Stockholders Information SupplementFinancial Reporting to Stockholder.
1. Did the company distribute to its stockholders prior to the (insert current year) Annual Meeting an Annual Report for the year (insert preceding year)? Answer__________________________
If answer is "Yes" attach copy. If answer is "No" explain in detail below. Attach separate sheet if necessary.
2. Will the company distribute to its stockholders prior to the (insert following year) Annual Meeting an Annual Report for the year (insert current year)? Answer__________________________
If answer is "Yes" a copy of the report shall be forwarded to the insurance commissioner of the company's domiciliary state at the time as it is disctributed to stockholders. If answer is "No" explain in detail below. Attach separate sheet if necessary.
3. If an Annual Report to stockholders was distributed for the year (insert preceding year): (a) Was such distribution prior to or contemporaneous with the solicitation of proxies in respect of the Annual Meeting? Answer__________________________
If the answer is "No" explain in detail below. Attach separate sheet if necessary.
(b) Did it contain the following financial statements (indicate answer in Column A) and were financial statements prepared substantially on the basis (individual or consolidated) as required to be presented in the company's Annual Statement (indicate answer in Column B)? To be answered by Life and A & H Companies:
(a) Statement of Assets, Liabilities, Surplus and Other Funds . . . .(b) Summary of Operations . . . .(c) Surplus Account . . . . To be answered by Fire and Casualty Companies:
(a) Statement of Assets, Liabilities, Surplus and Other Funds . . . .(b) Statement of Income - Underwriting and investment Exhibit . . . .(c) Capital and Surplus Account . To be Answered by Title Insurance Companies:
(a) Statement of Assets, Liabilities, Surplus and Other Funds . . . .(b) Statement of Income, Operations and Investment Exhibit . . . .(c) Capital and Surplus Account . | Column A | Column B |
| YES | NO | YES | NO |
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Information Regarding Management and Directors.
| Principal | Benefits Accrued or set aside During Current Year | Est. Annual benefits Upon Retirement |
| Name and Title (1) | Occupation or Employment (2) | Served as Director From (3) | Aggregate Direct Remuneration (4) | Retirement Plan (5) | Other Emp. Benefits (6) | Retirement Plan (7) | Other Emp. Benefits (8) |
1. Furnish the above information for each director, and for each of the three highest paid officers, whose aggregate direct remuneration exceeded $20,000 during the year, naming each such person. ______ ______ ______ ______ ______ ______ ______ ______
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Furnish on a separate sheet the following information as to each of the individuals named above or state below that such information is not present:
(a) Information as to any material interest, direct or indirect, on on the part of such individual during the year (insert current year) in any material transaction or any material proposed transaction as to which the company, or any of its subsidiaries, was or is to be a party.(b) Information as to all options to purchase securities of the company granted to or exercised by each individual during the current year.2. Answer "Yes" or "No" in each column as to whether or not the information in item 1 has been, or will be, furnished to stockholders in any proxy statement relating to: (a) The election of directors; or(b) Any bonus, profit sharing or other remuneration plan, contract or arrangement in which any director, nominee for election as a director, or officer of the company will participate; or(c) Any pension or retirement plan in which any person will participate; or(d) The granting or extension to any person of any options, warrants, or rights to purchase any securities, other than warrants or rights issued to security holders, as such, on a pro rata basis. If any answer is "No" explain in detail on separate sheet. ______ ______ ______ ______ ______ ______ ______ ______
3. Furnish the information specified in item 1 for all directors and officers of the company, as a group, without naming them. XXXXX XXXXX ______ ______ ______ ______ ______ ______
4. Did the stockholders have an opportunity to vote for or against the election of directors and also other matters to be presented at any stockholders' meeting? Answer_______________. If answer is "No" explain on separate sheet.
5. Will the company solicit proxies from its stockholders during (insert following year) and will the solicitation(s) precede any shareholders' meeting or meetings by at least ten days? Answer_______________. If answer is "Yes" and proxies are to be solicited, copies of the proxy statement and form of proxy and other soliciting material to be furnished stockholders shall be submitted to the insurance commissioner of the company's domiciliary state at least ten days prior to the date the material is first sent or given to stockholders. If answer is "No" and proxies are not to be solicited from stockholders, explain in detail below. Attach separate sheet if necessary.