American Capitol Assumption Agreement Exhibit IV.A Association Liability Exhibit IV.A is attached hereto and incorporated herein by reference. Calculation of Association Liability at Closing to American Capitol Medicare Supplement Attained Age
American Capitol Assumption Agreement
Exhibit IV.A
Association Liability
Exhibit IV.A is attached hereto and incorporated herein by reference.
Calculation of Association Liability at Closing to American Capitol
Medicare Supplement Attained Age
Percentage
Reserve Funding
State Reserves Adjustments By Block Total
Alabama 0 0 0.0000% 0
Alaska 0 0 0.0000% 0
Arizona 120 26 0.0061% 146
Arkansas 1,978 422 0.1000% 2,400
California 0 0 0.0000% 0
Colorado 0 0 0.0000% 0
Connecticut 0 0 0.0000% 0
Delaware 0 0 0.0000% 0
District of Colombia 0 0 0.0000% 0
Florida 0 0 0.0000% 0
Georgia 0 0 0.0000% 0
Hawaii 0 0 0.0000% 0
Idaho 0 0 0.0000% 0
Illinois 0 0 0.0000% 0
Indiana 0 0 0.0000% 0
Iowa 0 0 0.0000% 0
Kansas 0 0 0.0000% 0
Kentucky 0 0 0.0000% 0
Louisiana 115,928 24,703 5.8594% 140,631
Maine 0 0 0.0000% 0
Maryland 0 0 0.0000% 0
Massachusetts 0 0 0.0000% 0
Michigan 0 0 0.0000% 0
Minnesota 0 0 0.0000% 0
Mississippi 0 0 0.0000% 0
Missouri 1,775 378 0.0987% 2,154
Montana 0 0 0.0000% 0
Nebraska 810 173 0.0410% 983
Nevada 0 0 0.0000% 0
New Hampshire 0 0 0.0000% 0
New Jersey 0 0 0.0000% 0
New Mexico 654 139 0.0330% 793
New York 0 0 0.0000% 0
North Carolina 0 0 0.0000% 0
North Dakota 0 0 0.0000% 0
Ohio 0 0 0.0000% 0
Oklahoma 789,006 168,132 39.8795% 957,138
Oregon 0 0 0.0000% 0
Pennsylvania 0 0 0.0000% 0
Puerto Rico 0 0 0.0000% 0
Rhode Island 0 0 0.0000% 0
South Carolina 0 0 0.0000% 0
South Dakota 0 0 0.0000% 0
Tennessee 0 0 0.0000% 0
Texas 1,068,094 227,604 53.9857% 1,295,698
Utah 0 0 0.0000% 0
Vermont 0 0 0.0000% 0
Virginia 0 0 0.0000% 0
Washington 110 23 0.0025% 133
West Virginia 0 0 0.0000% 0
Wisconsin 0 0 0.0000% 0
Wyoming 0 0 0.0000% 0
---------------------------------------------------
1,089,485 421,700 100.0000% 2,400,075
=====================================================
Medicare Supplement Issue Age
Percentage
Reserve Funding
State Reserves Adjustments By Block Total
Alabama 0 0 0.0000% 0
Alaska 0 0 0.0000% 0
Arizona 1,185 1,502 0.0321% 2,687
Arkansas 678,271 859,352 18.3685% 1,537,623
California 135 171 0.0037% 306
Colorado 788 998 0.0213% 1,785
Connecticut 0 0 0.0000% 0
Delaware 0 0 0.0000% 0
Xxxxxxxx xx Xxxxxxxx 141 178 0.0038% 319
Florida 1,108 1,404 0.0300% 2,513
Georgia 0 0 0.0000% 0
Hawaii 0 0 0.0000% 0
Idaho 0 0 0.0000% 0
Illinois 584 740 0.0158% 1,323
Indiana 584 740 0.0158% 1,323
Iowa 0 0 0.0000% 0
Kansas 1,107 1,402 0.0300% 2,509
Kentucky 0 0 0.0000% 0
Louisiana 1,956,901 2,479,343 52.9955% 4,436,244
Maine 0 0 0.0000% 0
Maryland 194 246 0.0052% 439
Massachusetts 0 0 0.0000% 0
Michigan 715 905 0.0194% 1,620
Minnesota 0 0 0.0000% 0
Mississippi 0 0 0.0000% 0
Missouri 761 964 0.0206% 1,724
Montana 0 0 0.0000% 0
Nebraska 810 173 0.0410% 983
Nevada 57 72 0.0015% 129
New Hampshire 0 0 0.0000% 0
New Jersey 0 0 0.0000% 0
New Mexico 0 0 0.0000% 0
New York 0 0 0.0000% 0
North Carolina 0 0 0.0000% 0
North Dakota 0 0 0.0000% 0
Ohio 0 0 0.0000% 0
Oklahoma 500,276 633,837 13.5481% 1,134,113
Oregon 338 428 0.0092% 767
Pennsylvania 0 0 0.0000% 0
Puerto Rico 0 0 0.0000% 0
Rhode Island 0 0 0.0000% 0
South Carolina 359 455 0.0097% 815
South Dakota 0 0 0.0000% 0
Tennessee 0 0 0.0000% 0
Texas 548,508 694,945 14.8543% 1,243,452
Utah 86 110 0.0023% 196
Vermont 0 0 0.0000% 0
Virginia 388 491 0.0105% 879
Washington 93 117 0.0025% 210
West Virginia 0 0 0.0000% 0
Wisconsin 0 0 0.0000% 0
Wyoming 0 0 0.0000% 0
---------------------------------------------------
3,692,578 4,678,400 100.0000% 8,370,978
====================================================
Hospital Indemnity
Percentage
Reserve Funding
State Reserves Adjustments By Block Total
Alabama 0 0 0.0000% 0
Alaska 0 0 0.0000% 0
Arizona 3,221 (3,006) 1.6031% 216
Arkansas 1,748 (1,631) 0.8699% 000
Xxxxxxxxxx 000 (675) 0.3602% 48
Colorado 407 (379) 0.2024% 27
Connecticut 0 0 0.0000% 0
Xxxxxxxx 0 0 0.0000% 0
Xxxxxxxx xx Xxxxxxxx 286 (267) 0.1425% 19
Florida 1,085 (1,013) 0.5401% 73
Georgia 0 0 0.0000% 0
Hawaii 0 0 0.0000% 0
Idaho 121 (113) 0.0603% 8
Illinois 242 (226) 0.1205% 16
Indiana 999 (932) 0.4971% 67
Iowa 190 (177) 0.0046% 13
Kansas 518 (483) 0.2576% 35
Kentucky 0 0 0.0000% 0
Louisiana 2,320 (2,165) 1.1547% 155
Maine 0 0 0.0000% 0
Maryland 0 0 0.0000% 0
Massachusetts 0 0 0.0000% 0
Michigan 471 (440) 0.2346% 32
Minnesota 0 0 0.0000% 0
Mississippi 0 0 0.0000% 0
Missouri 387 (361) 0.1924% 26
Montana 0 0 0.0000% 0
Nebraska 0 0 0.0000% 0
Nevada 359 (335) 0.1789% 24
New Hampshire 0 0 0.0000% 0
New Jersey 0 0 0.0000% 0
New Mexico 6,141 (5,730) 3.0558% 411
New York 0 0 0.0000% 0
North Carolina 0 0 0.0000% 0
North Dakota 110 (103) 0.0548% 7
Ohio 824 (769) 0.4101% 55
Oklahoma 3,078 (2,871) 1.5315% 206
Oregon 132 (123) 0.0658% 9
Pennsylvania 0 0 0.0000% 0
Puerto Rico 0 0 0.0000% 0
Rhode Island 0 0 0.0000% 0
South Carolina 692 (646) 0.3445% 46
South Dakota 0 0 0.0000% 0
Tennessee 286 (267) 0.1425% 19
Texas 172,666 (161,108) 85.9242% 11,559
Utah 0 0 0.0000% 0
Vermont 0 0 0.0000% 0
Virginia 0 0 0.0000% 0
Washington 3,700 (3,453) 1.8414% 000
Xxxx Xxxxxxxx 0 0 0.0000% 0
Wisconsin 0 0 0.0000% 0
Wyoming 242 (226) 0.1206% 16
---------------------------------------------------
200,952 (187,500) 100.0000% 13,452
====================================================
Companion Life
Percentage
Reserve Funding
State Reserves Adjustments By Block Total
Alabama 0 0 0.0000% 0
Alaska 0 0 0.0000% 0
Arizona 1,644 (802) 1.6031% 842
Arkansas 892 (435) 0.8699% 000
Xxxxxxxxxx 000 (180) 0.3602% 189
Colorado 208 (101) 0.2024% 106
Connecticut 0 0 0.0000% 0
Delaware 0 0 0.0000% 0
Xxxxxxxx xx Xxxxxxxx 146 (71) 0.1425% 75
Florida 554 (270) 0.5401% 284
Georgia 0 0 0.0000% 0
Hawaii 0 0 0.0000% 0
Idaho 62 (30) 0.0603% 32
Illinois 124 (60) 0.1205% 63
Indiana 510 (249) 0.4971% 261
Iowa 97 (47) 0.0046% 50
Kansas 264 (129) 0.2576% 135
Kentucky 0 0 0.0000% 0
Louisiana 1,184 (577) 1.1547% 000
Xxxxx 0 0 0.0000% 0
Maryland 0 0 0.0000% 0
Massachusetts 0 0 0.0000% 0
Michigan 241 (17) 0.2346% 123
Minnesota 0 0 0.0000% 0
Mississippi 0 0 0.0000% 0
Missouri 197 (96) 0.1924% 101
Montana 0 0 0.0000% 0
Nebraska 0 0 0.0000% 0
Nevada 183 (89) 0.1789% 94
New Hampshire 0 0 0.0000% 0
New Jersey 0 0 0.0000% 0
New Mexico 3,134 (1,528) 3.0558% 1,606
New York 0 0 0.0000% 0
North Carolina 0 0 0.0000% 0
North Dakota 56 (27) 0.0548% 29
Ohio 421 (205) 0.4101% 215
Oklahoma 1,570 (766) 1.5315% 805
Oregon 67 (33) 0.0658% 35
Pennsylvania 0 0 0.0000% 0
Puerto Rico 0 0 0.0000% 0
Rhode Island 0 0 0.0000% 0
South Carolina 353 (172) 0.3445% 181
South Dakota 0 0 0.0000% 0
Tennessee 146 (71) 0.1425% 75
Texas 88,112 (42,962) 85.9242% 45,150
Utah 0 0 0.0000% 0
Vermont 0 0 0.0000% 0
Virginia 0 0 0.0000% 0
Washington 1,888 (921) 1.8414% 000
Xxxx Xxxxxxxx 0 0 0.0000% 0
Wisconsin 0 0 0.0000% 0
Wyoming 124 (60) 0.1206% 63
---------------------------------------------------
102,546 (50,000) 100.0000% 52,546
====================================================
Grand Total by State
Reserve
State Reserves Adjustments Total
Alabama 0 0 0
Alaska 0 0 0
Arizona 6,170 (2,280) 3,891
Arkansas 682,890 857,708 1,540,597
California 1,228 (684) 544
Colorado 1,402 517 1,919
Xxxxxxxxxxx 0 0 0
Xxxxxxxx 0 0 0
Xxxxxxxx xx Xxxxxxxx 573 (160) 413
Florida 2,748 120 2,869
Georgia 0 0 0
Hawaii 0 0 0
Idaho 183 (143) 40
Illinois 949 453 1,403
Indiana 2,093 (441) 1,651
Iowa 287 (225) 62
Kansas 1,889 790 2,679
Kentucky 0 0 0
Louisiana 2,076,333 2,501,304 4,577,637
Maine 0 0 0
Maryland 194 246 439
Massachusetts 0 0 0
Michigan 1,426 348 1,775
Minnesota 0 0 0
Mississippi 0 0 0
Missouri 3,120 885 4,005
Montana 0 0 0
Nebraska 810 173 983
Nevada 600 (353) 247
Xxx Xxxxxxxxx 0 0 0
Xxx Xxxxxx 0 0 0
Xxx Xxxxxx 9,928 (7,118) 2,810
New York 0 0 0
North Carolina 0 0 0
North Dakota 166 (130) 36
Ohio 1,245 (974) 271
Oklahoma 1,293,930 798,331 2,092,261
Oregon 538 272 810
Pennsylvania 0 0 0
Puerto Rico 0 0 0
Xxxxx Xxxxxx 0 0 0
Xxxxx Xxxxxxxx 1,405 (363) 1,042
South Dakota 0 0 0
Tennessee 433 (338) 94
Texas 1,877,380 718,479 2,595,858
Utah 86 110 196
Vermont 0 0 0
Virginia 388 491 879
Washington 5,791 (4,233) 1,558
West Virginia 0 0 0
Wisconsin 0 0 0
Wyoming 366 (286) 80
---------------------------------------------------
5,974,551 4,862,500 10,837,051
====================================================
