ X ] 5.2 If yes, what amount pertaining to these items is included in: 5.21 Page 3, Line 1........._._.._. $----------------- ..._._.._ ... ...... ..0 5.22 Page 4, Line 1 ............ .__._.- $----------------- ........................... 0 6. For stock reporting entities only: 6.1 Total amount paid in by stockholders as surplus funds since organization of the reporting entity: $ 1, 126,255 7. Total dividends paid stockholders since organization of the reporting entity: 7.11 Cash: ............ . ...... ._........................ $ 7.12 Stock: ................................................. $ ....................2.300.000 • 21 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • GENERAL INTERROGATORIES 8.1 Does the company reinsure any Workers' Compensation Carve -Out business defined as: .___.__._.._._. ................ _....._..........--- ---------- ........ Yes [ ] No [ X ] Reinsurance (including relrocessional reinsurance) assumed by life and health insurers of medical, wage loss and death benefits of the occupational illness and accident exposures, but not the employers liability exposures, of business originally written as workers' compensation insurance. 8.2 If yes, has the reporting entity completed the Workers Compensation Carve -Out Supplement to the Annual Statement? Yes [ ] No [ ] 8.3 If 8.1 is yes, the amounts of earned premiums and claims incurred in this statement are: 1 2 3 Reinsurance Reinsurance Net Assumed Ceded Retained 8.31 Earned premium ----------------------------------------------- ..........._..._........_............__.............._0 ......_.._................._.....0 ...._..._...___._________0 8.32 Paid claims............................................_--......._----....................._...........--------.._0 .....---...........................0 ._......_..._..--------_-0 8.33 Claim liability and reserve (beginning of year)_._ ................................. 0 __-_-__-_................_..0 ... ................... ........... ..0 8.34 Claim liability and reserve (end of year). ............................... ..__...____________ 0 ...........................0 8.35 Incurred Claims ........................................................................ .................................... .................. ................. 0 ..........__....__-------0 8.4 If reinsurance assumed included amounts with attachment points below $1,000,000, the distribution of the amounts reported in Lines 8.31 and 8.34 for Column 1 are: 1 2 Attachment Earned Claim Liability Point Premium And Reserve 8.41 <$25.000........_...................._.............._....._.....0................._.._..................................... 8.42 $25,000 - 99,999 .............................. .----------------�---...._.._..__..__.................._......._0 8.43 $100,000 - 249,999 ...----...................-..........._---.._.----0---------- ...--------..................................... 0 8.44 $250,000 - 999,999 ------------------------------------------ ..............................................0 8.45 $1,000,000 or more.__........................................................0..................................................______0 8.5 What portion of earned premium reported in 8.31, Column 1 was assumed from pools?.. ... ................................................ ....._....$_........_.................................._0 9.1 Does the company have variable annuities with guaranteed benefits? Yes [ ] No [ X ] 9.2 If 9.1 is yes, complete the following table for each type of guaranteed benefit. Type 3 1 4 1 5 1 6 1 7 1 8 1 9 1 2 Guaranteed Guaranteed Waiting Period Account Value Total Related Gross Amount Location of Portion Reinsurance Death Benefits LivingBenefits RemainingRelated to Col.3 Account Values of Reserve Reserve Reinsured Reserved Credit ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • FIVE-YEAR HISTORICAL DATA Show amounts in whole dollars only, no cents; show percentages to one decimal place, i.e., 17.6. Show amounts of life insurance in this exhibit in thousands (OMIT S0001 1 2 3 4 5 2008 2007 2006 2005 2004 Life Insurance in Force (Exhibit of Life Insurance) 1. Ordinary - whole life and endowment (Line 34, Cal. 4)------------------------------------------------------------------------------ . ._................... B56 ------------------------906 -------------------------946 ----------------- -1,065 -- ------------1,165 2. Ordinary - term (Line 21, Col. 4, less Line 34, Col. 4) ---------------------------D --------------------------------1) -------------- ............... _D -------------------0 ---------------------------0 3. Credit life (Line 21, Col. 6)._..-___ ---------------- ----------------------------D ---------------------- __ _ 0 ------------------------------ D ------------------------D -------------------------0 4. Group, excluding FEGLI/SGLI (Line 21, Col. 9less Lines 43&44, Col. 4)------------- ----------------- ------------------ ..---------------- 5.075,661 -------------__-4.827,932 ------------------4,978.024 --------------- ---5,019,326 ------------------5,298,661 5. Industrial (Line 21, Col. 2) ---- ------------------------------ D -------------- ___9 ---------------D------------------------- --------- D -------------------D 6. FEGLI/SGLI (Lines 43 & 44, Col. 4)-------- ------------------ 0 0 0 0 0 ------------._5,076,517 ----__-_-__ 4,828,838 ---------------_4,978,970--------------- ---- 5,020,391 -------------------5,299,826 7. Total (Line 21, Col. 10)---------------------------------.----------- New Business Issued (Exhibit of Life Insurance) 8. Ordinary - whole life and endowment (Line 34, Col. 2)-------------------------------------------------------------------------------- - ._........................D -------------- ------------------- D ------------------------------D -------------------- -D - ----------------------D 9. Ordinary - term (Line 2, Col. 4, less Line 34, Col. 2) - - - ......................... -- ---- - - - ------------------------------------ D ---------------- ---- - D ----------------------------D ------------------------------0 --- ---------------------------0 10. Credit life (Line 2, Col. 6)--------- ----- --- ------------- ----------------------------- ---- D ----------------- - ---- -0 ------------------------0 --------------------------0 ---------------------------D 11. Group (Line 2, Col. 9) ------------------------------------------------ ---------------156,080 -------- -- 192,650 ---------------------82,410 ----------------------142,350 .-----------------1,113,160 12. Industrial (Line 2, Col. 2) 0 0 0 0 0 --156,080 --------------------192,650 .................82,410 ._____ _ _142.350 .----------------1,113,160 13. Total (Line 2, Got. 10). Premium Income - Lines of Business (Exhibit 1 - Part 1) 14. Industrial life (Line 20.4, Col. 2)----------------------------------- ------------------------------ D -----____-_______0 ----------------------------------D ----------------------0 ------------------D 15.1 Ordinary life insurance (Line 20.4, Col. 3)----------------- ------------------------- 19,731 -------------------------18,522 .-_...------------------ 22,483 _ - _ 20,057 24,477 15.20rdinary individual annuities (Line 20.4, Col. 4) -- ---- --------------------------0 ----------------------0 ---------------------------0 -------------------------- D -----------------------------0 16. Credit life, (group and individual) (Line 20.4, Col. 5) --------------------------------------------------------- ----- ---------- --- ---------- --------- - ------ D --------------------------------D -------------------------------0 - - - - --- -0 ----- ----- ...............D 17.1Group life insurance (Line 20.4,Col. 6). 8,146.237 -------------------7,987,643 ----9,649,062 _6,754,698 ..-.--------------6,077,827 17.2 Group annuities (Line 20.4, Col. 7)---------------- -------------------0 ----------------------------------D--- ------------------------------- D -------------------- --__ D .............-`----0 18.1A&H-group(Line 20.4, Col. 8)._______ --------------192,775.385 .-..-.------199,611,341 _____---199,768,455 ----------------189,579,025 ---------------170,704,498 18.2A & Hcredit (group and individual) (Line 20.4, Col. 9)-------- -------- ------------------------------------------- ----------------------- --- -- ------ _......._..-0 ---- - - - - -- --------D -------------------------------0 ----------------------------D -------------------------------D 18.3A & H-other (Line 20.4, Col. 10)---------------------------------- -------- ------------ ------------- 0 ----------------------------------D ._.....-.--------------......._D ._-_-__ _ - _ - _ ______0 ____.---------- .......... .. D 19. Aggregate of all other lines of business (Line 20.4,Col.11) ----------------------------- .... 0 0 0 0 0 -------------- ------.._._207,617,506 --------------209,440,000 .----------_.196,353,780 ---- - ---------- 176.806,802 20. Total ------------------------------------------ - -------- --------------- Balance Sheet (Pages 2 and 3) 21. Total admitted assets excluding Separate Accounts business (Page 2,Line 24, Col. 3)----------------------------- ...------------ 180,558,066 --------------.196,901,736 -----------------170,400,730 ---------------166,680.517 -------..-----155,049,034 22. Total liabilities excluding Separate Accounts business (Page 3, Line 26)------------- __--- ______._--- -------------- 100,831,430 ----------------116,355,180 -----------------94,015,729 -----------------93,881.235 -----------------85,175,134 23. Aggregate life reserves (Page 3, Line 1)------- _- ------------------ 12.693,408 -----------------11,153,890 -.-.-----------11,021,083 ---------------.10,535.760 ---------------- 9,869,585 24. Aggregate A & H reserves (Page 3, Line 2) ---------------__ ---- __...41,417,973 ---------- --- _42,130,978 ..__........-...11,913,508 ____ .___._9,937,859 .-.--------------9,568,788 25. Deposit -type contract funds (Page 3. Line 3) -------- ------------------------0 --------------------------0 ------------------------------D -----------------------D ---------------------------0 26. Asset valuation reserve (Page 3, Line 24.1)--- --------- -..-.---------------------------0 ----.------- -------- ---------------------- 493,381 ----------------------529.205 -----------------------428.018 27. Capital (Page 3, Lines 29 & 30)___ -_.._--_-- ---------------2,500,000 -------------------2.500,000 .----------------2,500,000---- --------------- 2,500,000---- --------------- 2,500,000 28. Surplus (Page 3, Line 37)-------------------------------------------- _._..._....._77.226,636 ............_._78,046.556 ----------------73,885.000 --------------- ----------------67.373,900 Cash Flow (Page 5) 29. Net cash from operations (Line 11)__ ----- ---------------- (717,241) ..-----------..-24,668,220 .-..-----..----2,421,019 ----------------------- ..-D -------------------------- Risk -Based Capital Analysis 30. Total adjusted capital --- .-------- .--------------------------- ----------- --- ------------- 79,726,636 ---------------80,948,614 -----------------76,878,381 ---------..----73,328,487 .-..............-70,301,918 31. Authorized control level risk - based capital ---------------- -------------------- 3,786,493 -------------------2,193,057 -------------------9,961,284 -------------------9,431,036 -------------------8,755,376 Percentage Distribution of Cash, Cash Equivalents and Invested Assets (Page 2, Col. 3) (Line No. / Page 2, Line 10, Col. 3) x 100.0 32. Bonds (Line 1)------------------------------------------------------ ----------------_88.2 ----------- --- - _87.8 -------------------89.5 --------------------------86.7---------- ------------------- 89.4 33. Stocks (Lines 2.1 and 2.2)------------------------------------ ------------------------0.0 -------------------------0.0--- ---------------------------- 0.0---------------- - -------------- 0.0 --------------------------0.0 34. Mortgage loans on real estate (Lines 3.1 and 3.2 ) _ ___- ------- .............. 0.0 ..__._0.0 ----- 0.0 -------------------- ----------- 0.0 ---------0.0 35. Real estate (Lines 4.1, 4.2 and 4.3)---------------------------- _____.._............._0.0 ........--.------.._-...._ 0.0 ...-....-.---------------..._0.0 ------------------------------- 0.0 .---------------------------.0.0 36. Cash, cash equivalents and short - term investments (Line 5)----------------------------------------------- --- -------- --- ----------11.7 - -- 12.0 ---------------------- ------------------------9.8 -- - ------------------------13.0 - - ---------------------_-10.2 - - 37. Contract loans (Line 6)-------------------------- ---- - - --------------------------0.1 ---------------------------0.1 -------------------------------- - ---- -- -0.3 . - - ' ------------------- 0.4 38. Other invested assets (Line 7)-------------------------------- ------------------------------- 0.0 ---------------------------0.0 -----------------------------0.0 ---------------------------0.0 -------------- ._.._.._._0.0 39. Receivables for securities (Line 8) ----------------------- - --- -------------------_0.0 ---------------------------0.0 ---------------------------0.3 ---------------------------0.0 ------------------------------- 40. Aggregate write-ins for invested assets (Line 9) ....-.. 0.0 0.0 0.0 0.0 0.0 41. Cash, cash equivalents and invested assets (Line 10) 1 100.0 100.0 100.0 100.0 100.0 22 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company 1� u FIVE-YEAR HISTORICAL DATA Irnnenu d% 1 2 3 4 5 2008 2007 2006 2005 2004 Investments in Parent, Subsidiaries and Affiliates 42. Affiliated bonds (Sch. D Summary, Line 25, Col. 1) --------------------------------------------------------------------------------- -- ............................ - - - - - ------ - 0 -----D ------------------------ _ D -D 43. Affiliated preferred stocks (Sch. D Summary, Line 39, Col. 1)------------- -__------------ .._---------------------------- ------ - ----D ___ _ - _ __ _ .-_......_D --------------- ___ D ------------------------ -_-_D ____.............. .... _D 44. Affiliated common stocks (Sch. D Summary, Line 53, Col. t)--------------------------------------------------- ----- ----------------------------D --.-..-----------------------D --------------------------D ---------------------------0 ---------------------------D 45. Affiliated short-term investments (subtotal included in Schedule DA, verification, Cal. 5, Line 10)------ --- --------------- 5,690,010 ----------------5,072,905 ------- ------ -----.----D ----------------------------D ----------------------------------D 46. Affiliated mortgage loans on real estate -----------_-- --- _---------------------------- D ---------------------------------D ----------------------------------D ----------------------------------D -----------------------------------0 47. All other affiliated 0 1 0 0 0 0 --------------5.690,010 -----------------5,072,905 -------------------------------0 ------------------------------0 --------------------------------D 48. Total of above Lines 42to47-------------------------------------- Total Nonadmitted and Admitted Assets 49. Total nonadmitted assets (Page 2, Line 26, Col. 2) _ -..-------.--.-.--2,121,818 -----------------------688.602 -------.-- --------------- ---- .-738,337 ------.--.----------.--390,398 50. Total admitted assets (Page 2,Line 26, Col. 3)_-_- ---------------- 180,558,066 ----------------196,901,736 .--_170,400,730 ---------------166,680,517 --------------155,049.034 Investment Data 51. Net investment income (Exhibit of Net Investment Income) - --- ---------------- -------- _ _ - - --------------6,231,005 ------------------- 6,527,461 - -- -- 5,733,329 -------------- ---5, 219,166 ---------------5,001,676 52. Realized capital gains (losses) ------------------------------------ __------------ (2.812,112) ----------1,257,176 ------------------------958,009 .--------.--------.----665,149 .---------------------- 997.281 53. Unrealized capital gains (losses)--------- ------------ _...._-.. 0 24,265 24,265 21,982 7.555 --------- 3,418,893 ------------------7,808,902 -------------.--.6,667,073 -------.-.---------5,862,333 .----------.---.---5,991,402 54. Total of above Lines 51,52and 53----------- -._-.--- _---- ---------- Benefits and Reserve Increase (Page 6) 55. Total contract benefits - life (Lines 10, 11, 12, 13, 14 and 15, Col.1 minus Lines 10, 11, 12, 13, 14, and 15, Cols.9, 10 and 11)----------------- __-- -----------------4,644,678 ---------------5,335,668 --------_-_-__5,985,830 --------------------4,440,602 ----------------3,641,512 56. Total contract benefits - A & H (Lines 13 & 14, Cols. 9,10&11)....................--------..---.-...----.-----..----..-.....---.--------.--164,969,233 ___-_-_-142.301,091 --------------168,370,052 .-------------160.516.081 ______.-.144,484,850 57. Increase in life reserves - other than group and annuities (Line 19, Cols. 2 & 3 ) ------------------ ---- --- - -----------------------753 - - - -(2,891) -------------2,219 ---------------------(1,784) -- --------------- (452) 58. Increase in A & H reserves (Line 19, Cols. 9, 10 & 11)---------------__..................... ------ -------- -------------------.-67,011 ---------------24,437,609 ------------1,975,649 ............ 369.071 -- ------------------ 200,379 59. Dividends to policyholders Line 30, Col. 1 -------._..............-----D -------------------------D -----------------------------0 -----------------------------D ---------------------------D Operating Percentages 60. Insurance expense percent (Page 6, Col. 1, Lines 21, 22 & 23, less Line 6)/ (Page 6, Col.1, Line 1 plus Exhibit 7, Cal. 2, Line 2) x 100.00 ----------------- ------15.3 ------------------14.0 --------------------------13.3 .-----------------------13.3 ----------------------------13.8 61. Lapse percent (ordinary only). [(Exhibit of Life Insurance, Column 4, Lines 14 & 15) / 1/2 (Exhibit of Life Insurance, Column 4, Lines 1 & 21)) x 100.00.---------------------------------------------------- --------------------------.5.7 ----------------------------.3.2 -11.8 ------------------- ------ 0.0 6.2 62. A & H loss percent (Schedule H, Part 1, Lines 5 & 6. Col. 2)---------------------------------- ----- ------- _ --- ---------------------------85.6 --------------------------81.1 .-_------------85.2 ---------------------------_84.8 --84.8 ----------------- 63. A & H cost containment percent (Schedule H, Part 1, Line 4, Cal. 2)--------- ...........----------------------------- -------------------- - --------- 0.0 ----------------------------0.0 . -- - --- - 0.0 ....-...------------------..-0.0 __------------------------- 0.0 64. A & H expense percent excluding cost containment expenses (Schedule H, Part 1, Line 10, Col. 2)-- ------------16.0 ----.-------------------16.6 ---------------- ------------ 13.3 ------------------- .--- -13.3 _------------- --_-._.--13.5 A & H Claim Reserve Adequacy 65. Incurred losses on prior years' claims - group health (Schedule H, Part 3, Line 3.1 Col. 2) ---------------------- _......_.46,436,634 ------ ------ -40,758,075 -------------43,962,535 -- .--------..------38,850,117 ..._-45,615,345 66. Prior years' claim liability and reserve - group health (Sch. H, Part 3, Line 3.2 Col. 2)----------------- _____ --.---------.--42,974,153 --_---__--...-55,636,024 ---------------_57,235,981 .-----..-----.-50.462.016 ----------------45,817,148 67. Incurred losses on prior years' claims -health other than group (Sch. H, Part 3, Line 3.1 Col. 1 less Col. 2) ---------------------------------------------------------------- - -- -------------------D -------------.--------------0 - - - -- D D - 0 68. Prior years claim liability and reserve -health other than group (Sch. H, Part 3, Line 3.2 Col. 1 less Col. 2) ------------------------------------------------------ ---------------------- -----0 ------------------------0 - - D D Net Gains From Operations After Federal Income Taxes b Lines of Business (Page 6, ine 33 69. Industrial life (Col.2)------------------------------ --__--__ -------------------------------- D ____--___----- ------D ---------------------------------0 --------------------...-_____0 ---------------0 70. Ordinary - life (Col. 3) --------------------------------------------------- ------------------------8,186 -.--------------------15,046 -----------------------7,036 ---------------------15,878 --------------------17,868 71. Ordinary - individual annuities (Col. 4)------------------ -----------------------------D --------------------------.-D ._...--------- --- ------ ----1) ------------------------------0 ------------------------------0 72. Ordinary -supplementary contracts (Col. 5)---------- _ D ...-.------- --------------.-----0 ---------------------------._----0 .................... .------------- D - 73. Credit life (Col. 6)--..------------------------------------------------- -----------------------------D -------.----------.--------.---.--D ----- _--___--- -----D --- ------------------------------ D --------.-.---------------..._ D 74. Group life (CoL 7) --.--------621,976 ------- --- ------ --_376,418 ------------------_-564,781 -------------------------49.835 ----------------------(33,680) 75. Group annuities Col. 8 ------------------------ --- ___ D __-. -.-------------D 76. A & H-group (Col. 9) ----------------------------------------------------- -------------------------40A21 -----------------4,931,111 -----------------4,723,117 4,880.535 ____--_-.._5,129,990 77. A & H-credit (Col. 10)-------------------------------------------------- -...-------.---.--------.--------0 --- -_.._---- .--- _------------- 0 ------.--------..-----------.-----0----------------------- _----D ----------------------- 10 78. A & H-other (Col. 11)--------------------------------------- --_ _ _- __ ---------------------D --.----.-------.-----------.------0 ------- - --_.__--- ----- 0----- - ---------------------------- 0 ----------------------------------D 79. Aggregate of all other lines of business (Col. 12)---_ 2.997,605 2,301 , 0 0 0 3.668,188 7!6 9,134 5.294.934 4,946,248 5.114,178 80. Total Col. 1 23 • • To participate in the RFP process vendors need to sign and return this Business Associate Agreement. . BUSINESS ASSOCIATE AGREEMENT — SECURITY STANDARDS This agreement is entered into between BCS Insurance Company (Business Associate) and the City of Fort Collins. Business Associate agrees that it will implement policies and procedures to ensure that its creation, receipt, maintenance, or transmission of electronic protected health information ("ePHI") on behalf of the City of Fort Collins complies with the applicable administrative, physical, and technical safeguards required to protect the confidentiality and integrity of ePHI under the Security Standards 45 CFR Part 164. Business Associate agrees that it will ensure that agents or subcontractors agree to implement the applicable administrative, physical, and technical safeguards required to protect the confidentiality and integrity of ePHI under the Security Standards 45 CFR Part 164. Business Associate agrees that it will report security incidents to the City of Fort Collins, Security Manager. By: V / Theresa O'Shea PRINT NAME Vice President, Marketing Services TITLE Please return to: City of Fort Collins Attn: Purchasing P.O. Box 580 Ft. Collins, CO 80522-0580 Or fax back to: (970) 221-6707 Date: August 12 2009 '�rSEGAL s • E ���� ������ 8 0 0 9 8 5 2 0 0 8 4 3 0 5 9 1 0 0 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company DIRECT BUSINESS IN THE STATE OF Consolidated DURING THE YEAR 2008 1 ICC 1\ICII�A\IP�C NAIL. UrOup L.Oae UUL3 NAIL L:om an f L:oae aundo 1 2 3 4 5 DIRECT PREMIUMS Credit Life (Group AND ANNUITY CONSIDERATIONS Ordinary and Individual) Group Industrial Total 1. Life insurance ............................ _...........----...25,935 ---------------------------0 ...............17,059.873 ......--------------.......0 ------------17,085,808 2. Ann uityconsiderations ......................... '--------------.....__.... ..........D .............._....----D .---------------.._0 ................_...__.._---D -----------...------....D 3. Deposit -type contract funds------...---------------------------_..._-........................._.....D ...............XXK....... -...... ........1,071,122 ...............XXX. __1,071,122 4. Other considerations- .____- _-_.........D ----------------__._.-___ D - ______________D _....-..........-..__-__..D ...._.........----------------.D 5. Totals Sum ofLines1to4 25,935 0 18,130,995 0 18,156,930 DIRECT DIVIDENDS TO POLICYHOLDERS Life insurance: 6.1 Paid in cash or left on deposit. ....--_. ----------.........D ....................... -----D ----------_..._._...D .................... .----------- 0 ............................-...0 6.2 Applied to pay renewal premiums ..............--...............D .........-....---------...D .......---....--...._.......D ..---........----------.D --...----------------.0 6.3 Applied to provide paid -up additions or shorten the endowment or premium -paying period ------------------------ _._--------------------------- 0 ............_...................0 .............................0 ................................0 ............_...-----___0 6.4 Other.--- ------- ---.._............_.....-...._ ---------------------------- ------------------ -----.. D ....._.......-----.._... A __..._._...................D ._----------- ..........a -------- D 6.5 Totals (Sum of 6.1 to 6.4). ................................0 .................................0 ................................0 --._....---....___-_- _D Annuities: 7.1 Paid in cash or left on deposit ....._.------- ----------------------------- ._..._.................0 ................................D ....__.._._.._._..........0 ................................D ................_....._...._._0 7.2 Applied to provide paid -up annuities. .._...________............D 7.3other - _..._................................................................ ..................__................................_-_------------------0 --------------------------0 ........ ................D ......................--.0 .................-- D 7.4 Totals (Sum of Lines 7.1 to 7.3). ..._._........................D ............_..................D _____._-._-_._....._D .............................__0 -----------D 8. Grand Totals Lines 6.5 plus 7.4 0 0 0 0 0 DIRECT CLAIMS AND BENEFITS PAID 9. Death benefits. - -------- ............................................................. ...............................0 ....... ......................A .................12,790,152 ................................. A 10. Matured endowments ...._......................._.0 ................... .............D ..__-_-__......_._.....D .........__..._.._......D ----------D 11. Annuity benefits ---......._...................----------._...._.....----..... ----_.._.................... 0 ............................... 0 ..----_----------............ 0 ................................D ......................... 12. Surrender values and withdrawals for life contracts... 0 ..............._...............D ..__..__....._....._.... D -------------------..._A ________---------- D 13. Aggregate write-ins for miscellaneous direct claims and benefitspaid ........ .......... ............._........_____---- --- ----- ...........0 ---------- ---------- ._-...-_D .________------_.D _._............._._.........0 ------------------------_.......0 14. All other benefits, except accident and health ..........................D ....-------...........------D --------------------------0 ...............---...........0 .......------.... - ---_0 15. Totals 0 1 0 1 12,790.152 1 0 1 12.790.152 DETAILS OF WRITE-INS 1301. ---- -- - --- -- -- - ------....................._......_................................... ........... ..........D .........._..---------D ---------------_- D ...........................-----D -------------------0 1302. --- ------- ------------------ ............................................................. ...------- - ----------------- 0 ...------ ------------ ----D ._.._.._...........__..... D ......_.........---------- -D ------- --- - - - ---------0 1303. __ _____ ......__..._................................... ..._........._............ D .... -. --.------ _.....__.D 1 _._______-.-__......D ............................__0 _ -___-______--------- 0 1398. Summary of Line 13 from overflow page. _-__--__ ............0 ----------------------- .._---__.._........_...0 ..........................._...D .............................0 1399. Totals Lines 1301 thm 1303 plus 1398 Line 13 above 0 0 0 0 0 Credit Life Ordina(Group and Individual) roup Industrial Total 1 2 3 4 5 6 7 8 9 10 DIRECT DEATH No. of BENEFITS AND MATURED Ind. Pols. ENDOWMENTS 8, No. of INCURRED No. Amount Gr. Certifs. Amount Certifs. Amount No. Amount No. Amount 16. Unpaid December 31, prior year-------- ----------......0 _...__.._-79.885 --------------D .......... ........._0.............. ...9 ....._.._4,300,041 ...............D ...................0 ....._.........9 _4,379,926 17. Incurred during current year------------------- --------------0 ---------------(3,750) ---_.....__A ............0 .............323 ......... 11.510,909 ----------D ---._..._..........._.0 .---.._....323 --_._. 11.507.159 Settled during current year: 18.1 By payment in full ... ...._......._.0 ..........................0 .......---_ D --___.........._.0 .............329 .--.-12,790.152 _----_-_ ..D ____..........._.._0 ..--.--329 ----_ 12,790.152 18.2 By payment on compromised claims ----..............................................0 -------------------------0 ..-........_..D -......................_0 .............._0 -------------0 -------....D ---................_..0 ...___..---0 -----------_-0 18.3 Totals paid -______ .._......_....D .._....__.____0 ___.__....D ......._._.._......._0 .............329 .........12,790.152 ................D ..........................0 ...._.._...329 ..........12,790,152 18.4 Reduction by compromise--------- ---------------0 -----------------------0 ..-..__._._D ....._......._-....._0 ............._D ..-----..........----0 --..............D __------.__......... 0 ................0 ---......_.__-_-0 18.5 Amount rejected......................0 ------------------.0 -------------0 --................_.._0 ..........._._D ._..........._---..._0 ......._...._.D ......._..-----_....0 ................D ..--..--------0 18.6 Total settlements .... ................ D ...............__._..0 _........_._.D .........................0 .............329 ..........12,790, 152 ................0 .........................0 -------------329 ..........12,790,152 19. Unpaid Dec. 31, current year 16+17-18.6 0 76.135 0 0 3 3,020,798 0 0 3 3,096,933 No. of POLICY EXHIBIT Policies 20. In force December 31, (a) Ion oryear.._--- _......... ----------36 ..._.........906,000 ______D _____..._........0 .._......1,767 _-5,404,978,569 _______D ........................ 0 ......_. 1,803 _-5.405.884,569 21.Issued during year _- -- ..................D ........_______ 0 --__-__...D .........................0 .............207 ....... 498,917,969 ................ 0 ......................_0 - - - _ 207 498.917,969 22. Other changes to in force(Net)....--------- -----------(1) -----..-...(50.000) ................0 .........................0 .............(33) ----(235,495.155) .....--......0 ........................0 .------(34) ----(235.545,155) 23. In force December 31 (a) of cument ear 35 856.000 0 0 1.941 5,668,401.383 0 0 1.976 5.669.257,383 tat inauues inmwoual c.rean cue insurance: poor year a _------------------------------- . currem year a ...---..--..__.........._.....a Includes Group Credit Life Insurance: Loans less than or equal to 60 months at issue, prior year $--...._------_--- ._.._.._.D current year $---------------------------------0 Loans greater than 60 months at issue BUT NOT GREATER THAN 120 MONTHS, prior year $................_......_......_0 current year $ ..._................._.__-.. 0 ACCIDENT AND HEALTH INSURANCE 1 Direct Premiums 2 Direct Premiums Earned 3 Dividends Paid Or Credited On Direct Business 4 Direct Losses Paid 5 Direct Losses Incurred 24. Group Policies(b).............................................................._......------ ._182,813,246 ..........._.170,854,414 __._---..___...._....D .............155,563,949 .............142.316.767 24.1 Federal Employees Health Benefits Program premium (b)t-_- __- --__-___.........D ................__........._.D _._...._...------__-------.0 ................................0 ................................ 24.2 Credit (Group and Individual) ............................ ....-- - ------------------ .---------- ........... D ....._....................... .................................D ......-----...._..- 24.3Collectively Renewable Policies (b)..........._...-------­--- __-____ ............ ................................D .................................0 ..................__...__-.D -----___-_--____-___0 24AMedicare Title XVIII exempt from state taxes or fees ----------- ................................D ................................D ............... ______________0 Other Individual Policies: 25.1 Non-cancelable(b)t................................ ............................ ............ D ------------ -----_......0 ----------------------------0 ................................D 25.2Guaranteed renewable(b).------------------- -----...--...--------------- --- ........D ............... .----- .................--..0 ..........................D --.....................----....D 25.3 Non-renewable for stated reasons only(b)................................... ----- ...D ............... -........................----..D ...........................-.D .....------................0 25.4 Other accident only ........................................ .._-.__.-_..-_-_-..__.... ................................ D ..........................-.._-D _--_____-__-----_...D ..........................0 .................................D 25.5 All other(b)...................................... .............. .._..__-.__________ -------------------------------- --------------------------------D .._.__._.._....__.......D .............._.........._._.D .......__........._..-_-__0 25.6 Totals (Sum of Lines 25.1 to 25.5)....................... ............._..- -----...------............D ................................0 ...........................--.0 ..........--_...."'-- _D _---___-____-_ -__0 26. Totals(Lines 24+24.1+24.2+24.3+24.4+25.6 182,813,246 1 170.854,414 0 155,563,949 142,316,767 tot ror neafn ousiness on molcafe. Imes report: Numoer of persons Insure. under r- managea care proaucis _-----------------L and numoer of persons insured under Indemnity only products 0 24.GT Ll 11 T C W Q E O U d V C 7 C LU N w 7 J U m W N 2 LL Z W LU O LL N a J W LL w W O 2 F Q' m O LL z X w LLI N (0 — D m > O (0 v a E O j d � � o 00 0 0 90 O O O R R R R R R R R O R z' a v �RQ Rt?R o,,aco o RcaRR�coo�ao �t�c�o 000 o oaR, q o o w m 0 0 E m ¢ � tOORRRR :R� RRRR ^,R RORo-- 000 0 0 000 0 a N O X a E z' _ Q D y Q a_ o `m z R R R R R R ;R R R R R R R R 9.9.9. o 9.9. 999 R o R R R R O O E o 0 o 5 c m O T y o C 0 T O rn •� U N W C = O W V Cl 4��i, mcc c o`mD m ~ c !c u c a �c9Dy�mc"o"ouo cc� a ;Nym��d? O E N iZ icy iZo�y� yy ` a > O W,� N o 2`dy°1dNd J N N y> G iE W_o N — E y> E o>Z o Nci�na W�a'moonE o_o S rnmoc y F iEa�� '', E > B c 41KK=N ¢¢HOa 2a W V1JUO d' ¢ H K J O ! m F rn F •-N th 46166 O W N Ili RN(OA�6A O W N th c 66 W m m m m a 0 0000 O o N thm rn E rn rn rn rn rn �p 25 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • 11 0 EXHIBIT OF LIFE INSURANCE (Continued) annJTIGNAI INF:nRMATInN ON INAURANrF IN FORCE ENO OF YEAR Industrial ary 1 2 3 4 Amount of Insurance Amount of Insurance Number of Policies a Number of Policies a 24. Additions by dividends. ...._...----- _XXX ........ ..... ------..._._________0 _............... XXX_......._._.. -- 0 25. Other paid -up insurance ................._ ......................... _.._._............_..._......D ........................._....._D ..................._.............0 ....................._......_....0 26. Debit ordinary insurance XXX XXX 0 0 INFORMATION ON GRnINARV INSIIRANCF Issued During Year In Force End of Year Included in Line 2 Included in Line 21 1 2 3 4 Amount of' Amount of Insurance Term Insurance ExcludingExtended Term Insurance Number of Policies a Number of Policies a 27. Term policies - decreasing .------_...................D ..................................D ..-----............. ............. D .............................. 28. Termpolicies- other. ................._D D 29. Other term insurance -decreasing-------------- .......................... ......_-.._XXX-_............ ..... ..........--._.._.._.._D _--........-...XXX ............... ................................... D 30. Other term insurance ......... XXX......... ._____0 - - .........XXX ..._ .. 0 _------------._....--D --------------------------------D ---------------------......A ................................... 31. Totals (Lines 27 to 30).......................................................................................... Reconciliation to Lines 2 and 21: 32. Term additions ........... ._----------------------.._................. .-------- -------- -------- __---- XXX. _._...................---- - _........0 ................. XXX ............... .......... ---------------------D 33. Totals, extended tens insurance. ----------------- XXX........_..... .------- ........... XXX...______ ______...__........._..D .._..___.. _ ________0 34. Totals, whole life and endowment 0 0 35 856 0 1 0 35 856 35. Total Lines 31 to 34 CLASSIFICATION OF AMOUNT OF INSURANCE (al BY PARTICIPATING STATUS Issued During Year In Force End of Year Included in Line 2 Included in Line 21 1 2 3 4 Non -Participating Participating Non -Par alin Participating 36. Industrial. -----------------------------------D ...........................___D _-_.-__..__.._........ _.0 ._._____________0 37. Ordinary., ....D ......... 856 ......___________ 0 38. Credit Life (Group and Individual).............._.._..................................__............. ------------------------ ..................................D ---------- ........................ D ................................_0 39. Group ........................... .................. - ._................. .....- - 156.080 0 5,075.661 0 156,080 0 5,076.517 0 40. Totals Lines 36 to 39 AnnmiriNAI INFORMATION AN r:RFn1T I IFF ANn GROUP INSURANCE Credit Life Grou 1 2 3 4 Number of Individual Policies and Group Amount of Insurance Amount of Insurance Cenifcates a Number of Certificates a 41. Amount of insurance included in Line 2 ceded to other companies .... __.......XXX--------------- ................................... D........... .._...XXX............... ...................... ............ D 42. Number in force end of year if the number under shared groups is counted ona pro -rats basis---.................----------........................_......_.---------- --------------._........0 ..._ ------XXX--------- ..................................0 ---------XXX-------- 43. Federal Employees' Group Life Insurance included in Line 21 ....................... ..................................D ......----------------------------D ..._____ ..---_................ D ..................... 44. Servicemen's Group Life Insurance included in Line 21 ---------------------------------- ............................ ___ D .........._..........._......_.D .......................__......_0 45. Group Permanent Insurance included in Line 21 10 0 0 1 0 ADDITIONAL ACCIDENTAL DEATH BENEFITS 46. Amount of additional accidental death benefits in force end of year under ordinary policies a 0 BASIS OF CALCULATION OF ORDINARY TERM INSURANCE 47. State basis of calculation of (47.1) decreasing term insurance contained in Family Income, Mortgage Protection, etc., policies and riders and of (47.2) term insurance on wife and children under Family, Parent and Children, etc., policies and riders included above. 47.1_................................... _..._._...._._._.......------------ ............................................... ... 47.2 POLICIES WITH DISABILITY PROVISIONS Industrial Ordinary Credit Group 1 2 3 4 5 6 8 Number of Amount of Insurance Number of Amount of Insurance Number of Amount of Insurance of Amount of Insurance DisabilityProvision Policies a Policies a Policies a s a 48. Waiver of Premium -------------- -------_.....D D ..............A A ..............0 ..................................D8 t .......................1,730 49. Disability Income .......... . ............D .......................---..0 ... D ...........................0 ...--- -A - ---------- .09 _......_... - __6,317 50. Extended Benefits ..................._..__-_D ............... .._....._--------a .._...XXX_... _.._........_.XXX._.....------- ..............D ..................................0 ..................................0 51. Other....._.........._ .................... 0 0 0 0 0 00 0 O I°I 0 0 °I 0 0 m 07 N 8,047 52. Total (a) Amounts of life insurance in this exhibit shall be shown in thousands (omit 000) (b) See Paragraph 9 of the Annual Audited Financial Reports in the General section of the annual statement instructions. 26 • • • ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company EXHIBIT OF NUMBER OF POLICIES, CONTRACTS, CERTIFICATES, INCOME PAYABLE AND ACCOUNT VALUES IN FORCE FOR SUPPLEMENTARY CONTRACTS, ANNUITIES, ACCIDENT & HEALTH AND OTHER POLICIES ni. Ordinary Grou 1 2 3 4 Involving Life Not Involving Life Involving Life Not Involving Life Contingencies Contingencies Contin encies Contingencies L In force end of prior year. ............-------------0 ----------------------- 0 -- _ _........_._......_...0 ----------------------------------D 2. Issuedduringyear.----------._._.--------------------....._..__.....------------...----------....._....------D -- .................-------0 --------------------------------0 ..................------_-0 3. Reinsurance assumed. ____________.._._D 0-------------------- .............. D ............_________0 4. Increased during year (net)-.----.....--...................._......------..._....._._---_ 0 0 0 0 0 0 0 0 5. Totals (Lines 1 to 4)------------------------------- _...---......----.._..----------._..-------_---- Deductions during year: 6. Decreased (net).............................................................................................. .................. ----------------0 .................... 0 ........................0 ............................_..A 7. Reinsurance ceded 0 0 0 1 0 0 0 0 0 8. Totals (Lines 6 and 7) D ._......................____0 ____.._._....--- ..........D D 9. In force end of year 10. Amount on deposit ................._....__. ________..._...._....._......__ _ -�-____... ___......_..................0 I°I ...............................0 ........................_...._..D t°I -.-- _--____._..._-0 11. Income now payable.. ..................................D............................. _ D ____-__--....___.---D ........................D : 12. Amount of income a able °I 0 I°I 0 t°I 0 0 ANNUITIES Ordii ary Grou 1 2 3 4 Immediate Deferred Contracts Certificates 1. In force end of prior year. _._.............................D ......------------------------- .D __--- ------- ........... ......_.--.............._....D 2. Issued during year. ..._. .......... ......----__-_ -0 3. Reinsurance assumed .......................... .__.__._.._....---------- .......... .....----.___ .......... ...._------------ ......D---------------------- __--__0 ...................................0 ..........................._.__0 4. Increased during year (net) 0 0 0 0 0 0 0 0 5. Totals (Lines 1 to 4).. Deductions during year: 6. Decreased(net) ..-.................. 0 ------------------- 0 --._.......................D ..................................0 7. Reinsurance ceded 0 1 0 0 0 0 0 0 0 8. Totals (Lines 6 and 7) .....-----------------------------0 ----------------------------- ................0 .............................._._0 9. In force end of year ------ Income now payable: 10. Amount of income payable ..................... .... ........................................._____-__ °l 0 zzz zzz t°I 0 Deferred fully paid: 11. Account balance ...... zzx °t 0 zzz I°I 0 Deferred not fully paid: 12. Account balance zzz W 0 zzz I°I 0 AND HEALTH INSURANCE Group Credit Other 1 2 3 4 5 6 Certificates Premiums in Force Policies Premiums in Force Policies Premiums in Force 1. In force end of prior year .1,050 ....._...._.208, 587.609 .----------------------------D --------------------.......D - .....---------- _...0 .. --- - - --0 2. Issuedduringyear...... - - -..D ......... ............. ---D 0 ------------------- ------------- 0 ----------------------------------D ..................- D 3. Reinsurance assumed ....._.._...._...--------0 -------.-..._.................0 ---------------..............D ..................................D ._...._..-----------_0 4. Increased during year (net) 692 zzz 0 zzz 0 XXX 1,742 zzz 0 zzz 0 zzz 5. Totals (Lines 1 to 4) ............. Deductions during year: 6. Conversions. ..................................D.................. zzz--------------- _..............zzz.-------------- ................. zzX--------- --------.zzz........... _-- ----__.._J(zz------------- 7. Decreased(net)- -----------------0 ................. zzX.............. ----------------------------------- 0 ................. zzz._...__-- ---------------------.....0 _--------zzz............... 8. Reinsurance ceded ............... 0 1 zzz 0 zzz 0 zzz 0 zzz 0 zzz 0 zzz 9. Total (Lines 6 to 8)........._.._- 1,742 I°I 198,629,167 0 Im 0 0 w 0 10. In force end of year UtKVW I rUNUS ANU UIVIUCNU AGl.vmvLAI IVNS 1 2 Dividend Deposit Funds Accumulations Contracts Contracts 1. In force end of prior year .................. -------- ................ 1,294 .......... .........._----._- D 2. Issuedduringyear..._........................................................................................................................................................................... .----------......__.......0 ._------___--------..A 3. Reinsurance assumed........................._..............._....._......._..........................................._.._..................._............................_._...._. ................................0 ----------------------D 4. Increased during year (net) _______ ....................................... 0 0 5. Totals (Lines 1 to4)------------ -----__--- --___---_-_.._......_................---- -_--__-_--___- 1,294 0 Deductions during year: 6. Decreased (net) - --.....................................--...._-- ......................................_............................................................ __--._...............48 .... - D 7. Reinsurance ceded 0 0 8. Totals (Lines 6 and 7) 48 0 9. In force end of year 1,246 0 10. Amount of account balance °I 12,141,735 t°I 0 (a) See Paragraph 9 of the Annual Audited Financial Reports in the General section of the annual statement instructions. 27 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • FORM FOR CALCULATING THE INTEREST MAINTENANCE RESERVE 1. Reserve as of December 31, prior year,.-,-,.. ............... _ __....... ____..._.._3,609,838 2. Current year's realized pre-tax capital gains/(losses) of $ 135, 111 transferred into the Reserve Net of Taxes of $ 47,295 _______......_.87,816 3. Adjustment for current years liability gains/(losses) released from the reserve -------------- ._----- __------- .___.................................................................. ...................0 4. Balance before reduction for amount transferred to Summary of Operations (Line 1 + Line 2 + Line 3) 3,697.654 5. Current year's amortization released to Summary of Operations (Amortization, Line 1, Column 4)........................................................... __._.-........._..504,260 6. Reserve as of December 31, current year Line 4 minus Line 5 3,193, 394 AMORTIZATION 3 2 4 Adjustment for Current Years Current Years Realized Capital Liability Balance Before Reserve as of Gains/(Losses) Gains/(Losses) Reduction for Current Year of Amortization December 31, Transferred into the Released From the Years Amortization Prior Year Reserve Net of Taxes Reserve Cols. 1+2+3 1. 2008---------------------------------------- -_._......-------------_-------....._._-------- .. ........ ........502,919 - - _ 1,341 .............................. 0 .. 504,260 2. 2009.... -- ...... ---....._..._..-------..._------._..........--.._..___.................._......-- ..._....293,200 -_---- _ __3,182 ......--------------------------D ---------...........296,382 3. 2010............ .----------------------------------------------------------------------------------------------------------- .................... ._286.493 - 3,604 ................................... -------------------..290,097 4. 2011----------- ............. ............... ........ ..--...--.._..............................._...__............................270,086 -----------...... 3,566 ................. ........D .......... ............. 273.652 5. 2012.................................... - ------------------------------------------ --------------------246.125 ......................... 3,733 ....................... - D - - ----------249.858 6. 2013------------------------------- --------------___........................... .------------- -----------------217,479 .....----- ..............3,774 ..._.----- ----- ---------D ---------_.._..221,253 7. 2014 .................................. - - - ...... .---------------- 191,218 ............................4,333 ........____ ---------D ----..__........195.551 8. 2015.................................. ...--._...----.._...----.._..........----.......-----------.._..----......-----------------------171,174 .---.._..._......._..-.5,128 ......................------0 -----........... 176,302 9. 2016............................. - __............................ - - ...._...............151,245 .................6,056 ..........._.....__-- 0 __..157.301 10. 2017..-...........--- ......................136,086 .................._.......7,117 ......_._. ----- _ -0 - ........... .143,203 11. 2018............................... ............---........--.......---..........----------..................-_...._..............._.126.977 -----_.......__......8,124 ............................ .........._......................0 .......................135,101 12. 2019..........................--.. ---------............ 122.854 --7,803 ........................ .......D ............ .._....130.657 13. 2020......................... -- 118,780 6,096 ... D .. _.124,876 14. 2021 ..... ._ _... .............111.944 .... .4,169 ___ _ - -D ....................... 116. 713 15. 2022 ................ ............... ... 102,806 _2.231 ..D...................... .105.037 16. 2023 ----------------------------....................................._......-------------------........ ............_.. __...._......._92,357 ---------------------------125 .........__-_ - _D ............92,482 17. 2024 ......83,137 ....__.__.-........._...(693) .._......._......_....._...._D 82,444 18. 2025............... - .......................72,236 - _.(125) .................................D ..............72,111 19. 2026 ............ --- ........... ..............61,657 _--__-_-__- _504 ..................................D ..............._........62,161 20. 2027..............----...--------___.........---...--------........--------....................-----...-----._...........................51,455 ....... _..__1,152 -------------- --_.D - ........ ............... 52,607 21. 2028.... ............._....... - - 42,731 - .. .................1.862-------------------------- ..._.D .......................44,593 22. 2029........................................._........----------------------------......- .....__..........-- ............. .._...._.....--..35,390 --------------------.2.170 ......__.. ....._- -D .__........ -.._37.560 23. 2030........._...._......................_.._...--............................_....--.................. 29.015 _-_--- _..2,113 ----------------- _ __ ._.D ............ ..........31.128 24. 2031--------------------- -- - .................... .. - ..-- .........._..24,675 _-_-_--_... -2,001 ..................................0 .........................26,676 25. 2032..................... --.-------------------------------------------- ----------- ... .._.................. 22,250 _....._..__1.931 .................................. 0 ..... .................24.181 26. 2033 .................................................................................... ------------- ...... ................... 18,125 ... - 1,848 ..................................D.......................... 19,973 27. 2034 ........12, 790 .. 1,632 ...................................0.......................... 14,422 28. 2035....................... ----- - - -.._- .............-- ....... .............._............. _ ........................ ............... ............ 1,294 10,069 29. 2036......... .........-- - , - --- -----.................._........_.._-------..._--------- -----------------------._4.682 ............................... ------------------ 0 .__._...--........._-.5,639 30. 2037 ....._-------------- - - - 1,177 - . ..............591 ------------------ -- -D 1,768 31. 2038 and Later 0 197 0 197 32. Total Lines 1 to 31 3,609.838 87.816 0 3.697,654 a 0 0 � E J� k f W a � W m U) W / � o z co O § � § w > \ � F z ui Q ® a °Cwt 19 ~\� `)\ \`\\ ` ( : : \ B ! ! - ° 2 . } E E ) - i | ! iz ! ) ) \ \ \ ] \ ) ! t ) ) ) { ƒ 29 • • • Cl) Z `O r Q J c.i J Q V W � N LWi. U) W W LV Z CO) C W WQ-/ 0 O Z a. 0 < 2 W O i J U J aW� m LL W O W / Cl) ` / I Q ,W, V^ / W w Z 0_ r M� r Z U V Cl) W q m.-rn o00o qv o, o,o o.ov O O C o N O u Q m E E w O _ o0 LL o g q q q 0 g o O q q q 0 0 - �a m ggqo8o q q N a LL qqq ^�$�^tRaO o0o 00000,0� p'O >o� Q U �U mvU r m L ° �� >t �tX x>t �.txx xxxxx'tx x.xc x>tx �txx H D ° ¢W d N Tj xxxxa'�cx a'Ic axc �1x x�l aG%X X�G �GXXXX xxaxcxxxx" XX,X XXXxK — W XXXXXXXx K a o g q q q q q 0 g M q q O o o A o m °Z N d � y cj� a G d Y o z o p o m i Q m N m m 1 W ~ O f7 N LL E Y OZ wd ', titw0 :N x o75 m ¢ o c := E ..1 r 0 r'w N_ TON D mT T"NO~9a mL _.momC O dmdmd � 10D y O mC, mZ OOmdmd �t az o.md �3 Z�mE �p mod°nmdEO ZN 0 �°ti v m m y 3 3 `o o wx=i����� 22����GH LUMX2 ,o 0 U m Z "w O E �Nmainmrmm 12 12 o u�mr mrno.-NMvv� jcN N N N N N N ZZ 30 • N Z O r J U J Q V W W N W C � C � VXz \/ 5Q Z wO U)<2 W`W O w / V Z H OUJ W SOLL LU ~ W WCl) U) W N a, Q Z _O N� r Z U N W � o�i`q'Oo o�o- o00 ov �ov o LL o 0 ggo,qo 000 q ggqqqoo ggqqqq gqqqq y _r �o z q q oho- - qq-- q qqq goo qq q s qq ggqqqqq q qqq qqq q gqqqq gqqqq qqq gqqqq q o LL o Q o q ORRRRoo Rqo RRR 9c1R9R RRRRO o. ° x O ul o � U < a m��oggqo m s q - q - q ggqo - Aa K O R�c]o0ogq qqq q qqq � t ° V N m Z U mw y � v E 'txxx'1xx" xxxx�tx xx�txx >e >txxX -? xxxxxxxx xxxxxic xxxXX P a a � i c a g q q q q q g q q q q N 75 Tj a�cxxxxX>xcx X X x x iw 2 W X X X X w u C V �a c R 9.9.9.9.9. RRRR 0 0 R R R R O q g R R R q O g q 0 0 0 ° ca U N : Oi a Z O N W J m m � N N uj c2 may, is ^'y$d :atilt atdL E iw O �Ou �O°O �OyON > r i - w _ OH w`� cQcQw cQ-Q �-Q�QHNmo ° N ? o E a m m 1d 1° C C o o nil y rn rn t 0 o o Z v 2 W O `vN -�mm`vd m d O Z 0¢ °° E a w E E o a° Ewa E E o E 'w w E E m d in i rn rn v o o° 0 0 O m cr K U U O m LL K K U U a LL� M U U o o m W 2 2 2 J J H H s so U - Q c N n v n o Z _ d O UI E mrmO�O�NM C ��rmAO NQ e�OQ Q, Woo Z N M N N N N N M fh M t7 M t7 t7 M V O V O--o. N N J � 31 • • Cl) Z O r Q J J Q U W c Z E (n Z " w ad C C L G O ' W N S V C > r_ w wU) m w�cn W Q Q Z z a LL a0o O Q W CD CD LU LLJ J V Z Q o w0=L LLLLI r w U)>O w Q o W Z a N Q w} j � H z 00 a w LL r Z U N W O) w x K ° .' 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O y y ! d N E v m Q m E t O 'c OO rn m 0 N o C _ m > m a a s o J> o o v m o m o a a J m O o a s 'Q ., w -- � •• m o m E —c E E E E E E E ° U¢ E °1 N w - p ?: _" o o o c c `4c m° v `m E E: E. m i 0 4 m O = `m c m m d d O EC K y n p>> O Z 3 m m a m m d m aai aai aai aai aai c m r E m o '9 > mLU c c y x K x x x x x c o o o o> LL Q Q LL LL LL LL LL li LL» i K Q Q H Q 2 LL H = W S= J J C F O U `m Q C •- N th P N t0 Z _ O p N C E . N. V .. r m. 0 �� [�f �� (° ` O � � N N N N N N N N N N lh J Z 32 • • • N Z `O r a J J LLJ U Z W W aLLIa G c = U V V r va^ W > a uJZp a LLI W W W U) �W OUz COuj W J o _ W1-- O �-Wc LLJ W Cl)W Q Z :D 00 �W NW r Z U N W 0 o O R R R o R o 0 0 o O R o 0 o R o 0 o R o 0 w N N Q G U w o 0 oo��c S s 0 sosm s 0 .ei 000- 0 r�ID ID X� `o 0 00 o RR ooR oci cao w > F r -x ?Q m o Q o R R R R R o 0 0 0 o R o O o 0 0 o R R R R o R o w o O m w I > Mm00000 <oo�R N��,� oho oR N S000��S gggo ossgo �gsg� w r O LL o _ D O g o_ o_ -- R - - - - — Z Ex Q R o o R o 0 o R R O R R R R O R R R R O Q o 0 0 � m o m aU f Z O o 0 0 oAAAo aQQ� Q0000 o LL o o c. LL, m m ' o 0 o R R R o o q o R R R o R O O R R R O R R o 0 y w� m U U a0 LL� x x x x x x x x Qw` � m X N waE m cr X x X axc X x �cxxxxxxx X ix ',, ' D 7 V J > Q C � O m� 0 m 0 N iz cc L UJ yQW c rn = N U Y o U m m 9! H o i E c O v 0 j m y Z 'o J N fn W W j A C9 m C O i� o �rt ymj oa'o 8 W m W W O Q� Q U 'may; o ;,boo t mo � Z = L Z Of T O) rn m m m Oi 01 m m rn rn N & & C D° p m r N w `l N oo m o y.• l0 T N rN O LL y rn 2 2 m m m m .F 'u m N m m A '` 'b ° rn- m m m '` '` W Z d 0 Z o 3 Z m m E E o o ;� E E o ;�-° L °' E E3 o p� L L m c o o E E " o O a a E o 0 oo a o 0 `000 J J S 2 Q H m` LL 0 o (2 K 00 LL W K U U m LL K d' U U H O U c N m a N m Z 'w m �E 2 M mr� n �n M,ri ,n v v v a a v a a as NNNNN N 33 Yes No Description of Item X Proposal for Transplant Coverage Included in Section 5 of this proposal X Signed Business Associate Agreement Included in Section 3 of this proposal X Signed Proposal Compliance Letter Included in Section 2 of this proposal X Signed Plan Design Confirmation Included in Section 5 of this proposal X Completed and Signed Questionnaires) Included in Section 6 of this proposal X Transplant Network Access Analysis (if applicable) LifeTrac Network Map and Program Reference Grid is included in Section 9 of this proposal. X Proposed Implementation Timeline for the City. As the incumbent, there would be no need for any reenrollment or implementation of the program that employees already have. X Audited Financial Statements and/or Department of Insurance filings for the past two years (Only if requested by the City) Included in Section 9 of this proposal. X Provider "Report Cards" used to provide feedback on clinical and non -clinical performance measures Currently, there are 86 facilities listed in the LifeTrac Network representing over 700 transplant programs. There are 70 facilities that offer one or more Select programs. When a transplant center is identified as a candidate for inclusion in the LifeTrac Network, the contracting staff works to secure a contract. Once contracting negotiations are underway, the LifeTrac Data Coordinator requests RFI data from the transplant center. LifeTrac uses the standard United Network for Organ Sharing (UNOS) RFI for solid organ programs and the standard American Society for Blood and Marrow Transplantation (ASBMT) RFI for bone marrow/stem cell programs. The Data Coordinator compiles the data and submits it to the LifeTrac Sr. Quality Management Consultant for review. The Sr. Quality Management Consultant performs a review that includes, but is not limited to: _7�_SEGAL 4 • • g O q q 0 q q o q q q o o q 0 0 m w c x Ko E'N y� Qb w U K D o-- -aq 1,7 m LL q q q q o g o 0 o q q q o o q q o r W c x w ¢o m U O I w > o0 W - So N o 0 w n E LL q q q q o q q o o q q q o q o 0 N Z c x Z m QU WOf ZZ oq O O" U o 0 0 0 0 0 0 0 0 0 0 aN o aA o Ao � co LL O V Q c + -0 N = N N � U V/ co q q o q q q o q o � 41 aE xx H I '¢w q q o g o a o —y K m x �exxx Xx N tLE xxxx xx m � v w q q q q o o q q o o q q q o o q o 0 W � Q O O Co LL LL N N U U N o N N N Z C w ! N yQQ m Qy v > w E _ y U J= m= c H to p L f N 2 O Y a o V D U HLu 0 YQ- J~ N J H p cc ci W Z o. u W W75 c ❑ f-_ �; m 2 V a W m O> u'�¢ 0- 7 E5 K F- I- y a m y= C_ y i o co; U �J ,N= ~ �mQp cF d2 y�°Z1°LL=E N=E _=a EZ 2 g 5 m N f o 3 mt E f LLa v0;LL IL `w JNO mJW N p L L N o E O t 3 :D ~ =-a F 0' 'US) OEO>o- Fm 0 U c Q U f0 r 0 N R . r. m O . N M -E NN m io co co co so N ion nr r f JZ H 9 E t `o E i a m n m � u w c o w 0 O C m v c i e `o 'm m QZ0 D o L i w w E -- d E 34 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • • Asset Valuation Reserve RSA NONE Schedule F - Claims NONE 35,36 • • E xogogoq X X d a Q g q q q g q q R q R q q q q q q q d � � E O ¢ i o y0� o 0 0 0. R o x x ca a' d z N Q O v d 0 0 0, o 0 N a m - R R R R o 0 'o o\ x x i o ¢4 N O IL rn w CL z E Q O 0 z q q q q q 3 q q ;�= s x w x °z LL R R R q R R R R R R q q q o q q q q u r U Q a m a 0 amp oggq 000000q qq o qqq R O C7 Q co 1 x m 90 0 0 0 0 aL 2 - 7 r x X qloo X X 0 0 iz,$ q q q g � � O 'o o °' V o - D o 3 a10i m e v: u '� m 3 y `o C O N m 7 o o a 0 N N O� _ ,E .E ? o d3a 2 E v o m c a a EE m- L m m a m a m m� a - a w ._ E- o? NJ a s O O O ~~¢ U' o 0 O cli R (V lh Q N CO O) C� 0 0 o m rn 37 L` • • g000 qo N � a Q Dili' 0 U a � d m wK o � a c d o ZN 4) o g O O q q o q q q q o q O o fD m O � U L iM� N o O O g q O g o O O o O q O m _ W Z g q 0 0 0 ti q q q q t q q 0 y 0I j, E°�jm "�yva2i� O E m E m E? g Z" i 8.2 ? m d` m m N c a s° E E m d m v i2 mc m y y m u.n v o d oZ c d m m y E m-a a y `o 0 o tO o o �NCf R j 6 C6cN t7O L6 (j:NCf 38 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • SCHEDULE H - PART 5 - HEALTH CLAIMS 1 Medical 2 Dental 3 Other 4 Total A. Direct: 1. Incurred Claims .................................. ............................ .......................138,725,811 ............1,081.377 ...........................2,668,630 142,475,818 2. Beginning claim reserves and liabilities ... .........................36.118.381 ..........................489,460....................... ....... .792,730 --.......................37,400,571 3. Ending claim reserves and liabilities -...._.................... ..................____23,119,631 ...................294,060 __.._..-.--......-.....-....898,747 ........... ._..24,312,438 4. Claims paid .................. ._------ ------------- .................... ....151,724,561 ..........................1,276,777 1.562,613 ........................155.563,951 B. Assumed Reinsurance: 5. Incurred Claims.. -- — ................ ........ ----27.784,400 _....... -------------- _-.-.... 88,897 -.... - 27,873,297 6. Beginning claim reserves and liabilities ...................... ........................... 10,366,599.................................. ...... -D ____________...386,289 .........................-10,752,888 7. Ending claim reserves and liabilities....._................................._.--...-.._13.905.327 ____-............. ..._..-.----------- D .........................282,458 .-._-._.__-____14,187,785 8. Claims paid........................ .......... .... .......................... 24,245.672 ..............................D -._-____....--_—__192,728 ..........................24,438,400 C. Ceded Reinsurance: 9. Incurred Claims ................................. ...... .................... ......3,396,711 -...--........... ................. D .............1,983,170 ............................ 5,379,881 10. Beginning claim reserves and liabilities...-__.............. ...........-.--...-..._._4,350,515 ___.---...-..._.._.__...._........0............... ............. 1,204,927 ............................5,555,442 11. Ending claim reserves and liabilities ...................... ___ 4,861,225 ...-..._...---------- .................... D -._..---.-_-----___ -..950,286 ..--.......................5.811.511 12. Claims paid —....................-_...__...-_....__2.886.001 .-...--..--..._.. ......---...D _- 2,237.811 .................... _5.123.812 D. Net: 13. Incurred Claims ..... ................... ._.163,113 , 500 ....._.__........-......1,081,377 ................................ 774, 357 ............ ._..--....164, 969, 234 14. Beginning claim reserves and liabilities...._.__......................_.....-..__42.134,465 ...............489,460 ..................(25,908) --........................42,598,017 15. Ending claim reserves and liabilities _.-.---------------------- ............__.-..-...-32,163,733 ..........................294.060 .__....230,919 ._--..--.-.-______32.688.712 16. Claims paid ..................................................................... .--...................-173.084,232 ----.....................1,276,777 .......................517,530 .........................174.878,539 E. Net Incurred Claims and Containment Expenses: 17. Incurred claims and containment expenses ............... ............... .._.._163,113.500 ............................. -...-.---..-....___..-......774,357 .....-__-..._..--.._164,969,234 18. Beginning reserves and liabilities.-.--.._............................................._..42,134,465 ....................--._489,460 ........................-.-...-(25,910) 42.598,015 19. Ending reserves and liabilities, ...--....-_.-----.._-. ...._...................32,163,733............................-..294.060 ----------------------------_.230,919 .........................32.688.712 20. Paid claims and cost containment expenses 173.084,232 1.276,777 517,528 174,878,537 39 • • • H Q a U) w J G W 2 U U) 40 • 0 • N Z O H U w Q a U) w J W 2 U 41 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • SCHEDULE S - PART 2 R..... —hlw nn P.id —11 I Inn. iel I ..... 1 ief.d by Rwi--i.n r--- of n... mh— n1 r..... of v- 1 2 3 4 5 6 7 NAIC Company Federal ID Code Number Effective Date Name of Company Location Paid Losses Unpaid Losses 61105 _._.._.---- --._41-0451140..... _._..D1I01/2003...... Rol iastar Lie Insurance Company . Minneapolis, MN......._...........-_--------------------- .............. 804,824 -----------1,756,296 82627. .....06-0839705.._ _01I0111994..--.. Swiss Re Life 8 Health America Inc .................... Armonk. NY ................................................... .__..... 419, 511 76,135 0299999 - Life and Annuity - Non -Affiliates 1,024.335 1,832,431 0399999 - Totals - Life and Annuit 1,024,335 1,832,431 38245.....__.............36-6033921...-- __-.-D1/0112001.--. BCS Insurance Can an .._._...____._.-_.....-'.......... Worthin ton.. OIL..-..---.- ------------------------ ----....--- __-_-__-----_D ..........3.583.059 0499999 - Accident and Health Affiliates 0 3.583.059 19453_...................13-5616275 ..... ..... ---D1/01I1997---_. Transatlanlic Reinsurance Company. .................... New York. NY..._._......_......--._.._-.--.--------..._-.------- _..-...._---.-.--..---0 ........... - 153,197 53007.--_............ .....53-0078070..._ ...._ D1/Ot11991-__ Group Hospital Medical Service-.--------..--..----------- Washington, DC_______................-_.- ................. ........_..._...--..._0 ...-.......--13.870 00000.......... ----AA-9995055___ __.-_11101/1981--..-. American Disability Reins U/W............... Portland, ME ...................................... ................_- ...._______504 _-.-..__._48,565 67105._..._.........--A1-0451140.-.-. ---__011101/2003.-_-. Reliastar Life Insurance CompanY__-........-._..... Minneapolis, MN-.._...__--- ----------------------------------- _._.__.-171,981 --...--..--..510,383 97055-- --- .. -----59.2213662.. __- 1/1998.-... Mega Life 8 Health Insurance Company ................. Oklahoma City, OK_._____....._.............-._-_...._-.. -...._--..._..._..._0 ............._25, 021 81531.---------------- -----63-0477090..... _..---01/01/2006.---.. United Trust Insurance Company....-................._-.. Birmingham, AL.-...- ........................................ _. -_--.0 .................. --.._..---..._.5,244 19445._.............. ..... 5-0687550..... 01/01/2008 National Union Fire Ins Cc of Pittsburgh......--.. Harrisburg, PA, __.........__...--.._............... -------- --...---..-_0 -..._-..--.._40,635 00000..__.-_...-......_00-0000000.-... ...---.D110112007__.. Inter Partener Assistance______._.._ ............... Muenchen. Germany......-...... . w ........................... ------ --- -------- 0 --...--...1, 100,000 0599999 - Accident and Health - Non -Affiliates 172,41 1,896.915 0699999 - Totals - Accident and Health 172,485 5,479.974 0799999- Totals -Life, Annuity and Accident and Health 1, 196,820 7,312,405 Lya C� • 0 c m m t � � 3v5 o00 0000 0 D 7 � U IL m O� � C � U u C y v U N n a` aN c m c� y I m U U c c � •c N C E a` S a `m y o o a � w e J x N m O o 0 0 w ~ � m " c m a o 0 a it m m Y 0 a c m � U i N U C C N U LL Y 0 U Eo W = a Q t0 N O 9 w 0 « � NUo J t m a m L N O O LL t5 w - - O 000g�c xc s 16 'c Q u c � C o E U `o _ m m` u m _ _ _ _ C_ °1 m oSm H �'' 0o W��--- ! _ - N � T � U no rn � m � ^N U 43 0 0 / E a § CN , 2 / O_ \ � U q W m m x [ cl o d Q K 0. w W � § § W § (L) cl) 44 Accreditations and memberships (Joint Commission, UNOS, NMDP) Volume =Survival Waiting time Transplant team stability Patient continuum of care process Site visits are also part of the evaluation process, and they are conducted every three to five years. At the site visit, LifeTrac talks to key members of the transplant team, including but not limited to: Medical Directors, Surgical Directors, and Transplant Coordinators. LifeTrac also tours the inpatient and outpatient treatment areas and talks with key staff in these units, such as Nurse Managers and Clinical Educators. For programs currently in the LifeTrac Network, the clinical RFIs and contract financial performance are reviewed on an annual basis. LifeTrac utilizes data reported by the transplant programs in their annual RFIs. This data presents their entire experience and allows for larger samples and improved reliability. We routinely review patient survival, graft survival, wait time, and lengths of stay. The survival data for solid organs is risk adjusted, while the hematopoietic cellular programs report unadjusted survival data. X Copy of your Policy Assuring Member Satisfaction N/A X Samples of all Standard and Optional Reports you are 0 proposing to provide on an account specific basis Reports will be provided on an as needed basis and the format must be outlined. X Copy of your Banking Services Agreement As the Incumbent, The City of Fort Collins already has our Banking Services Agreement on file. X Copy of your Customer Satisfaction Survey N/A X Copy of your Administrative Services Agreement or Insurance Contract that will be in effect January 1, 2010 As the Incumbent, The City of Fort Collins already has a copy of the Insurance Contract for the program on file. Signature of Authorized Representative: • '�SEGAL L 45 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • • SCHEDULE S - PART 5 Five Vwar Fxhihit of r.d.d R—inwee rnnn r]miMeA1 A. OPERATIONS ITEMS 1 2008 2 2007 3 2006 4 2005 5 2004 1. Premiums and annuity considerations for life and accident and health contracts ......................._ --__- -------------------19.112 -------------------------- .........................18.784 ____---------...18,46E ...-_------...........16.978 2. Commissions and reinsurance expense allowances_ ............. ............4.579 .........................._3,369 ______............1.960 ----------- 3. Contract claims ............_..................................... -_-......._..._12,938 ----._............._12,909 -------------------11,967 -.__...._.._.........11,244 _--__..._..._.12,320 4. Surrender benefits and withdrawals for life contracts — --.........---------- — ..................................0 ---------------------------D — -........__ ..0 ----------------------------D .............................. 0 5. Dividends to policyholders __..-............... ....... __--_-__. ... ............................... D .._---------------------------- 0 ............ .0 -_..-............................ 0 - ..........................D 6. Reserve adjustments on reinsurance ceded . ................................... ...................................D ._..._..._.._....__.__....D 7. Increase in aggregate reserve for life and accident andhealth contracts- . ...............................660 ....................... ---758 —_......................... 0 ..................................0 ..................... .0 B. BALANCE SHEET ITEMS 8. Premiums and annuity considerations for life and accident and health contracts deferred and uncollected--------- - — ................. -- ...........................3,679 ........_........._3,326 ---------- .......... 3,893 ............................3,395 _ — ....'-.1,868 9. Aggregate reserves for life and accident and health contracts.--------------- .---------------------------------------------------- _...... ........2.672 __.................................... ........... 1,254 ...............1,072 ....................1,181 10. Liability for deposit -type contracts.- ..................... ............ ........... .----0 --..__.__........._..---_D _--------------------------- --0 ---------------__---D --------------0 11. Contract claims unpaid ...........................7,312 ..----- _............... 7,987 ....._._.................9,248 ___-__-_.._......7,245 .-_------........_.._7,650 12. Amounts recoverable on reinsurance ................... ._.-1,197 -__--_............ --._966 .............................._545 ..............714 ............................2.328 13. Experience rating refunds due or unpaid ....__..._.---- ........................ _0 -..........._......`----._..A ...._................... ...- _ 0 --___........._.__._.D -------_----------------------D 14. Policyholders' dividends (not included in Line 1 0)............................_..........D .......................... _D __........................... D ---------------.__...._....__D .............0 15. Commissions and reinsurance expense allowances unpaid................. -- ........ _....__707 ................461 ----------.........._...........D ............................ ..D _.,._0 16. Unauthorized reinsurance offset .................................. _._.._..................... 257............................. .-790 _-_-------------------- .......D ..._..._._....._._....___ D .............._................._0 C. UNAUTHORIZED REINSURANCE (DEPOSITS BY AND FUNDS WITHHELD FROM) 17. Funds deposited by and withheld from (F) _...___- _....._.._.....................0 ..................................0 ........_..................._- D .................D ..................................0 18. Letters of credit (L)........... ---------------------------------- — ...............1,233 -... ---------------------1,233 _.. -._.....................D........................... __-0 ---- ....................D 19. Trust agreements (T) _._....._._.....1.132 ....--------------------1.101 _-_--_--_-------------- 1,054 ...........................1,014 _------------------------- 1,950 20. Other O 0 0 0 0 0 46 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company 0 • • SCHEDULE S - PART 6 Rnefwfnmanf of Rala nrn Shnnf fn Idonfifv Nwf Crndif Fnr Cndnd Rnin-r . 1 2 3 As Reported Restatement Restated eded net of ceded) Adjustments(gross of ceded ASSETS (Page 2, Col. 3) 1. Cash and invested assets (Line 10)---------- ..._._.................. _.._._._...... ................. ...... ................150,662,976 .........._..-_D ...-.....-...-_150,662,976 2. Reinsurance (Line 14) ------------------------------------ - - - ......_.._.__.._.. - .. ........................... -- ...........1,768,352 -------------._.(1,768.352) -----------------------D 3. Premiums and considerations (Line 13)............................_-...-.__------------- ...-_____._._.-....------.._.--...-.-_ .................25.297,220 .-..--...-3,678,807 ...............--28,976,027 4. Net credit for ceded reinsurance ........................................................................................ .._-..--...----------..----.._-..--_XXX............_..._......._-...7,816,413 -------------._--..7,816,413 5. All other admitted assets (balance) .......... 2.829.518 0 2,829,518 ...--...-----_180,558,066 _..._........__9,726,868 ..--_--.--.._190,284,934 6. Total assets excluding Separate Accounts (Line 24) ........................._.........--------------------------------- - 7. Separate Amount assets (Line 25)......................_..-._----......_.--...-..--_..--....--.--------------------- 0 0 0 180.558.066 9,726,868 190,284,934 8. Total assets Line 26 LIABILITIES, CAPITAL AND SURPLUS (PAGE 3) 9. Contract reserves (Lines I and 2) ............... ------- ----- --- -------------------------------------- --------------------- ............. .-____---_..54,111,381 ..--.___-..-.._2,671,637 56,783,018 10. Liability for deposit -type contracts Line 3- .......... -----------._.----------D ............................... __0 -_--.._..------------------ .-D 11. Claim reserves (Line 4) -----...--------....---------------...----...----------------------------------------- -._ ....--.......34,238,473 ------ ...7,312,406 ...................1,550,879 12. Policyholder dividends/reserves (Lines 5 through 7) ......................... -------------------------- _._D .................0 .............................. ._D 13. Premium & annuity considerations received in advance (Line 8)._.__..--._..____-_.-_.......................... --._-__...-...--.15,375 .........................D -...-...-15,375 14. Other contract liabilities (Line 9) ....................... ____..--.._3,200,238 ............................ __0 .____.-..--..3,200,238 15. Reinsurance in unauthorized companies (Line 24.2).............. ____ __............ ................. ....257,175 ---------------------(257,175) __..-............. 0 16. Funds held under reinsurance treaties with unauthorized reinsurers (Line 24.3) _.............................. .......... _0 .......................D ____ _ .__.._.-...-_..-A 17. All other liabilities (balance) ......................................................................... ......................... _. 9,008,788 0 9.008.788 ____._----700,831,430 ------.------------9,726,868 ....--...-...-_110.558,298 18. Total liabilities excluding Separate Accounts (Line 26)_.._._.-.---------- ............ ...._--_........--..---..--.........--. 19. Separate Account liabilities (Line 27) 0 0 0 ..---_.___.._9.726.868 ...............110,558,298 20. Total liabilities (Line 28) ---..-._.-._------------ .............._.......------......--.._...--.---.......--............-.--_.--.__100,831,430 21. Capital & surplus (Line 38) _____ 79,726,636 XXX 79.726,636 180,558.066 9,726,868 190,284,934 22. Total liabilities, capital &surplus Line39 NET CREDIT FOR CEDED REINSURANCE 23. Contract reserves ............................................................... .......... ..-__.__ ....................2,671.637 24. Claim reserves _ - -------------------7,312.406 25. Policyholder dividends/reserves ................. ._.-______............................................................. .............................. .._0 26. Premium and annuity considerations received in advance ......._ .................. ...._..__D 27. Liability for deposit -type contracts ._.._____ __---._.......................D 28. Other contract liabilities ......_...... . .................._-.--...- D 29. Reinsurance ceded assets ..-----.............................................................. -_................. ..-...-------------- - --- -...1,768,352 30. Other ceded reinsurance recoverables----------------------------------------------------------------------------------- 0 11,752.395 31. Total ceded reinsurance recoverables.._................._---.._.._-.--.._-..--.._...--........... ...........-3,678,807 32. Premiums and considerations.._ ........................___. 33. Reinsurance in unauthorized companies .............._-..--.--. -----.._..........._257,175 0 34. Funds held under reinsurance treaties with unauthorized reinsurers ................ 0 35. Other ceded reinsurance payables/offsets..._______.__........................................................... ...____ 3.935,982 36. Total ceded reinsurance payable/offsets... 7.816,413 37. Total net credit for ceded reinsurance 47 • • • ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company SCHEDULE T-PREMIUMS AND ANNUITY CONSIDERATIONS States, Etc. 1 Active Status Lne l:ontracts 2 Life Insurance Premiums 3 Annuity Considerations 4 Accident and Health Insurance Premiums Including Policy, Membership and Other Fees 1. Alabama_ ................................................... AL ............_L------ ------------------31,131 ................... -1) ......--------------114,437 2. Alaska __._...._......................_................. AK ...... ........ L...... ..................... 2,901 ....._................. ._D ..........3,350 3. Arizona _-_............................ AZ _...- ........ ........ J51,254 ............. ­­_0 __------..._.63,138 4. Arkansas_---------...._ .............. .------AR-------._L.........-----......._12.837 -----..._.---------D ---------------32,093 5. California______ ............................ ...__.CA.._.. ......_L........ ....... ...._.i, 001,960 ...------------------------- D ................._288,530 6. Colorado___- _CO ._L..........._.._.__.. 24,427 ---------------------D .--_.__-_..32,555 7. Connecticut--_-_ CT _- _..._L...... ----- 94.428 ---------------------------0 ._.......... _._..73,897 8. Delaware .............----_...._...._..-----...-------. DE -- -- -_..._L......- -------------...._35.387 ...........------------D ---------------- .49,196 9. District of Columbia ------------------------------------ DC ...... ___.L........._..____....349 ----------------------------D ..__..._... 15,777 10. Florida ..____------_----................ ..-------FL--_-_........L........ ---------------118.989 ........................ _0 ..............._. 185.543 11. Georgia-------................._------.................GA......----._L........................._51,225 ............... __0 ---------------59.037 12. Hawaii ----------------- .-------------------------------------- HI....... ........ L....... .................. - 225 ............... _0 ...........................160 13. Idaho.......................................................... ID....... -------- L........ .................... 4,043 ..................... ...._0 _-____..........8,045 14. Illinois ............ ............ ------------------------------- IL........ _-_L._.... ..... ....__2,699,802 ...........................0 ....................396,236 15. Indiana ._................ ............................... IN ....... ........ L........ .............. ,466,242 _......................... D .....-------273,492 16. Iowa ............ ...--- ------------------- ..................... IA_ ..... ........ L ........ _._......_._.... 7,534 ........... ................ 0 ..__-------19,836 17. Kansas........------- ---------- ......__-------..._KS.-... .----.L........ ....... --......105,648 ...........................0 .............._...206,253 18. Kentucky..._......._ ------------------------------------- KY ._... L ........ .................J21,991 -___ ............ _....0 ___.__...._. 141,683 19. Louisiana.......-.. __._............................... LA ------ -----L....... ................... 15,471 ......................_._0 ---______.._..33.681 20. Maine .................._._... ------ .----..------------- ME._... .__...L....... ......... ___-_ 12,966 ...........................D ....................... 9,791 21. Maryland..._ ...... ----------- ............................. MD..... L ........ --- ___ -_.-__84.660 ...........................D .................... 146.619 22. Massachusetts _-__.......................... _--_-- MA __- .__ L....... ...... ._.__522.603 .----------------------D .................1,326,336 23. Michigan _ MI ___ ___L_..............._1.169,180 ........................... D -------------174.306,591 24. Minnesota ------------------------------------------------- _MN ..... ........ L------- --------------__.16.749 ............................D ._.._.....__....134,943 25. Mississippi ._....... ................................ ...._-MS_...._.._.L ....... ................... 4,813 -------------......_D .___.-__.-......32.384 26. Missouri ....................._...._..____ MO __ ......_L....... ................. 144,291 ------------------0 _______._._A0,891 27. Montana.._ .......................................... MIT - -------- L-------- ----------._.._.98.581 ----------------------------D -------------------10,772 28. Nebraska........................ ......_.__NE_.._-------- L........ ..... ____.__ 28,864 ............................D -----------------------7,891 29. Nevada .......................... ..........................-------NV ___ ......_L....... ..... 4.085 ........................... 0 -----------------------7,661 30. New Hampshire ......................................._.NH _.._ ........ L........ ........ .__..__47,842 ----------------------------D ----------------------68,884 31. New Jersey _........_.__..----------------------------- NJ ...._ ___.L._................._1.066,8% ---------------------------D ---------------------203,544 32. New Mexico......_ ......................... NM_ --- ------- 1..._........-..___.18,866----------- .---------------- 0 -----------------------3,245 33. New York ---------------------------------------------------- NY...... --------L------- ...............__.9,368 ---------------------------0 ................... 198,134 34. North Carolina._ ................................... .NC.__........L........ ..........__.42,449 ---------------------------0 --------------------118,897 35. North Dakota_............................ .._.-__ND_._.._....L. ....... ........ ___ 113,868 ---------------------------0 ........................3,878 36. Ohio ............... OH __ ........L........ ..................125,451 ---------------------------D ..._..__--- -_229.567 37. Oklahoma _______.__............. ___ _._.__ OK ........L........ ................._27,170 ......................_..D ......_._.___68,039 38. Oregon-_ -------------------------------------- --OR--- ........L ........ ....... ._.........17,328 ............................0 ............. 83,316 39. Pennsylvania_ -____PA ___ ___.L........ ......... _4,922,478 ._........................ 0 .............. .2,877,931 40. Rhode Island _._............................ _.. RI ... -..L....... ... ....._____ 27,968 ........................... 0 ............... 41. South Carolina ........................................... SC ...... ........ L------- ----------_._._.38,887 ...........................0 ............. .....__57.072 42. South Dakota ..........................._._------------- SD__ ....._1........._.....____._2.736 ................._....._.0 -----------------------4,375 43. Tennessee ------------- ------------------------------------ TN...... _ ....L........ ..........._._-266,794 ---------------0 ---------------114,513 44. Texas ..........__-____------ .....--------------- ........ TX............_L...... -------------A, 119.551 .....................D ____-__._...382,804 45. Utah ..._..---..__........--............................. UT_ --..._L....... .....................5,729 .........-----------------0 ---------10,237 46. Vermont------------.........................._..VT..-- -......L........ ....... ........... . 1,844 .................. _0 -----_--_.-__3,543 47. Virginia--------------. .......... ._-............. .. VA. ..... ........ L........ .... -.----37,974 ........................--0 ............. 106,926 48. Washington _ ------------------------- WA ___1 ........ ..... _.-----68.567 .............. _0 -.__............53,624 49. West Virginia.__..............--------------_-WV_._....__L........ .___.._-----4.659 ------------------ 0 .....------------9,003 50. Wisconsin ------------------------------------ WI...--- -------- L........ ------- __..31.205 ..---...---............D ..................... 48.307 51. Wyoming...._....___ ................................. WY ..... ..... ..L ....... ................... 35,602 ---------------------------0 ...........................628 52. American Samoa____.._ ............................ AS ------ ........ N------- --------------------------- 0 -----------------------D -------------------------.._..0 53. Guam ....._______-_._............................. GU----- ...... ..N....... __..- ---_____0 ____ ................. _0 ............0 54. Puerto Rim..__ ...............__....................... PR.........__D.. ..... ---------- ...._-___-D .- .................. .__D --______..-__.__....0 55. US Virgin Islands......................._......._.VI __ ___..N_......._........._______ 0 _.__.............. ._..D ________..._.._..0 56. Northern Mariana Islands,,-... ------------ MP__...._._.N. ....... ......................... A .....................D ............................_0 57. Canada ---------------------- CN ___ ___N........ ....... _........____0 .._---------------- -_...D ..____-____.._._0 58. Aggregate Other Alien ............................. . OT ........._.XXk.._.. ......-_..0 ...........................D ..................0 59. Subtotal ------------ a).........51 .....--.-17,085.808 ...........-...D __--___-182.813,246 90. Reporting entity contributions for employee benefitsplans._ ...................................................... _....XXk------ ................... ......_D ............................0-------- ------- -209,129 5 6 7 Total Other Columns Deposit -Type :iderations 2 Throu h 5 Contracts ___0 __- ......... 145,568 __0 ----------------0 .-............... 6, 251 ............ ._----..... 0 ................ ----------------214,392 ...........----------- 0 .....------0 -----.....44,930 .------------_..0 0 .._........ 1290,490 .8,691 .......... ...0----------------56,982 ---------- .........................0 ------------0 .............. 168,325 ....--..................0 ..._------_0 ---...84,583 .----------� __0 .._........._.0 ................ 16.106 ......................... .............._0 ............._304.532 ........................ 0 ...........- 0 ---------------110.262 ---------- 0 .............._0 .____ ------------ 385 ......._..______ 0 ................0 ..................12.088 ........................0 ..._.____0 -_._...3,096,038 ---____755,518 -0 ...........2,739,734 ----.---._........0 ................0 .................27,370 .........................0 _......--_0 -.__..... 311.901 ..____.____._..0 ................0 263,674 ......................... -------- 0---.............49,152 --------------------------0 ...------ 0 ----.........22.757 -------------- -0 ---------0 ----_....231,279 __-____------0 .._..____0 -__-___1,848. 939 -_-___35,136 ...........__0 ..__.. 175,475, 771 ..............207, 514 0 -___...... 151,692 ....________.0 ................0 ................107 197 .__.._.._...0 ................185 182 ..-- ------ .........79 0 -__--...._109,353 .-__-__--(4,226) _.....___-0 _._.---------.36,755 ---------- ._...........-..1.683 ............_.0 ---------- 11,746 .........---- -_.---- 0 ._..------ 0 -------....116,726 ........... ---- 0 ------------- _ 0 ........__1,270,400 ..................9.344 ........... __0 ................22. 111 ---------- 0 -_-_----_0 _____._207,502 ---------_---_0 0 _...------..161.346 .....-......--------0 -----------.._0 ..........._. 117,746 --------------- _3,079 _-_--_-- 0 _-_.._,.....355.018 __0 ---------0 --......_.....95,209 --------_-_..0 ...------_ 0 __.._........100.644 __ 0 ...........__..0 ......._..7.800.409 ------------_----1,326 ..----------0 ---------------123.929 ------------------4,029 .---------- __ 0 ..._ ........... 95,959 -------------------------0 ................0 ------------------7,111 .........................0 ................0 ................381,307 -----------------------133 ......._..._..0 ............ 1, 502, 355 ..___-_-_ 45.155 ----------0 ___....15.966 ._-----------_0 ---------0 .............5,387 ------------ _0 ................0 ................ 144,900 .........................0 ................0 ................122,191 .....-------(443) ................0 ..................13,662 .._._- -----....0 ................ ................19,512 ------------ - _.._.....__0 ____ _....._36, 230 ............. 104 199, 899, 054 ._.1,071,122 _.._209,129 .............__....... 0 91. Dividends or refunds applied to purchase paid -up additions and annuities .................................--- .............XXX...... ------------------------- _0 ---------------------------0 ..............................0 ......................... ......................._0 ........................ 0 92, Dividends or refunds applied to shorten endowmentor premium paying period ------------------- ..... .XXX ...... -------------------- ------D ...............D ._..._....__..............0 ._._------..........._0 ................0 .........................0 93. Premium or annuity considerations waived under disability or other contract provisions----------------- _-XXX...... ._._............._..._.D ...................._.....D .._.._........3,020,882 ......................_0 ...........3.020,882 .........................0 94. Aggregate of other amounts not allocable by State .__.XXk...... ........................... 0 -------------------------D ..............................0 .........................0 .........................0 ---------- _.__......0 95. Totals (Direct Business) ----------------------------------------- --- ..XXX------- ------------ 17,085,808 ------------------------D ..............186,043,257 ........._....._._._.0 ........203,129,065 _ 1.071,122 96. Plus Reinsurance Assumed ................. ...... --- ------ Xk...... ................ 507,650 ......................D ......_...._27,856,861 ......................... ---------28,364, 511 -------------------------0 97. Totals (All Business) -------------------------------- --...XXk .................. 17,593,458 ............................D -------------213,900,118----------------- _.__-.0 ..._...231,493,576 1.071,122 98. Less Reinsurance Ceded..................._........................XXk...................9,285,494 .._......_............... 0 ----------------9.473,728 .........................0 ...........18,759.222 - _0 99. Totals All Business ded less Reinsurance Ce XXX 8,307,964 0 b 204.426,390 0 212,734,354 1,071.122 DETAILS OF WRITE-INS 5801..............D ..................._----D ---_......................0 ........_..------_0 _------..........._0 5802. - - .....XXX........._....._.........._....D ...................._.._.0 ._ ..................0 5803. ....XXX.................................0 ............................D 0 ......................... .........................0 --------------0 5898. Summary of remaining write-ins for Line 58 from overflowpage ....--------------------------------------------------- --- _XXk ...... ................. .......... 0 ...........................D ...............................D ..........................0 ..........................0 .__________0 5899, Totals (Lines 5801 through 5803 plus 5898)(Line 58 above) %XX 0 0 0 0 0 0 9401............ .......-----_._.................---......-------- ---...XXk.---- ................_---....0 -----------------------D _0 - ----._.............._0---------------------- ... 0 9402- - .....XXk.................................D ......._._...............D ..............................0 .....__......_.__.. 0 ..........._............0 9403. ....XXk...... -----------------------0 ------------------0 0 ._......--------0 ---- -------- ......_0 -----------------.....0 9498. Summary of remaining write-ins for Line 94 from overflow, page -__............................................. ...... Xk......0 --....................... ----------------_..0 ....................._._0 ........---.............0 ----------------------0 9499. Totals (Lines 9401 through 9403 plus 9498)(Line 94 above) Frnlanafln. %XX of haala of 0 MI-0- h. efa 0 Mr• M nromh- 0 ­4 annnlh• .nnc 1Aaenrinn. 0 0 0 Individual and group business are allocated by state of residence of the policyholder or certificate holder. (a) Insert the number of L responses except for Canada and Other Alien. (b) Column 4 should balance with Exhibit 1, Lines 6.4, 10.4, and 16.4. Cols. 8, 9 and 10, or with Schedule H, Part 1, Line 1, indicate which: Exhibit 1, Lines 6.4, 10.4 and 16.4, Cols. 8, 9 and 10. 48 0 • 0 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company SCHEDULE T - PART 2 INTERSTATE COMPACT - EXHIBIT OF PREMIUMS WRITTEN Allocated by States and Territories Direct Business Only 1 2 3 4 5 6 Disability Life Income Long -Term Care (Group and Annulties(Group (Group and (Group and Deposit -Type Stales, Etc. Individual and Individual Individual Individual Contracts Totals 1. Alabama ...._..._....._............_...............................AL................._........31,131 _......_..._............._0 ._....__..................0 ..............................0.............. ................ 0 ._31, 131 2. Alaska.............._..._...._........_............._..............AK......................_....2, 901 ................ -0 ..........................._0 ......_.._.._..............0 .............................0....................... 2 901 3.Arizona..............................__.._...........................AZ......................... 151,254.......................... .A ............ _0 .....___._._...._..._0 ......................._...0 ............._... 151,254 4.Arkansas........................................................... .AR......--------------------- 12. 837 ........................____O ............ .............0 .._..._......_..._....._0 --------------------- 12,837 5. California .----------- ---.._.................................. CA ------......1.001.960 ---------------- __A ---------------------------- 0 .------.--.....----.......0 --------_._....8,691 _--------1,010,651 6.Colorado..................__.__._.......----------------------- CO ------ ........... ........ 24,427 .................. ._._._A .._.._..._................ 0 ..............................0 .............................0 .........____...24,427 7. Connecticut ........................................................... T................._.---_94,428 . ...................... 0 ..............................0 ........._--.......------.0 ..-------..._........0 ..----------94,428 8.Delaware..__........_....___.................................. DE.._......_...._........35,387 ............................D .._......_..............._O __-_--_--- ......._..0 ............ 0 ....................35,387 9. District of Columbia ............ ................................... DC ...... ......................... 329 ..................... 0 -------........_......_0 ..................... _0 .............................0 .......... --.......... 329 10.Florida--------------------- .___------ .............. ___ _____FL _... ...................118,989 ..._................._..._0 _____................__0 ........... ............................. ...................118,989 11. Georg ------------------------ .__ GA ___..._ ................. 51,225 ..._.................__..0 ____..`__-............_0 ----------------- ............................. ....................51,225 12.Hawaii ............ ....._.......................... I -------- ........................ . 225 ------------------- __- 0 .................0 ..............................0 .............................0 _._..__.___._.....225 13. Idaho ._.._._....._... ------------ .................... ....ID_ ...... .................... 4.043 .............................0 ......................... __0 . ...........0 .....---------------------- ----------------------4,043 14, Illinois --------------------------- ------------------------------------- IL ........ ............... 2,699,902------------------- ___ -O _-------.._.......... 0 ......................0 .....--.........755,518 ..........--_3,455,320 15. Indian a ............... ...__..........................IN...._..._....._..._2.466.242 ........................ __0 .................-O _--___-_........._0 .............................0 ...............2,466,242 16. Iowa_........................__...__.................._._.IA _--- .. ....... 7, 534 --------------------- --- ... 0 .___..._................. 0 17.Kansas....._......................_.............-------------- ____ HS __.... ................. 105,648 ..................._....._D _..__...._.............._0 ......_..._.............__0 .............................0 .................. 105,648 18.Kentucky ------------------------ .......................... .--KY _.... ................... 121,991 ......................_0 ................0 19. Louisiana.._...................................................____ LA ___ ..................... 15.471 .._............... 0 ._..._...._...............0 ..............................0 .-..--_-_-_____.._0 ............___ 15,471 20.Maine........................... ........................................ ME ...... .................... 12,966 ---------------- .....___.0 __..._._...._...........0 .............................0 ._._----_..._......A 12.966 21.Maryland.................................................... _____ MID _... -------------------- 84,660 ...._............._.._ 0 ................ .............................0 .................1) -----__84.660 22. Massachusetts ......................................... ---MA--- . .............--522.603 ------------------------- __0 ------------ .............0 -------------.35,136 ...-------557,739 23. Michigan --------------------------------------------------- .__ MI _ _ ......._...._... 1.169,180 ....._................._- 0 ------------0 .............................0 ..._..__.__.107, 514 .......1, 376, 694 24.Minnesota..............................................._ MN __. ......_..._...._ 16,749 _._....................... ----------------------------- ............0 ....._...._............__0 .................... 16.749 25. Mississippi --------------- -____...------------------- ----_MS ----- .............. .---24,813 _....._...................0...............---...._0 -------.........._0 ..............................0 ......-----......24,813 26.Missouri__.................................................... MO _. .................. 144,291 ............................ .............................0 __.___.__..._.........._0 ......__..__........_79 ................._144,370 27. Montana ................ _____.............._._.......MT.._...............__...98.581 ............_..._.0 .............................D ......................0 __.______(4.226) ....................94,355 28. Nebraska ----------- ---- -____--.............................. NE ...... .................. ..28.864 .................. ..........0 .............................D ....................... .._0 ..__-__-_-....1,683 ....................30,547 29. Nevada ----------------------------------------------------------------- NV......._........._.._._ 4.085 _...._..................... ......................... ._0 ___ 0 ................._.._...D ......................4,085 30, New Hampshire.....__............._....................._..__NH.__..................._47,842 .................... .._....0 ............................. 0 .............................0 ______________....._ 0 ....................47,842 31.14ew Jersey....._....._..__-____ ......... --------------------- NJ ------- --------------- 1,066,856 -------------------- ..0 ...----------------- .............................0 ____9.344 ............._ 1,076,200 32. New Mexico ----------------------------------------------- .__NM __. _................... 18,866 ...................... ..__0 _-____..............._0 .............................0 ......___._..__..__0 ............_.._.18.866 33. New York _.............................. ...................._....__NY._...._.........._....._9,368 ..............................0 _.__.... ...... ......__0 ......._...._-------------- 0 ........... ............. .._D ... 9,368 34. North Carolina --------------- ..._....................... -,____-NC___ ....................42,449 ...................... 0 -_......................... 0 ............................ 0 _ 0 .._............._42,449 35, North Dakota --------------------- ....................... . ND _.... ........... ._._113,868 .....................0 ................_....._.._0 ...........0 ......................3,079........ ._116,947 36. Ohio -------------------------------------------------------- ..._______ OH _...................__125,451 .......................... ...................... __0 ____.._........-.__0 .............................0 .-----__125,451 37. Oklahoma -_OK __ -------------------- ..................D........................ ...._0 ------._.....0 ............................ JD __27,170 38, Oregon ......................... --- ----------------------------------- OR ...... ..........._._-- 17,328 .................---......0 ..........................._0 ......_........._--......D ............. ............... D ._._.------17,328 39. PennsMania....._._........._..........-------------------------- PA ....... .._._......_4,922,478 _................_.........0 ................. _0 ......._._.................0 ......................1,326 4,923,804 40. Rhode Island . ._............................. RI ....... ................ .._27,968 ___...------------------- 0 ........................ _.A _____....----------- 0 ......................4,029 ..-_--__-31,997 41. South Carolina ....._.._____ .......... .............. SC.._.. .................... 38,887 ------------------------- _D __.____................ 0 ............................. 0 _._______.....0 ....................38,887 42, South Dakota .............................................. SD._... ............._.._.. 2,736 _........................... ..........................._0 ..__-_-_................ 0 ............................0 ....___-___.___2,736 43.Tennessee........................................................... TN...-.. .......... ...._266,794 --------------------------- _0 -------..._._....._0 ..............................0 ._133 ...-._..........266,927 44.Texas TX ............. .. 1, 119,551 ..........._............._.0 ._........._............._0 ..............................0 _..._____ _ 45,155 ...............1.164.706 45, Utah .............................................................. -- UT ---- ....................5.729 ........--------------A ----_ .......... -...0 .....--------...--------0 ------------_...._D ...--------.........5,729 46, Vermont ........................................................ -VT._._. ----------- ._........1.844 ----........._...........0 ....................... ---0 ---------_.........0 ........... ----------------- 0 ___-----1,844 47, Virginia ------------------------------------------------------- ._. VA _._. ------------- ...__37,974 .........................0 ........................... ­0 ...____.................. 0 ----------------- D ..... ..... -_37,974 48,Washington------------------- _..........---------- .._.._____WA_ ... ............ _._._68,567 ............................0 ..............__0 ....___ ------------------- --------(443) ............... 68,124 49. West Virginia ------ ----------------- -------------------------------- WV.............._....._._ 4,659 .........................0 __......._._..........._0 .......__......----------- ...._________..... 0 _............... .._4,659 50, Wisconsin ............................................................. WL...... ....................31,205 --_................... -D ............0 ............................. .-----------._.....0 ....................31,205 51. Wyoming ........................ ....... ...__........................ WY........ .............. ..35.602 ..................... 0 --___.__......._....0 52. American Samoa .................................................. AS ..... ---------------------- _.__0 _._............._......_0 ..........................._0 _--__-_.........._.....0 ......._._........_..__.0 .._.._.........._.......A 53. Guam ............ _-------------- -------------------------------------- GU.........._............._.._....0 ---------------- ............ D ............................_0 ___--___............. 0 ............................D ._.._._-_.__...A 54. Puerto Rico ............................................. ......_...._PR.. ---- ----------------------- .._.0 ._.._..........__......_0 ._................._.__0 _--__........_.......0 .........._._......_.....0 ..............__.........D 55, U.S. Virgin Islands ................................. .......__..._VI ... .........................._.0 .._.._.._................. ........................""O -______.................0 ----------- .................. 0 .................._........D 56, Northern Mariana Islands ............................. ____ _MP..---- _......................._.0 ..__..._......._.._.._.0 _.........................._0 .__-___......._.._....0 .....-...__...._.___..0 ..................._.......0 57. Canada.................................................... ... ......_cN..._. ............_............_D ......._..............._..0 _---......._......_._0 ........................._..0 .................__._.....0 ...........------_.0 58. Aggregate Other Alien ................................ _____OT_. ... .................... ........ 0 ......_.................._A ................0 --------------------------- ..0 ...._..._..............._0............... ._..__.__0 59. Totals 17,085,808 0 0 0 1.071,122 18,156,930 49 • • • a D O z Q 0- 2 O U O _z J O 2 Z' 1 W J W 2 U 0 � a N�N Lei E Q 0 U — c 12 N J � � QD z 0 C J w W 0 U U � t0 � N C V Z iL U a o U Q V—I m E 2 2 y u9 N c0 � c0 r c7 U CU �a th J ` m Nr Q a o 0 0 J Q tl � O � N N �'p C C'J h C1 aO 50 0 Ll 0 a W I F) cl W x U U) C*4 � � Q 0- _ © )\\\\ )' \ , �242 ° E2--- \ E l25� Ei 7 § |) /.S -6 -6 {{\/ 12 Zd /\\L\ QQ)] ` \�9?2 Q 51 0 0 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES The following supplemental reports are required to be filed as part of your statement filing unless specifically waived by the domiciliary state. However, in the event that your domiciliary state waives the fling requirement, your response of WAIVED to the specific interrogatory will be accepted in lieu of fling a "NONE" report and a bar code will be printed below. If the supplement is required of your company but is not being filed for whatever reason enter SEE EXPLANATION and provide an explanation following the interrogatory questions. MARCH FILING Responses 1. Will the Supplemental Compensation Exhibit be fled with the state of domicile by March 1? .....................YES........ 2. Will the confidential Risk -based Capital Report be filed with the NAIC by March 1? .....................YES..................... 3. Will the confidential Risk -based Capital Report be filed with the state of domicile, if required, by March 1? ..................._YES____..__...... 4. Will an actuarial opinion be filed by March 17 ............. _.___ YES _________. APRIL FILING 5. Will Management's Discussion and Analysis be filed by April 1? -------------- _..__ YES _____.___.. 6. Will the Life, Health 8 Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit be filed with the state of domicile and the NAIC by April 1? ............ __.....YES ____-._........ 7. Will the Adjustment Form (if required) be filed with the state of domicile and the NAIC by April 1? .....................YES..................... 8. Will the Supplemental Investment Risks Interrogatories be filed by April 1? JUNE FILING 9. Will an audited financial report be filed by June 1? ................... YES ------ - - YES - - The following supplemental reports are required to be filed as part of your annual statement filing. However, in the event that your company does not transact the type of business for which the special report must be filed, your response of NO to the specific interrogatory will be accepted in lieu of filing a "NONE" report and a bar code will be printed below. If the supplement is required of your company but is not being filed for whatever reason enter SEE EXPLANATION and provide an explanation following the interrogatory questions. MARCH FILING 10. Will Schedule SIS (Stockholder Information Supplement) be fled with the state of domicile by March 1?.._...._....._.....NO_-...._._.._._... 11. Will the Medicare Supplement Insurance Experience Exhibit be filed with the state of domicile and the NAIC by March 1?.....................YES..................... 12. Will the Trusteed Surplus Statement be filed with the state of domicile and the NAIC by March 1?.............._......NO.________... 13. Will the actuarial opinion on participating and non -participating policies as required in Interrogatories 1 and 2 to Exhibit 5 be filed by March 1?......................NO...................... 14. Will the actuarial opinion on non -guaranteed elements as required in interrogatory #3 to Exhibit 5 be filed by March 1? .....................YES..................... 15. Will the actuarial opinion on X-Factors be filed with the state of domicile and electronically with the NAIC by March l?......................NO...................... 16. Will the actuarial opinion on Separate Accounts Funding Guaranteed Minimum Benefit be filed with the state of domicile and electronically with the NAIC by March 1?......................NO...................... 17. Will the actuarial opinion on Synthetic Guaranteed Investment Contracts be filed with the state of domicile and electronically with the NAIC by March 1? 18. Will the Reasonableness of Assumptions Certification required by Actuarial Guideline XXXV be filed with the state of domicile and electronically with the NAIC by March 1?......................NO...................... 19. Will the Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXV be filed with the state of domicile and electronically with the NAIC by March 1?......................NO...................... 20. Will the Reasonableness of Assumptions Certification for Implied Guaranteed Rate Method required by Actuarial Guideline XXXVI be filed with the state of domicile and electronically with the NAIC by March 1?..._.................NO........._....__... 21. Will the Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXVI (Updated Average Market Value) be filed with the state of domicile and electronically with the NAIC by March 1?...................... NO 22. Will the Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXVI (Updated Market Value) be filed with the state of domicile and electronically with the NAIC by March 1? ................._...NO.. 23. Will the C-3 RBC Certifications required under C-3 Phase I be filed with the state of domicile and electronically with the NAIC by March 1?......................NO._-_____-__.. 24. Will the C-3 RBC Certifications required under C-3 Phase II be filed with the state of domicile and electronically with the NAIC by March 1?....._...............NO.__..___..___ 25. Will the Actuarial Certifications Related to Annuity Nonforfeiture Ongoing Compliance for Equity Indexed Annuities be fled with the state of domicile and electronically with the NAIC by March 1?...................... NO-_ 52 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES 26. Will the Workers' Compensation Carve -Out Supplement be filed by March 1?......................NO...................... • 27. Will Supplemental Schedule O be filed with the state of domicile and the NAIC by March 1? .....................YES..................... 28. Will the Medicare Part D Coverage Supplement be filed with the state of domicile and the NAIC by March 1?..................NO.______..... APRIL FILING 29. Will the Long -Term Care Experience Reporting Forms be filed with the state of domicile and the NAIC by April 1? .....................YES..................... 30. Will the Interest -Sensitive Life Insurance Products Report Forms be fled with the state of domicile and the NAIC by April 1?......................NO...................... 31. Will the Credit Insurance Experience Exhibit be filed with the state of domicile and the NAIC by April 1?......................NO...................... 32. Will the Accident and Health Policy Experience Exhibit be filed by April 1? .......__...___YES____._.._._.... EXPLANATIONS: 10.Not Required the company has fewer than 100 stockholders 12.Not Required the company is not United States Branch of a Non -US insures. 13.No Par business written 15. No business written 16.No business written 17.No business written 18.The company does not have equity indexed annuity products (Guideline XXXV) 19.The company does not have equity indexed annuity products (Guideline XXXV) 20.The company does not have any equity indexed universal life products (Guideline XXXVI) • 21.The does have indexed life XXXVI) company not any equity univeral products (Guideline 22.The company does not have any equity indexed universal life products (Guideline XXXVI) 23.No business written 24.No business written 25.No business written 26.The company does not have Workers Compensation carve out business 28.The company does not have any Medicare Part D coverage business 30.The company does not have any Interest Sensitive Life Insurance Products 31.The company does not have any Credit Business BAR CODE: I 10. IIIIII IIIII 8 IIIII 0 IIIII 9 IIIII 8 IIIII 5 IIIII 2 IIIII 0 IIIII 0 IIIII 8 IIIII 4 IIIII 2 IIIII 0 IIIII 0 IIIII 0 IIIII 0 IIIII 0 IIII 0 IIII IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 12. 8 0 9 8 5 2 0 0 8 4 9 0 0 0 0 0 0 IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 13. 8 0 9 8 5 2 0 0 8 3 7 1 0 0 0 0 0 • 1IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 15. 8 0 9 8 5 2 0 0 8 4 4 2 0 0 0 0 0 52.1 ANNUAL STATEMENT FOR THE YEAR 2008 OF THE BCS Life Insurance Company • SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES 16 I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 1111111IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII III ». 8 0 9 8 5 2 0 0 8 4 4 4 5 9 0 0 0 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 IN III 18. 8 0 9 8 5 2 0 0 8 4 4 5 5 9 0 0 0 IIIIII IIIII IIIII IIIII IIIII IIIII IIII111111 IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII Ill fig• 8 0 9 8 5 2 0 0 8 4 4 6 0 0 0 0 0 20 I I I II I I Iilll l l 111 IIIII l l l l l l ll l l ll 111 IIIII l l 111 1 1 1 ll ll l ll ll l ll ll 111 l IIII 1 1 1 ll 1 1 1 ll IIIII l l ll ll ll IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII lull lull IIII IIII 21. 8 0 9 8 5 2 0 0 8 4 4 8 0 0 0 0 0 IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII lull IIIII lull lull IIIII lull lull IIII IIII 22. 8 0 9 8 5 2 0 0 8 4 4 9 0 0 0 0 0 IIIIII lull IIIII IIIII IIIII IIIII IIIII IIIII IIIII lull IIIII lull IIIII IIIII lull lull IIIII IIII IIII 23. 8 0 9 8 5 2 0 0 8 4 5 0 0 0 0 0 0 IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII lull lull lull IIII111111 IIIII IIIII lull IIIII IIII IIII 24. 8 0 9 8 5 2 0 0 8 4 5 1 0 0 0 0 0 IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII lull IIIII IIIII lull lull lull IIIII IIIII IIIII IIII IIII 25. g 0 g g 5 2 0 0 8 4 5 2 0 0 0 0 0 IIIIII IIIII IIIII IIIII IIIII IIIII IIIII lull IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 26. g 0 9 8 5 2 0 0 8 4 9 5 0 0 0 0 0 IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII lull lull IIIII IIII IIII 28. 8 0 9 8 5 2 0 0 8 3 6 5 0 0 0 0 0 30. I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII Iilll IIII IIII IIIIII lull IIIII lull lull IIIII IIIII IIIII lull IIIII IIIII IIIII IIIII IIIII lull lull IIIII IIII IIII 31. 8 0 9 8 5 2 0 0 8 2 3 0 0 0 0 0 0 52.2