Pocahontas Mutual Insurance Association

Kaye Van Genderen

137 South 3rd Street, P. O. Box 99

Laurens IA 50554-00

Iowa Company Number: 0119

December 31, 2016 - Annual Statement

Annual Sialementfor the year 2016 of the Pocahontas Mutual Insurance Association

ASSETS

Assets

1 , Bonds (Schedule D)"""",,,,,,,,,,,,,,,,, ""'"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' "',,,', """",,1,948,060

2, Stocks (Schedule D):

2,1 Preferred stocks,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ","""""""""""""'"

2.2 Common stocks"" "" """""""", """""" ,., """"""""""""""", ,,""""" """'"''''''''''

3, Mortgage loans on real estate (Schedule B):

3,1 First liens"""""", ""',',,,,",,"" "" "'"'''''''''''''''''''''''''''',,'''''''''''''

3,2 Other than first liens"""",,,,,,,,,,,,,,,,,, '"''''''''''".,,''''''''''',''''''''''''''''''''''''''''',,'''

4, Real estate (Schedule A):

4,1 Properties occupied by the company (less $"""",,0

,,,,,,,,,,,,,,,,,,,,,,391,640

"""""""',' ,,2,188,617

Current Year 2

Nonadmitted Assets

3 Net Admitted

Assets (Cols,1 - 2)

Prior Year 4

Net Admitted Assets

""'"" """ " " 1 ,948,060 """""""'"'' 1 ,843,757

""",,,,,,,,,,,,,,391,640 ,,,,,,,,,,,,,,,,,,,,,,440,450

""""""""",2,188,617 """"",,,,,,,,,1,776,284

""",,,,,,,,,,,,,,,,,,,,,,,,,,,0

""",,,,,,,,,,,,,,,,,,,,,,,,,,,0

encumbrances)""""""" ""'"'''''''''''''''''''''''''''''''''''' "" ,""""""""""""""""""", """""""""'" ,61 ,571 """"""""", """"'" """ """,""'" """'" ,61 ,571 """"",,,,,,,,,,,,,,68,370

4,2 Properties held for the production of income (less $"""",,0

encumbrances)""""""""""""""""",,,,,,,,,,,,,,,,,,,, """""""""""""""""""""""",

4,3 Properties held for sale (less $"""",,0 encumbrances)"",

5, Cash ($"",582,530, Schedule E-Part 1), cash equivalents ($"""",,0, Schedule E-Part 2) and short4emn investments ($"""",,0, Schedule DA)"" """""""" """""""""",,582,530

6, Contract loans (including $, """,,0 premium notes)""""""""""" ",,""""""""""""""'" """"""'" """"""""""

7, Derivatives (Schedule DB)",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, """',,',,"""",,""""""""""'''''''''''''''''''' ",,",,"""''''

8, Other invested assets (Schedule BA)"""""" """"''''''''''''''''','''''''''''''''''''''''''''''''''''''',,' """"""""""""""""""

9, Receivables for securities"""" ""","""'"'' """""" """""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,, ""'" """""""''',,'''''''''''''' '"

10, Securities lending reinvested collateral assets (Schedule DL)""""""""", """""""""'" """"""""""""",,""""

"""""""""""",0

"""""""""""",,0

"'" """",,,,,,,,,582,530 ,,,,,,,,,,,,,,,,,,,,,,716,631

"""""""""""""""",0

"""""""""""",0

""",,,,,,,,,,,,,,,,,,,,,,0

"",,,,,,,,,,,,,,,,,,,,,,,,,,,,0

""""",,,,,,,,,,,,,,,,,,,,,,,0

11, Aggregate write-ins for invested assets",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ","',,""'" """"""""""",,,,,,,,,,,0 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0 """"""",,,,,,,,,,,,,,,,,,,0 """"""",,,,,,,,,,,,,,,,,,,0

12, Subtotals, cash and invested assets (Lines 1 to 11)"" ",,"""'"'''''''''''''''''''''''''''''' " "" " , """""""",,,5,172,418 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0 """"""""",5,172,418 """"""""",4,845,492

13, Title plants less $"""",,0 charged off (for Title insurers only)""""""""""""""""""""", """,,"""'"'''''''''''' " " " , "''''''''''''''''''''''''''''''',,' """,,,,,,,,,,,,,,,,,,,,,,,,,,,0 """" '" " " ",,"""""""'"

14, Investment income due and accrued""""", """""""""""""",""""'''''''''''''''''''''''",,'',,' ",,,,,,,,,,,,,,,,,,,,,,21,063

15, Premiums and considerations:

""""""",,,,,,,,,,21,063 """"""""""",,21,013

15,1 Uncollected premiums and agents' balances in the course of collection"" ,,,,,,,,,,,,,,,,,,,,,,,,20,077 ",""""""""",,",,"""'" "",,,,,,,,,,,,,,,,,,,,20,077 """""""""""" 11 ,578

15,2 Deferred premiums, agents' balances and installments booked but deferred

and not yet due (including $"""",,0 eamed but unbilled premiums)""""""""""" """""""""""""""''''''

15,3 Accrued retrospective premiums ($"""",,0) and contracts subject to

redetemnination ($"""""0)"""",,, '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' "",,''''''''''''''''''''''''''''''

16, Reinsurance:

16,1 Amounts recoverable from reinsurers""""""""""""""""""""""" """""""""""

16,2 Funds held by or deposited with reinsured companies"""""""""""""""".""""" """"""""""""""""""

16,3 Other amounts receivable under reinsurance contracts"""""""""""""""""""",

17, Amounts receivable relating to uninsured plans"""""""""""""""""""""""""""""""" """"""""""""""""",,

18,1 Current federal and foreign income tax recoverable and interest thereon""""""""""", """",,' """"''''''''''''''''

18,2 Net deferred tax assel.., """"""""",,,,,,,,,,,,,,,,,"""" " " " " " '" "',""""""'''''''''''''''''''''''''''' """,,""''''''''''''''''''''''''

19, Guaranty funds receivable or on deposil.."""""""""""""""" """""""""""""""""""" """"",,""''''''''''''''''''''

"""""""""""""""",0

"""""""""",,,,,,,,,,,,,0

","""""""""""" ""'''' ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0

",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0

"""",,,,,,,,,,,,,,,,,,,,,,,,,0

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0

" ",,,,,,,,,,,,,,,,,,,,,0

""",,,,,,,,,,,,,,,,,,,,,,,,,,,0

"""""",,,,,,,,,,,,,,,,,,,,,0

I I I I I I I I I I I I I

20, Electronic data processing equipment and software"""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,, """,,,,,,,,,,,,,,,,,,,,1,378 ","""""""""''''''',,'''''' """"""""""""" 1 ,378 "",,",,""""""'"'''''',,'''

21. Fumiture and equipment, including health care delivery assets ($"""""0)""""""""",, ,,,,,,,,,,,,,,,,,,,,,,,,19,010 """""",,19,010 """""""".""",,,,,,,,,,0 """""",,,,,,,,,,,,,,1,754 I 22, Net adjustment in assets and liabilities due to foreign exchange rates"""""""""""""" """""""""""",,,,,,,,,0

23, Receivables from parent, subsidiaries and affiliates """'''''''"'''''''''''''',,,,'''' """"""""" "",,""""""'"'' """",0

24, Health care ($"""",,0) and other amounts receivable""""""""""""""""""""""""""" """""",,,,,,,,,,,,,,,,,,,,,0

25, Aggregate write-ins for other-than-invested assets""""""""""""""""""""" """'" ""'" 1-""'''''''''''''''''''''''''''''''''''''''''''''''-'' 1",2=:25'4-""'''''''''''''''''''''''''''''''''''''''''''''''-'' 1",2=:25'4-'==="-'"" '-'"" '-,",,,-,",,,,,",,0'4-'=='-'"" ,-,"",,,,,,,,,,,,,,,,,,,,,,,,,,,",,0<-1

26, Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 12 to 25)"""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"""'''' ,,,,,,,,,,,,,,,,,,,5,235,171 ",,,,,,,,,,,,,,,,,,,,,,20,235 """,,,,,,,,,,,,,5,214,936 ",,,,,,,,,,,,,,,,,4,879,836

27, From Separate Accounts, Segregated Accounts and Protected Cell Accounts""""""", """""""""""",,""""" ",""""""'" """""""""""""""",0

28, TOTAL (Lines 26 and 27),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,',",,",,"""'''''''' """",,,,,,,,,,,5,235,171 ",,,,,,,,,,,,,,,,,,,,,,20,235 """""",,,,,,,5,214,936 """"""""",4,879,836

DETAILS OF WRITE·INS

1101, """"""""'"''''''''''''''''''''',,,,',''''''''',,'''''''''''''''''''''''''''''""'''''''''''''''''''''''''''''''''''''''''''''''''' "",,",,''''''''''''''''''''''''''

1102, """""",,""""",',''',,''''''''''''''''''''''',,''''''''''''''''''''''''','',,'"""""""""""""",,,,,,,,,,,,,,,,,,,, ,",,""""""""'''''''''','

1103. """''''''','''''''''''''''''',''''''''''',,''''''''',''''''''''''''''''''''''''''''''",""",,""""""""""""""""'''''',''

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0

""""""""",,0

"""",,,,,,,,,,,,,,,,,,,,,,,,,0

1198, Summary of remaining write·ins for Line 11 from overflow page""""""""""""""""""" """""."""""""""",,0 """""""""""""""",0 """"""""""",0 """","""""""" """,0

1199, Totals (Lines 1101 throu~h 1103 plus 1198) (Line 11 above)""""""""""""""""""""" """"""",,0 """""""""""""""",0 """""""""""""""",0 """",,,,,,,,,,,,,,,,,,,,,,,,,0

2501, Foreign Tax Withheld"""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"""""''''''''',,''''''

2502, "",,"" " , """"''''''''''''''''''''''''''''''''', """"""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

2503, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"""""",,",,' ""'"''''''''''''''''''''''''''''

"""""""""",,,,,,1,225 ,,"""""""",,""" 1 ,225 """",,,,,,,,,,,,,,,,,,,,,,,,,0

"""""""""""""""",0

""""""",,,,,,,,,,,,,,,,,,,0

2598, Summary of remaining write·ins for Line 25 from overflow page""""""""""""""""""" """""""""""""""",0 """"""""""""",,,,,,,0 """""""""""""""",0 """",,,,,,,,,,,,,,,,,,,,,,,,,0

2599, Totals (Lines 2501 throuah 2503 plus 2598) lLine 25 above)"" """"""""""""""""'"'' """""""""""",,1225 """"""."""""",1225 """""""""""""""",0 """",,,,,,,,,,,,,,,,,,,,,,,,,0

2 01/24/2017 7:56:55 AM

I I I I I

---~--~.--,---~--------------------------

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

OIl .. OIl .. ... .. -... .. ... .. ------.. ----------.. -.. --

LIABILITIES, SURPLUS AND OTHER FUNDS

1,

2,

3,

4,

5,

6,

Losses (Part 2A, Line 35, Column 8)""""", """,,""""""",""'''''''''''''' "",,",,""""''''',''''''''''''''''

Reinsurance payable on paid losses and loss adjustment expenses (Schedule F, Part 1, Column 6)""""""""""""""""""""""",

Loss adjustment expenses (Part 2A, Line 35, Column 9), ,""""""""""" " ,

Commissions payable, contingent commissions and other similar charges""",

Other expenses (excluding taxes, licenses and fees)""""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"""'" """"""""'"

Taxes, licenses and fees (excluding federal and foreign income taxes)"""""""""""""""""""""""""""""""""""""",

7,1 Current federal and foreign income taxes (including $"""",,0 on realized capital gains (losses)) "'" """""""",,"""""""""""""'"

7,2 Net deferred tax liability""""""""""""""""""",,,,,, """"""""""",,,,,,,,,,,,,,,,,, """"""""", '"'',,'''''''''''''''',,'''''''''''''''',,'''''''''''

8, Borrowed money $"""",,0 and interest thereon $"""""0",, """""""""''''',,'' """"",,""""""""" ''',,'' " " """ " " " " " " """ """""""'"

9, Unearned premiums (Part 1A, Line 38, Column 5) (after deducting uneamed premiums for ceded reinsurance of $"",9,020 and including warranty reserves of $"""",,0 and accrued accident and health experience rating refunds including $"""",,0 for medical loss ratio rebate per the Public Health Service Act)"""""""""""""""""""""" """"""""""""'"

10, Advance premium""""""""""""""""""""""""",,,,,,,

11, Dividends declared and unpaid:

11,1 Stockholders"""""""", "",",,""""""""""""""""""",""",,",,",,",,"""""""" "'"'' '"'' """""""""""",,",,",,","""""''''''''''''''''',

11 ,2 Policyholders", ",,"",,""",,""""""""""', "'"'' '" ""'" """"""""""" """"""""""""""""""""""",,, ""'" "'" """""",,,,",,'"'''''' ""

Current Year 2

Prior Year

,,,,,,,,,,134,585 """""""""""",,205,318

"""",,,,,,,,,,,,,,,,,,,,,,6,505 ",,,,,,,,,,,,,,,,,,,,,,,,4,044

,,,,,,,,,,,,,,,,,,,,,, """"",981 '''''''''' "",,694

""""""""""",14,060 """",,"""""",,' ,,15,658

""",,,,,,,,,,,,,,,,,10,133 ''''''''','''''''''''''',,'' 10,725

""""",,,,,,,,,,,,,,,,983,105 """""""""",,,,,,923,083

12, Ceded reinsurance premiums payable (net of ceding commissions)"""""""""""""""""""""""""""""""""",,,,,,, """"""""""'" """"""",,,,,,,,,,,,,,16,481 """""""",,,,,,,,,,,,22,642

13, Funds held by company under reinsurance treaties (Schedule F, Part 3, Column 19)""""""", """"""",," """""""'''''''''''' """"""",,",, """"""""'''' """"""""""",,"""

14, Amounts withheld or retained by company for account of others"""""""""""""""""""""""""""""""""""""" """"""""""""""

15, Remittances and items not allocated""""",.""""""""", """"""""""""",,' """""""""'" """""""""""""""""""""",,.,,

16. Provision for reinsurance (including $""""".0 certified) (Schedule F, Part 8)""""""""""""""""""". """""""""""""".,,,,""

""""",,,,,,,,,,,,,,,,,,14,108 """","""''''''',,'''' 11 ,083

17. Net adjustments in assets and liabilities due to foreign exchange rates""""""""""""" .,,""""""""""""" ,,"""""""""""""""""" """""""""."""

18. Drafts outstanding""""""""""." """""'" """"""""""""""""""""""""""""""""""" .. """"""""""""", ""'" "."""""", """.""""",,. """"" """ "",," """""""'"

19. Payable to parent, subsidiaries and affiliates"""""""""""""""""""""""""""""""""""""""""". """,,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.

20. Derivatives"""""""""".""""" """""""""""""""""""""""""""""""""""""""",,.,,"",,""""""""""",,"""""",,.,,"""""""",,"""

21. Payable for securities"""""""""""""".".", """,,,,,,,,,,,,,,,,,,,,,,,,,, .,""""""""""".,"""""" """""""""""",,"""",,",,"""",,.,,"

22. Payable for securities lending"""""""""""", """""",,",,,""""""""""

23. Liability for amounts held under uninsured plans"""""""""""""""""""""""""""""""""""""""""""""""""""""""""

24. Capital notes $""""".0 and interest thereon $."""".0""""""""""""""""""""""""""""""""""""".""""""" """" ,,""",,""""""" """""""""""""""""""."

25. Aggregate write-ins for liabilities""""""""""."""."""."""""""""""""". ,,', """",,,,,,,,,,,,,,,,, "",,,.,,""""""""",,""",,"",,.,,"'''''''''' """"""""""""",,25836 '"'''',,''''''''''' "",,,28479

26. Total liabilities excluding protected cell liabilities (Lines 1 through 25)"""""""""""""""""""""""""""""".""."."""""""""""""" """.,,1,205,794 """""""""".,,1,221,726

27, Protected cell liabilities""""""""""""""""".",,,,,,,,.,,,,.,,,,,,,,,,,,,,, ,,' """""""""""" ,',"""""""'''''''''"."'''',,'',,'''''''''''''''''''''''''',,. """""""""""""""""""". """'"''''''''''''''''''''

28. Totalliabi/tties (Lines 26 and 27)"""""""""."""""""""""", """"""""""""""""""" """""""'"'''''''''''''''''''''''''''''''''''''''' "",,"""" """"""."""",,1205794 """"""""""".1221726

29. Aggregate write-ins for special surplus funds""""""""""""""""""""""""""""""""""""""""""""""". """.,"",',"',",'" """""""" """""""""""""""""",,0 """"'," ".," """,,'" ".,'''' ,0

30, Common capital stock""""".""."",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"""",,""""""""""""""'" """"""''''''',,'''''''' "".""."""""""". """"",,",,"" , """ " " " " " " "

31. Preferred capital stock""""""""", """"""""",,"""""""",,"""" """ ",," """"""" """""" """"""""""""""""""""" ".,'''''''''''''''''','' ,,",,"" "" """"""""" ". """ """"""""".,,""" """""""

32. Aggregate write-ins for other-than-special surplus funds""""""""""""""""""""""""""""""""""""""""""."" """""'''".,,'''''''''' """""""""""""""""",,0 """.", .. """""""""""",,0

33. Surplus notes"""" """"""""""""".""""", ". """""""""",,"""""""""""",,""""""",,"""""""",,"""""",,. ""., "."",,,,,,,,,, """"""",,. """"" .. ",,",," """"""""".

34. Gross paid in and contributed surplus"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"""""""""".,'," """"""""""""". """""""""""""",,"""",,.

35. Unassigned funds (surplus) ,,,,,,,,,,,,,,,,,,,,,,,.,,,,,,,,,,, ,',""""',"""""""""""" """""""""""""",,,,,,,,,.,,,,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,"""""'''',,., """.""""""" . .4,009,142 """"""""""",3,658,110

36. Less treasury stock, at cost:

36.1 ."""".0.000 shares common (value included in Line 30 $"""""0)""""""",,

36.2 """",,0,000 shares preferred (value included in Line 31 $"""",,0) """""""'''''''''''''''''''''''''''''''''''''''''''''''' """""""""""""'r'~"~"'~"'~"'~"'~"'~"'~"'~"'~"'~"'~"'~'"'to =="''''''''''''''''''''''''''''''''''''''''''''''''''''''1'' 37, Surplus as regards policyholders (Lines 29 to 35, less 36) (Page 4, Line 39)".""""", """'''''''''''''''''''''''''''''''''''''''''''''''''''''¥f-==="~".~".",.4",0",09,,,1!.:!4:=.2+,"".""".",,,.,,,,,.,,,,,.,,,,,.,,,,,.,,,,,3,,,6,,,,5""8,,,11,,,0'-1 38, TOTAL (Page 2, Line 28, Col. 3)".""""""" ""."".""""",,""",,. """"""""""""""""",,,,,,,.,,,,,,. ".".""""""""""" ,,",,",,"",,",,""" """"" ,,5,214,936 """"""""""".4,879,836

DETAILS OF WRITE-INS

2501. Accrued Wages & Vacations""""""."."""" "".""""""""""""""""""""."""""""""""""""""."" """""""""" """""""""""""'" ",,', """."""."."",9,830 """"""""""""",,13,759 2502. Accrued Profit Sharing.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,""""""""""""""""""""""""""""" """"""""""."".,, 16,006 """""""".""""".14,720 2503. """"""""". """",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,. """"""""",,,,,,, """"""""""""""""""""" """'''''',."'''''''''''''''''',,'''',,'''''''''',,.

2598. Summary of remaining write-ins for Line 25 from overflow page"""".""."""".""""."""""." """""''''''''".".,,'',,'''''''',,''.,,'''''''''',,.,, """"" .. """""""""""",,0 """"""""."""."""""",,0

2599, Totals (Lines 2501 through 2503 plus 2598) (Line 25 abovel.."""""""""""""""""""""""""""""."."""""""""", """"""""". """"""""""""",,25836 """"""""""""",,28479

2901. """"""".",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, """""""'"."""".".,"""",,. '"'''''' ,,,,,,,,.,,,,,,,,,,,. "'''''''''''''''''''''''''',,'''''''''',,'',, .. ,""""" """",,"""""""""""""",,' """""""""""""""""""."

2902.

2903.

2998. Summary of remaining write-ins for Line 29 from overflow page""""""""""""""""""""""". """"".,,""",,""",,"""""""""""

2999. Totals (Lines 2901 throuQh 2903 plus 2998) (Line 29 above)""""""""""""""""""""""""""""""".""".""""" """'" """"""""".

3201. """""."". ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,, "'"'' ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,. """'""""""""""""""""""""""""""",,.

3202.

3203.

"""""""""""""""""",,0 "",,,.,,,,,.,,,,,,,,,,,,,,,,,,,,,,,.0

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.0 """,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.0

3298. Summary of remaining write-ins for Line 32 from overflow page.".""""""""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,".",,"""""""",,". ""."""""",,,,,.,,,,,,,,,,,,,,.0 ".",,,.,,,,,,,,,,,,,,,,,,,,,.,,,,,,,0

3299. Totals (Lines 3201 through 3203 plus 3298) (Line 32 abov~""""""" """""'",''''''''''''''''''''''"'''''''''''''''',, ... ''' "."""'"'',,.,,''''' , ""."""""",,,,,,,,,,,0 ."""".""""""""""""",,0

3 01/24/2017 7:56:56 AM

Annual Slatementfor ihe year 2016 of the Pocahontas Mutual Insurance Association

STATEMENT OF INCOME

UNDERWRITING INCOME 1. Premiums earned (Part 1, Line 35, Column 4) ...................................................................................................... ..

DEDUCTIONS:

Current Year 2

Prior Year . ..................... 1,598,799 ......................... 1,571,433

2. Losses incurred (Part 2, Line 35, Column 7)........................................................................................... ....................... .. ............................ 850,616 ........................... 1,109,550 3. Loss adjustment expenses incurred (Part 3, Line 25, Column 1)............................................ .................................................. .. ............................ 115,998 .............................. 117,690 4. Other underwriting expenses incurred (Part 3, Une 25, Column 2).................. ...................................... ................... .. ............................ 642,915 .............................. 634,933 5. Aggregate write-ins for underwriting deductions ......................................................... y ......................... ........................... ........ .. ....................................... 0 .......................................... 0 6. Total underwriting deductions (Lines 2 through 5).............................................................. ....................................................... .. ......................... 1,609,529 ........................... 1,862,173 7. 8.

Net income of protected cells................................................................. ................................................................................... r·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·~ .. r""''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''-I' Net underwriting gain (loss) (Line 1 minus Line 6 plus Line 7)................................................................................................... .. ............................. (10,730) ............................. (290,740)

INVESTMENT INCOME 9. Net investment income earned (Exhibit of Net Investment Income, Line 17)............................................................................. .. .............................. 92,409 .............................. 114,178 10. Net realized capital gains (losses) less capital gains tax of $ .......... 0 (Exhibit of Capital Gains (Losses)) ................................................................. 54585 .............................. ..40649 11. Net investment gain (loss) (Lines 9 + 1 0) ................................................................................................................................. .. . .................. 146,994 .............................. 154,827

OTHER INCOME 12. Net gain (loss) from agents' or premium balances charged off (amount recovered $ .......... 0

amount charged off $ .......... 0) ................................................................................................................................................... . .......................................... 0 13. Finance and service charges not included in premiums ........................................................................................................... . .. .............................. 30,213 ............................... 30,420 14. Aggregate write-ins for miscellaneous income...................................................................... ..................................................... .. .............................. 10969 .................................. 9462 15. Total other income (Lines 12 through 14).................................................................................................................................... .. .............................. 41182 ................................ 39882 16. Net income before dividends to policyholders, after capital gains tax and before all other federal and foreign

income taxes (Lines 8 + 11 + 15) ............................................................................................................................................... . .. ............................ 177,446 .............................. (96,031) 17. Dividends to policyholders .................................................................................................................................................................................................................................................. . 18. Net income, after dividends to policyholders, after capital gains tax and before all other federal and foreign

income taxes (Line 16 minus Line 17)....................................... ............................................... ................................................. .. ............................ 177,446 ............................... (96,031)

19. Federal and foreign income taxes incurred....................... ........................................ .. ...................................................... r·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. ·"' .. "' .. ·"' .. ·"' .. ·"' .. ·"' .. ·~ .. 1-''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''-1'' 20. Net income (Line 18 minus Line 19) (to Line 22) ...................................................................................................................................................... 177,446 ............................... (96,031'

CAPITAL AND SURPLUS ACCOUNT 21. Surplus as regards policyholders, December 31 prior year (Page 4, Line 39, Column 2) ...................................................... .. . .......................... 3,658,110 ........................... 3,975,623 22. Net income (from Line 20) ......................................................................................................................................................... .. .............................. 177,446 ............................... (96,031) 23. Net transfers (to) from Protected Cell accounts ......................................................................................................... . 24. Change in net unrealized capital gains or (losses) less capital gains tax of $ .......... 0 ............................................................... .. ............................ 168,367 ............................. (205,706) 25. Change in net unrealized foreign exchange capital gain (loss).................. ................................................................................ .......................................... .. .......................................... . 26. Change in net deferred income tax..................................................................................................................... ........................ ....... ..................................... .. .......................................... . 27. Change in nonadm'lt!ed assets (Exhibit of Nonadmitted Assets, Line 28, Column 3)................. .............................................. .. ................................ 5,218 ............................... (15,775) 28. Change in provision for reinsurance (Page 3, Line 16, Column 2 minus Column 1) ........................................................................................................... . 29. Change in surplus notes................... ....................................................... .................................................. ................................ .. ......................................... .. 30. Surplus (contributed to) withdrawn from Protected Cells ...................................................................................................................................................... . 31. Cumulative effect of changes in accounting principles ............................................................................................................................................................ .

32. Capital changes: 32.1 Paid in .......... .. 32.2 Transferred from surplus (Stock Dividend) .................................................................................................................................................... .. 32.3 Transferred to surplus ........................................................................................................................................ .

33. Surplus adjustments: 33.1 Paid in.................................... ............................................... ............................................................................... ............. .................................... ........ .. ......................................... . 33.2 Transferred to capital (Stock Dividend) ....................................................................................................................................................................... . 33.3. Transferred from capital................................................................................................................................ .................... .. .................................. .

34. Net remittances from or (to) Home Office ............................................................................................................................................................................. . 35. Dividends to stockholders.................. .............................................................. ........................................................................... ............................................. .. .......................................... . 36. Change in treasury stock (Page 3, Lines 36.1 and 36.2, Column 2 minus Column 1 )............................................................... ............................................. .. .......................................... . 37. Aggregate write-ins for gains and losses in surplus................ ................................................................................................... .. ........................................ 0 ........................................ 0 38. Change in surplus as regards policyholders for the year (Lines 22 through 37)...................................... ............................... .. ............................ 351032 ............................. 1317513 39. Surplus as regards policyholders, December 31 current year (Line 21 plus Une 38) (Page 3, Line 37)................................... .. ........................ .4,009,142 .......................... .3,658,110

0501. 0502. 0503.

DETAILS OF WRITE-INS

0598. Summary of remaining write-ins for Line 5 from overflow page............................. ......................................................... .. ........................................ 0 .......................................... 0 0599. Totals (Lines 0501 through 0503 Dlus 05981 lLine 5 above) .............................................................................................................................................. 0 .......................................... 0 1401. Commission Income .................................................................................................................................................................................................... 10,969 .................................. 9,391 1402. Miscellaneous Income.......................................... ............................................... ....................................................................... . ........................... .. ...................................... 71 1403. ................................................... ............................................................................................. .................................................... ........ ................................. .. ......................................... . 1498. Summary of remaining write-ins for Line 14 from overflow page ........................................................................................................................................ 0 1499. Totals (Lines 1401 through 1403 olus 1498) lLine 14 above) .................................................................................................................................... 10969 3701. .. .................................................................................................................................................................................................................................... .. 3702 ................................................................................................................................................................................................................................................ .. 3703 ................................................................................................................................................................................................... ..

.......................................... 0 .................................. 9462

3798. Summary of remaining write-ins for Line 37 from overflow page................................................................................................ .. ........................................ 0 .......................................... 0 3799. Totals (Lines 3701 throuqh 3703 plus 3798) (Line 37 above)........................................ .. ................................................................................................. 0 .......................................... 0

4 0112412017 7:56:56 AM

I I I I I I I I I I I I I I I I I I I

- .•. ~-----------------------

Annual Statement for Ihe year 2016 of the Pocahontas Mutual Insurance Association

...

....

... .. ....

-.. -----------------.. -.. --

1,

2.

3,

4,

5,

6,

CASH FLOW

CASH FROM OPERATIONS

Premiums collected net of reinsurance"""""" ............. """""" ... ,, ......... ,,""""""" ........ ",""""''',''

Net investment income"." "''''''''',''''''" ... "''''''''''''''',, ............ ,,''''''''''',,'' "".""""""",, ............ ,,''''''',' ,

Miscellaneous income"""".",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,.,, .. ,,,,,,,,,,,, ....... ".""""""" ........... ,,"""",,... """.,"""""'"

Total (Lines 1 through 3)"""""",,,,,,,,, """""""" ...... """"""""""" ..... """"""" ...... ",,.,,",,",, ...... """"""",, ........ ,," """'"

Benefit and loss related payments"""""" ........ ,,""""",.,,,.,," """'"'''' "",",.,,'''' """"""', "'''''''''' "" """ ... "." .. """"""" ........ ",,.

Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Acoounts""" ....... """"""""" ... "",,.,,"""""",,.

Current Year

.. """",, ......... ,," 1 ,644, 161

2 Prior Year

" .... "."".".1,584,326

." ....... ,,""""'" ",,105,552 ... "".""""" ....... ,,.124,160

.""""" ........ """",,.41182 """"""" ... """""",39882

""""" ....... ,,",," 1,790,894 "'" ." .... ,,""""" 1,748,368

"" ........ " .. """".".921,349 " ..... """""",, .... 1,085,392

7. Commissions, expenses paid and aggregate write-ins for deductions ........... """"""" ..... ,,""""""",, .... ,,"""""""" ..... ,,"""',,'" .... " .. """""." .. ,,.,,758,180 ".""",750,820

8. Dividends paid to policyholders""."." .... """""""" .... ",,.,,'''''''''''''' ... "",.""""""." .. """""".",,.,, ....... ,,"",,"""",, ...... ,,",,."""", ,.""""""""" .. ".""""",, .... ,,

9. Federal and foreign income taxes paid (recovered) net of $" ..... ".0 tax on capital gains (losses)"""", "",,,,,,,,,,,,,.,,.,,,, .. ,,,,.,,,, 1-==""''''''''' '''''' '''''' '''''''''''''''''''''''''''''''''''''''''''-l--''''''''''''''''''''''''''''' ."""""",--",,,,,,,,,,,",,(!o,29~3,,,2'-"l15 10. Total (Lines 5 through 9)"""""""", ".,"'''''' """.""""""""""""".""""""""".",,.,,"""",,"",, .. ,,.,,"""",, ......... """""",,.,""""',',. "" .. " ..... ,,""",," 1 ,679,529 " ..... ,,""""" ."",1,806,888

11. Net cash from operations (Line 4 minus Line 10).""" ""."" .. """"""""" ".,,""""""'" """"""""."" ....... """"""" .......... ,,,,"" "" ..... ".""""".,,.,,111,366 " .... """"""".".",,.(58,520)

CASH FROM INVESTMENTS 12. Proceeds from investments sold, matured or repaid:

12,1 Bonds"""""""""". ,,""""'" " .. """""" ........ """"""""." .... " ... ",,"""",, ..... ,,,,.,,"""" ......... " .. ,,""" '",''''''''''' '" ". .." ... " "."""" .. " ... 199,418 ...... '''''''''''' "." ... ,,344,303

12.2 Stocks".,,,,,.,, ... ,,,,,,,,,,,,,,,,,,,, .. ,,,,,,,,,,,,,,.,,,,,,,,, """'''''''',','' "'.""""",, """."".453,419 """"""" ,,335,744

12.3 Mortgage loans""" .. """"''''''''''''''''" ...... ".,,'''''''''''',, ........ ,,''''''"""""".""."."""""" ........ ,,"""",, .......... ,,""",, .. ,

12.4 Real estate""""""""""".""""."""" '''' ".,,",,""" ". ". "" "., """"""""""'" """""" .. ""

12.5 Other invested assets"" ...... """"""""" .... ",,.,,""""""" """""""""" """""""""""" ''','' "" "".""" .... "",,""""""",,.,,,,",

12.6 Net gains or (losses) on cash, cash equivalents and short-term investments"""""".".""""."""""""" ....... ,,""",,.,, ... ,,'

12.7 Miscellaneous proceeds""""" .... ".". """"""""""""," " ... " ....... ,," "" ".,,' """"""""",. ,," ..... ".""",,. r""""''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' t·",,,·,,",,,,,,",,,,,,",,,,,,,,,,,,,,, ''''. ",,"," ',,"," ',,",' ",,"," ',""',,",'"'''-1'''

12.8 Total investment proceeds (Lines 12.1 to 12,7)".""""""""" ...... """""""",,.,,""""""""",, .... ,,""""""""."""",,.,," """"""" ...... """,,652,837 ""."" .. """"""".,,680,047

13. Cost of investments acquired (long-term only):

13.1 Bonds" " .... """"""",,. ,,",","'"'''''' """" ....... """""""" ......... "".""""" ..... ,, ... ,,"",,."""" .. """"""""." ..... ,,.,,""""''''','' ' ,,"""",""" ,31 0, 190 ",,,,,,, ..... """""",,253,451

13,2 Stocks"""""""",,,, ""., """"""""""'"'''''''''''''''' ,,',""""""" ".",," """""""", '" '''' ".," ".,,"'" """",,,,,,,,,, ,',' .. " .""""""". """"",594,085 "."""""""""""",335,830

13.3 Mortgage loans .. " .. """""""" .... ".".,,""",,.,," ""',","""''''''''','''' ,',"."".,,"'''''' "',""""""""" ... """,,""""""",, ..... ,,"",'" " ....... ".,,"""'" ,,', "''''''''''''

13.4 Real estate"" ... "."""""""". "',"""""".""""." .... " .. ,, .. ,,"""""",, ........ ,,"""""""" ........ """""" ...... ""."",,.,,',, """",,,,,,,,. "" ......... """"""" ..... ,""".,,.

13.5 Other invested assets ..... ,,""""""" """",,,,,,,,,,,,,,,,,,, "'".,"""',""""" """,,,,,,.,,,,,,,, .,"'''''''''''''''''', "'''""""""""" .. "",,, """""" .. """""""" .. ,, .. ,,",,.

13.6 Miscellaneous applications""."""",,,,,.,,,,,,, ... ,,,,,,,,,,,,,,,,,,,, ... ,,,,,,,,,,,,,,,,,,,,,, .. "."""""""""" .. """""", ", .. " ...... """""" ..... ".""""""",, ... ,," """." .. ".""""""""',,.,,"",,.

13.7 Total investments acquired (Lines 13,1 to 13.6) """.,,"""""'" """"""""""'''' """""""".""""" ....... "."""".,, """"""""." .... "".904275 """"" ..... ".""."",589281

14. Net increase (decrease) in contract loans and premium notes" .. """"""""""""."".""""",, ..... ,,"""",,.,,""""'"''''''""""""""" """""""'"'''''''''''''''''''''''''' ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

15, Net cash from investments (Line 12,8 minus Lines 13.7 minus Line 14)"""""" .......... " ... """"" ....... ,,"""",, ........... ,,"".""""", .""""""" ..... "",,.(251,438) """""""""""""",,90,766

CASH FROM FINANCING AND MISCELLANEOUS SOURCES 16. Cash provided (applied):

16.1 Surplus notes, capital notes""""" ........ ,,"""'''',. """"""""""""" ",,,,,,,,,,,,,,,,,,,,,,,,, """".".""",, ... ''''""""""""" ... "."". """""""""",,",,.,,""""""" """""""""""'"''''''''''''''''''

16.2 Capital and paid in surplus, less treasury stock"""" "."""""".,,"",,.,," "."".,,",,"""", """"""""" """".".""""""",, ....

16.3 Borrowed funds""""""""""""""" ..... ",,.,,""""""""'" """""""""", '''',." .. ""."".",,""",,""""""""" .... '" """""""" .. """""""" .. " .. ,,.

16.4 Net deposits on deposit-type contracts and other insurance liabilities" ............. """"""""",,.,,"""""" ""."""",,.,,"",,"" .""""""" ..... "."""""",, .. ,, ..

16.5 Dividends to stockholders""" ....... " """"""""" ... " .. " .. """"" ............ ".,,""""",, .......... """"",, ....... ,,""""'," """",.".,,"" ." ...... "."""""".,, .. ,,"""""" ."".""""""" ... ".""""",,,,,,,

16.6 Other cash provided (applied)""."."",,,,, ........ ,,.,,,,,,,,,, .................. ,,"""."." ......... ,,""""" ... ""."""""" """"""'''''''''',,'''' """.",,,,,,5 972 """"""" .. """"""".(8 230'

17. Net cash from financing and miscellaneous sources (Lines 16.1 to 16.4 minus Line 16,5 plus Line 16,6)"""""". """,,"",,",,. ".""""""""" """,5 972 " ... """""""" .... ",,,,(8230\

RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT·TERM INVESTMENTS 18, Net change in cash, cash equivalents and short-tenm investments (Line 11, plus Lines 15 and 17)""""" ......... """,,.,,"""""" """"""" ... " .. "",,(134,101) "".".""."""""""".24,016

19. Cash, cash equivalents and short-tenm investments:

19.1 Beginning of year,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,,,,,,,,, """"'"'"."''''''',,.,''''''''''''''''''' ,,,"",,.,"""""""''',',',''''''''''''',,.,,,, ....... ,,,,'''' """" .. ".""""""".716,631 "" .... """""""".,,.692,615

19.2 End of year (Line 18 plus Line 19.1 ).,'''" .. "."'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''',, ....... """""" .. " .. "".",,,,,,,,,,,,. . .... """""""",, ..... 582,530 .... """"""" ..... ",,.716,631

lemental disclosures of cash flow information for non-cash transactions:

5 01/24/2017 7:56:56 AM

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

1.

2.

3.

4.

5.

6.

8.

9.

10.

11.1

11.2

12.

13.

14.

15.

16.

17.1

UNDERWRITING AND INVESTMENT EXHIBIT PART 1B· PREMIUMS WRITTEN

Line of Business

Direct Business

(a)

Fire ............................................................................................................. 1,474,012

Allied lines ................................................................................... . ............... 882,968

Fanmowners multiple penL ........................................................... ..

Homeowners multiple peril ............................................................. ..

Commercial multiple penl. ............................................................. ..

Mortgage guaranty .......................................................................... .

Ocean manne ................................................................................ ..

Inland manne .................................................................................................... 17,667

Financial guaranty ......................................................................... ..

Reinsurance Assumed 2 3

From Affiliates

From Non-Affiliates

Reinsurance Ceded 4 5

To Affiliates

To Non-Affiliates

6 Net Premiums

Written (Cols.l +2 +3

-4 -5)

............... 441,674 ............ 1,032,338

............................. 2.7~~.1.~.2. ::::::::::::: .. ~~~:~1.: I . .......... 0 I

.. ........................ 0

. ......................... 0

.......................... 0 I

.. ............... 17,667

Medical professional liability - occurrence ................................ .

. ......................... 0 I ............................. ............................. ............................. ............................. ............................. .. ........................ 0

Medical professional liability - claims-made .................................... . .................... ............................. .. ........................ 0

......................................................................... 0 I .................... .................... ........ ............................. .. ........................ 0

Earthquake ...................................................................................... .

Group accident and health .......................................................... ..

.. ..................................................... 0 I Other accident and health................................................................ ............................. ............................. ............................. ............................. ............................. .. ........................ 0

Credit accident and health (group and individual) .......................... ..

Workers' compensation .................................................. . ............................. .......................... ............................. ............................. .. ........................ 0

Other liability - occurrence ............................................................................................ . ....................................................................................................................................... 0 I 17.2 Other liability - claims-made............................................................. ............................. ............................ ............................. ............................. ... ......................... . ......................... 0

17.3 Excess workers' compensation........................................................ ............................. ............................. ............................. ............................. ............................. .. ........................ 0 I 18.1 Products liability - occurrence...................... ................................... ............................. ............................. ............................. ............................. .. ........................ 0 II 18.2 Products liability - claims-made........... ............................................ ... ......................... ............................. ..................... ............................. ............................. .. ........................ 0

19.1, 19.2 Private passenger auto liability ...................................................... . ............................................................................................................................................. 0 I 19.3,19.4 Commercial auto liability. ................................................................ ............................. ............................. ............................. .................. ............................. .. ........................ 0

21. Auto physical damage ............................................................... . . ...................................................... 0

22. Aircraft (ali perils)............................................................................. ............................. ............................. ............................. ............................. ............................. .. ........................ 0 I 23. Fidelity.... .................................................... .................................... ............................. ............................. ............................. ............................. .. ........................ 0

24.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

3401.

3402.

3403.

3498.

3499.

Surety...... ........................................................................................ ............................. ............................. ............................. ............................. ............................. .. ........................ 0 I Burglary and theft................................................. ........................... ............................. ............................. ............................. ............................. ............................. .. ........................ 0 II

. .................. ::: ...... : ... :: .... :.::::::: :::.: .. : .... : .... ::::::::: ....... ::: .... ::::::::::::::. :::::::::::.:: ........ ::::~ I .................... .. ........................ 0

Boiler and machinery ..................................................................... ..

Credit... ......................................................................................... ..

IntemationaL ................................................................................. ..

.. ............ 0 I Reinsurance - nonproportional assumed property ....................................... XXX............ ............................. ............................. ...................... ...... ............................. .. ........................ 0

Warranty ......................................................................................... .

Reinsurance - nonproportional assumed liability .......................................... XXX ........................................ . . ......................... 0

.......................... 0 I Aggregate wnte-ins for other lines of business.. ............................. .. ........................ 0 ................... ..0 .......................... 0 .......................... 0 .......................... 0 .......................... 0

Reinsurance - nonproportional assumed financial lines ............................... XXX ....................................... ..

TOTALS ........................................ .. .. .......... 2.374,647 ......................... 0 .. .................. 0 ........... 0 ............... 715,826 ............ 1,658,821 _

DETAILS OF WRITE-INS I .. ........................ 0

.......................... 0 I

. ......................... 0

. .................. 0 .......................... 0 .......................... 0 .......................... 0 .......................... 0 Summary of remaining write-ins for Line 34 from overflow page .....

TotalsjLines 3401 through 3403 plus 3498) (Line 34 aboveL........ .. ........................ 0 .......................... 0 .......................... 0 .......................... 0 .......................... 0

. ......................... 0 I

.. ........................ 0

(a) Does the company's direct premiums wntten include premiums recorded on an installment basis? Yes ( I No [X I If yes: 1. The amount of such instaliment premiums $ .......... 0.

I 2. Amount at which such instaliment premiums would have been reported had they been recorded on an annualized basis $ .......... 0.

I

8 01/24/2017 7:56:58 AM

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

UNDERWRITING AND INVESTMENT EXHIBIT PART 2A· UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES

.... o

Reported Losses 2 3 4

Net Losses Excluding Incurred but

Reinsurance Deduct Reinsurance not Reported Line of Business Direct Assumed Recoverable (Cols. 1 + 2 - 3)

1. Fire.................................................................................... ............................ .. ........................... 80,085 ......................................... ......................................... .. ........................... 80,085 2. Allied lines...................................................................................................... .. ........................... 34,500 ......................................... ......................................... .. ........................... 34,500 3. Fannowners multiple peril.............................................................................. ......................................... ......................................... ......................................... .. .................................... 0 4. Homeowners multiple peril.. ............................................................................................ " .. " .. " ....... "",,. " ...... "............. .. ............................................................................. 0 5. Commencial multiple peril. ............. "............................................................... ......................................... ......................................... ......................................... .. .................................... 0 6. Mortgage guaranty......................................................................................... ......................................... ......................................... ......................................... .. .................................... 0 8. Ocean marine................................................................................................. ......................................... ......................................... ......................................... .. .................................... 0 9. Inland marine.................................................................................................. ......................................... ......................................... ......................................... .. .................................... 0 10. Financial guaranty ........................................................................................................................................................................................................................................................... 0

11.1 Medical professional liability - occurrence...................................................... ......................................... ......................................... ................... ..................... .. .................................... 0 11.2 Medical professional liability - claims-made................................................... .. ............... "...................... ......................................... ......................................... .. .................................... 0 12. Earthquake ...................................................................................................................................................................................................................................................................... 0 13. Group accident and health .............................................................................................................................................................................................................................................. 0 14. Credit accident and health (group and individual).......................................... .. ................................................................................................................................................ 0 15. Other accident and health.. ............ ......... ............... ........................................ .... ....... ..... ........ ................. .. ....... ........................ ........ .................. ....................... .. .................................... 0 16. Workers' compensation ................................................................................................................................................................................................................................................... 0

17.1 Other liability - occurrence.............................................................................. ......................................... ......................................... ......................................... .. .................................... 0 17.2 Other liability - claims-made ............................................................................................................................................................................................................................................ 0 17.3 Excess workers' compensation... ................ ............. ...... ................. ............... ..... ..... ........ ........... ..... ....... ..... ........... ........... ......... ..... .... ...................... ............... .. .................................... 0 18.1 Products liability - occurrence........................................................................ ......................................... ......................................... ....................... .. .................................... 0 18.2 Products liability - claims-made ....................................................................................................................................................................................................................................... 0

19.1, 19.2 Private passenger auto liability....................................................................... ......................................... ......................................... ......................................... . ..................................... 0 19.3,19.4 Commencial auto liability................................................................................ .. ............................................................................................................................................................... 0

21. Auto physical damage.................................................................................... ......................................... ......................................... ......................................... .. .................................... 0 22. Aincraft (a/l perils)........................................................................................... ......................................... ......................................... ......................................... .. .................................... 0 23. Fidelity... ................. .......... ...... ...... ........ ............... ..... ................. ........ ............. ..... ............. ................ ....... ............... ......... .......... ....... ........... ........ ............. ......... .. .................................... 0 24. Sunety............................................................................................................. ......................................... ......................................... ......................................... .. .................................... 0 26. Burglary and theft........................................................................................... ......................................... ......................................... ......................................... .. ............................ 0 27. Boiler and machinery ...................................................................................................................................................................................................................................................... 0 28. Credit ............................................................................................................................................................................................................................................................................... 0 29. Intemational.................................................................................................... ......................................... ......................................... ......................................... .. .................................... 0 30. Warranty......................................................................................................... ......................................... ......................................... ......................................... . ..................................... 0

~ 31. Reinsurance - nonproportional assumed property .... ", .................................................. XXX ...................................... "" ............... " ............................................................................... 0 ~ 32. Reinsurance - non proportional assumed liability............................................ .. .............. XXX.................. ............................. ......................................... .. .................................... 0

O 33. Reinsurance - non proportional assumed financial lines................................. .. .............. XXX.................. ......................................... ......................................... .. .................................... 0 ~

--.,J 34. Aggnegate write-ins for other lines of business.............................................. .. .................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 :-:J 35. TOTALS ................................................................................................................................... 114,585 ...................................... 0 ...................................... 0 ........................... 114,585 ~ DETAILS OF WRITE·INS ~ 3401. . .............................................................................. , ..... " ..................... , ............................................................. , ............................................................................................................. 0 » 3402. .. ...................................................................................................................................................................................................................................................................................... 0 ;;: 3403. ....................................................................................................................... .. ............................................................................................................................................................... 0

3498. Summary of remaining write-ins for Line 34 from overflow page................... .. ...................... 0 ...................................... 0 ...................................... 0 ...................................... 0 3499. Totals (Lines 3401 through 3403 plus 3498) (Line 34 above)............... .. .................................... 0 ...................................... 0 ...................................... 0 ...................................... 0

(a) Including $ .......... 0 for pnesent value of life Indemnity claims.

- - - - - - .. - - .. .. -

5

Direct ..... 10,000

............................. 10,000

Incurred But Not Reported 6

Reinsurance Assumed

7

Reinsurance Ceded

................ XXX.................. ......................................... . ....................................... .

................ XXX.................. ......................................... .. ...................................... .

................ XXX.................. ......................................... .. ..................................... .. ...................................... 0 ...................................... 0 ...................................... 0 ............................. 20,000 ...................................... 0 ...................................... 0

...................................... 0 ...................................... 0 ...................................... 0

...................................... 0 ...................................... 0 ........ " ............................ 0

- - - - -

8

Net Losses Unpaid

(Cols.4 +5 +6 -7) ............................. 90,085 ............................. 44,500 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 (a) ................................. O ...................................... 0 (a) ................................. O ...................................... 0 ..................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ...................................... 0 ........................... 134,585

...................................... 0

...................................... 0

...................................... 0

...................................... 0

...................................... 0

-

9

Net Unpaid Loss Adjustment Expenses

............................... 4,354

............................... 2,151

...................................... 0

............................... 6,505

...................................... 0

...................................... 0

Annual Statement for the year 2016 oflhe Pocahontas Mutual Insurance Association

.. 1. Claim adjustment services:

1.1 Direct .......................................... .

UNDERWRITING AND INVESTMENT EXHIBIT PART 3 • EXPENSES

Loss Adjustment Expenses

............... 39,449

2

Other Underwnting

Expenses

1.2 Reinsurance assumed ..................................................................................... ..

3

Investment Expenses

4

Total

.......................... 39,449

..... 0

1.3 Reinsurance ceded .......................... .. . .......................... f"== .. = ... = .... = .... = ... = .... = .... "'-. .. 1" .. = .... = .... = ... = .... = .... = ... = .... = .... = ... = ... 1" .. = .... = ... = .... = .... = ... = .... = .... =. =+.= .... = .... = ... = .... = .... = ... = .. =""'-1.0

1.4 Net claim adjustment services (1.1 + 1.2 - 1.3) .......... . .......................... 39,449 . ....................... 0 ................................... 0 ...................... 39,449

.. 2. Commission and brokerage:

...

...

...

... --.. -

2.1 Direct, excluding contingent... ........... 352,577 ..................... 352,577

2.2 Reinsurance assumed, excluding contingen!.. .. .. . ..................................................... 0

2.3 Reinsurance ceded, excluding conlingen!.. ........ . ................................... 0

2.4 Contingent - direct.. .................................... . . .................................. 0

2.5 Contingent - reinsurance assumed ........................................ . .. ............... 0

2.6 Contingent - reinsurance ceded .................... . ........................ 0

2.7 Policy and membership fees.................... ................................................. ...................................... .............................. .. ................................... . .................. ................ 0

2.8 Net commission and brokerage (2.1 + 2.2 - 2.3 + 2.4 + 2.5 - 2.6 + 2.7)............... .. ................................. 0 ........................ 352,577 ................................... 0 .......... 352,577

3.

4.

5.

6.

Allowances to manager and agents ........................ .

Advertising ................................................................................................................. .

Boards, bureaus and associations ......................................................................... ..

Surveys and underwriting reports ...

7. Audit of assureds' records ............ ..

8. Salary and related items:

8.1 Salaries ........................................................................................................... .

8.2 Payroll taxes .......................... .

.. .......................... 9,652

.......................... 7,503

.. ....................... 27,242

.................... .. ........ 0

................ 9,652

.. ......................... 7,503

................. 27,242

.. .......... 0

.. ........................ 47,855 .......................... 89,025 .......................... 15,209 ........................ 152,089

...... 3,695 ........................ 11,086 ........................... 1,642 ....................... 16,423

9 .

... 10.

Employee relations and welfare ................................................................................. .

Insurance ............................................... ..

................ .4,217 .......................... 12,652 .... 1,874 .......... 18,743

.. .............................................................. 17,198 ............................ 1,911 ......... 19,109

11. Directors' fees ............................................................................................................................................... .. ........................ ... 9,627 ............................ 1,070 .............. 10,697

12. Travel and travel items ......................................................................... .. ........... 13,825 ............................ 1,536 ................. 15,361

13. Rent and rent items ................................................. . .. .............. 2,618 .. ................. 10,340 ............. 131 .......................... 13,089

_ 14. Equipment.. .......................... .. .. .............. 7,680 ............... 18,316 ................................. 12 .......................... 26,008

15. Cost or depreciation of EDP equipment and software.................... ........ .............. ......... .. .................. .. . .......................... 0 .. 16. Printing and stationery.............. ....................................................... ........................... . ................... 978 ................... 3,864 ................................ .49 .............. 4,891

_ 17. Postage, telephone and telegraph, exchange and express........................................... .. .................. 898 .......................... 7,377 ............................ 898 ..... .. .......... 9, 173 .. 18. Legal and auditing ..................................................................................................... r'''''' ==."' ... "' ... "' ... "' ... "'6,"'29"-7+=== ... "' .. "' ... ""18"',8""90'+=."' ... "' ... "'."", ... ", ... ", ... ", ... ",6""29"-7+ .. ", ... ", ... ", ... ", ... ", ... ", ... ", ... ", ... "-.31,,,,4,,,84"-1

19. Totals (Lines 3 to 18) ........................................................................................................................... 74,238 ... 256,597 .......................... 30,629 ........................ 361,464

20. Taxes, licenses and fees:

- 20.1 State and local insurance taxes deducting guaranty association credits

of $ .......... 0... .......................................... .. ............................ .. . ...................... 24,048 .................. 24,048 - 20.2 Insurance department licenses and fees....... ............................. ...................... .. ........................... 555 ...................................... .. ................... 555 - 20.3 Gross guaranty association assessments............... .................... ............... ...................................... .................................... ...................................... .. ................. 0

20.4 All other (excluding federal and foreign income and real estate). ... ...................................... .................. .................. ......................... .. ............................. 0

- 20.5 Total taxes, licenses and fees (20.1 + 20.2 + 20.3 + 20.4).... .. ............................................ 0 .......... 24,603 ...................... ...0 .......................... 24,603

_ 21. Real estate expenses.................................................. .......................... .. ... 1,192 ............................ 4,709 ............................ 5,288 .......................... 11,189

22. Real estate taxes......... ................................................. ................................ ........................... . ......................................... " ............. 2,781 ............................ 2,781

- 23. Reimbursements by uninsured plans.................... .................... ........................... ...................................... ....................... .. ................................. 0

_ 24. Aggregate wnte-ins for miscellaneous expenses.......... ....................... ........................ .. ........... 1119 ............ .4,429 .......................... 21,884 ......... 27,432

25. Total expenses incurred.................................................... ...................... .. ... 115,998 ....................... 642,915 .......................... 60,582 (a) .................... 819,495

- 26. Less unpaid expenses - current year.... .......................................................... .. ..... 6,505 .......................... 13, 110 ............................ 7,207 .......................... 26,822

_ 27. Add unpaid expenses - pnor year....... .. ............................................................ .. ... 4,044 .......................... 13,949 ........... .7,381 ....... 25,374

28. Amounts receivable relating to uninsured plans, prior year........................................... .. ...................... . ........................... .. ....................................................................... 0

,. 29. Amounts receivable relating to uninsured plans, current year ........................................ r""'''''''''''''''''''''''''''''''''''''''===f''''''''''''''''''''''''''''''''''''''''''''''''''''''''''."' ... "' ... "'. +"''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''':.c' r'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''-10 .,.j 30. TOTAL EXPENSES PAID (Lines 25 - 26 + 27 - 28 + 29)........... ........................ .. ..................... 113,537 ................ 643,754 ................ 60,756 ............... 818,047

DETAtLS OF WRITE-INS

2401. Fumiture and Equipment Depreciation ..................................................................................................... 160 ................. 632 ..................... 8 ............................... 800

......................... 3,788 ................................ .48 ................... .4,795

................... .. ........................ 21,828 .......................... 21,828 J' 2~4~0~328·: Auto Depreciation..................................................... .................................... .. ............................. 959

Investment Expense..................... ............................................ .......................... .. ...................... ..

Summary of remaining write-ins for Line 24 from overflow page................................... .. ................................ 0 ........ 0 ................................... 9

~2~49~9.~To~ta~ls~(lLi~·n~es~2~40~1~th~ro~,UQ~th~2~40~3~p11~lus~2~49~~uLI(~lLin~e~24~a~b~~~~~ .... "' ... "' ... = ... = ... = .... = ... = ... "' ... = ... = ... = .... = .. ~.= ... = ... = .... = ... = ... = ... "' ... = ... ~ .. 1~,1~19~~=."' ... = ... "' ... = .... = ... ~.4~,4~29~ .. "' ... = ... "' ... = .... = ... = ... = ... ~ .. 2~1~88~4~ .. = .... = ... = ... = ... = ... "' .. = .... ~.2~7~43~2 .. (a) Includes management fees of $ .......... 0 to affiliates and $ .......... 0 to non-affiliates.

11 01/24/2017 7:56:59 AM

Annual Stalement for the year 2016 of the Pocahontas Mutual Insurance Association

EXHIBIT OF NET INVESTMENT INCOME 2

Collected Earned DurillQ Year DurillQ Year

1. U.S. government bonds ...................................................................................................................................................... (a) .................................................................................................... .. 1.1 Bonds exempt from U.S. tax.............................................................................. .................................................................. (a) .................................... 57,099 ......................................... 56,863 1.2 Other bonds (unaffiliated)................................................ ...................................................... .............................................. (a) ..................................... 20,110 ........................................ 20,314 1.3 Bonds of affiliates..................................... . ......................................................................................................... (a)................................................. .. .................................................. . 2.1 Preferred stocks (unaffiliated)............................................................................................................................................... (b) ..................................... 23,848 ......................................... 23,848

Preferred stocks of affiliates .................................................................................................................................................. (b)................................................. ..................................................... I 2.11 2.2

2.21 3.

Common stocks (unaffiliated) ...................................................................................................................................................................................... 38,311 ......................................... 38,311 Common stocks of affiliates ................................................................................................................................................ .

4. 5. 6. 7. 8.

Mortgage loans..................................................................................................................................................................... (c)................................................. ........................................... ......... I Real estate........................................ . .................................................................................................................. (d) ..................................... 18,700 ......................................... 18,700 Contract loans................... ..................... .............. ................................................... ......................................... .................... ..... ..................... .................. ......... .. .................................................. . Cash, cash equivalents and short-term investments ............................................................................................................ (e) ....................................... 1,671 ........................................... 1,754

~~~:~:~v:~~:~rua::~=::::::::::::::::::::::::::: .................. ::.:::::::.::::::::::::::::::::: ....... ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: m ........ :.::::::::::::::.:::::::::::::::::::: ..... ::::::::::::::::::::::::::::::::::.:::.:::::::::::::: I 9. Aggregate write-ins for investment income..................................................... ............................................................... ..... .. ................................................ 0 ..................................... 0 10. Total gross investment income................................................................................ . .................................................................................... 159,739 ....................................... 159,790 11. Investment expenses.................................................................................................................................................................................................................... (g) ..................................... 60,582 I. 12. Investment taxes, licenses and fees, excluding federal income taxes ........................................................................................................................................ (g) ................................................ . 13. Interest expense.............. . .......................................................................................................................................................................................... (h) ................................................ . 14. Depreciation on real estate and other invested assets........................................................................................................................................................ (i) ........................................ 6,799 15. Aggregate write-ins for deductions from investment income...... ............................................... ................................................................................................. . ................................................. 0 I 16. Total deductions (Lines 11 through 15)................................................................. ....................................................................................................................... . .................................. 67381 . 17. Net investment income (Line 10 minus Line 16) .................................................................................................................................................................................................................. 92,409

0901. 0902. 0903.

DETAilS OF WRITE·INS

I 0998. Summary of remaining write-ins for line 9 from overflow page............................................... ............................................ .. ................................................ 0 .......................................... 0 I 0999. Totals (Lines 0901 throuah 0903 plus 0998) (Line 9 aboveL ............................................................................................................................................... 0 .................................................. 0 1501. ....................... . ............................................................................................................................................................................................................................................................ .. 1502. ................................................................................................................... ...................................................................................... .................................... . ................................................... .

~~~~: s~~~~·~·~f ~~;i~i~~·~;i;~~i~;·;;;·Li~·~ .. ;·~ .. ;~~·;~~~·~~·~~~~:::::::::::::::::::::::::.:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:::::::::::::::::::::::::::::::::::: ·::·:·:::::::::::::::::: ...... :::··.·:·::::.··:::::::0· I 1599. Totals (Lines 1501 through 1503 plus 1598) (Line 15 above) ........................................................................................................................................................................................................ 0

(a) Includes $ .... .457 accrual of discount less $ .... .7,025 amortization of premium and less $ ..... 3,067 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 $ .......... 0 amortization of premium and less $ .......... 0 paid for accrued interest on purchases. I (d) Includes $ ..... 13.000 for company's occupancy of its own buildings; and excludes $ .......... 0 interest on encumbrances. (e) Includes $ .......... 0 accrual of discount less $ .......... 0 amortization of premium and less $ .......... 0 paid for accrued interest on purchases. m Includes $ .......... 0 accrual of discount less $ .......... 0 amortization of premium. (g) Includes $ .......... 0 investment expenses and $ .......... 0 investment taxes. licenses and fees, excluding federal income taxes. attributable to segregated and Separate Accounts. I (h) Includes $ .......... 0 interest on surplus notes and $ .......... 0 interest on capital notes. (i) Includes $ ..... 6.799 depreciation on real estate and $ .......... 0 depreciation on other invested assets. I

I ~ _____________ E=X~H=IB~ITrO~F~C~A~P~IT~A=L~G~~~IN=S~(L~O~S~SE~3S~;)~--~4--~---5~1

Realized Change in Gain (Loss) Other Total Realized Change in Unrealized

on Sales Realized Capital Gain (loss) Unrealized Foreign Exchange I ~ __________________ ~_~o~r~M~at~u~riwL-_+-~A~d~i·,u~stm~en~ts~-4_~(IC~0~lu~m~ns~I~+~2~)~~C~a~Dii~ta~IG~a~in~lIlo~ss~)+-~Ca~Dita~I~G~ai~n~lIl~o~~~~)

1. U.S. govemment bonds .............................................................. . ................................. 0 .. ............................... 0 ................................ 97

.. .................. 0

1.1 Bonds exempt from U.S. tax ...... .. 1.2 Other bonds (unaffiliated) .......................................................... .. .. .................. 97 I 1.3 Bonds of affiliates ....................................................................... . 2.1 Preferred stocks (unaffiliated) ........ . .. .............................. 0 ........................ (23.810) ........................ .

....................... 192.177 :::::::::::::::::::::::::::::::·· .. ·1 2.2 Common stocks (unaffiliated) ..................................................... . 2.21 Common stocks of affiliates ........................................................ .

.. ....................... 54,488 .. ................................ 0 ......................... 54,488

. .................... 0

2.11 Preferred stocks of affiliates .................... .

3. Mortgage loans ........................................................................... . .. ................................ 0 4. Real estate .................................................................................. . .. ................................ 0

.. ................................ 0 ::::::::::::::::::::::::::::::::::::: I 5. Contract loans.............................................................................. . .................................. .. 6. Cash. cash equivalents and short·term investments ...................................................... .. .. ............... 0 7. Derivative instruments.................................................................. ..... .............................. ..................................... .. ................................ 0 .... ................................ . ................................... . 8. 9.

Other invested assets............... ................... .................. ............... ................... ................. ..................................... .. ................................ 0 ........ ............................ ... ............................ ...... I Aggregate write·ins for capital gains (losses)............................... .. ................................ 0 .................................. 0 .................................. 0 .................................. 0 .................................. 0

10. Total capital gains (losses) .................................................................................... 54.585 .................................. 0 ......................... 54.585 ....................... 168,367 .................................. 0

DETAilS OF WRITE·INS 0901. 0902. 0903. 0998. Summary of remaining write·ins for Line 9 from overflow page... .. ................................ 0 0999. Totals (Lines 0901 through 0903 olus 0998) (Line 9 above)........ .. .......................... 0

12

.. ............................... 0

.. ............................... 0

.. ............................... 0 ........ 0 ................................. 0 .................. 0 ....................... 0

............. 0 .................................. 0 ................... 0 .................................. 0

01/24/2017 7:57:00 AM

I

..

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

EXHIBIT OF NONADMITTED ASSETS

1. Sonds (Schedule D) .................................................................................................................. .

2. Stocks (Schedule D):

2.1 Preferred stocks ................................................................................................................. .

2.2 Common stocks .................................................................................................................. .

Current Year Total

Nonadmitted Assets

... 3. Mortgage loans on real estate (Schedule B):

2 Prior Year

Total Nonadmitted Assets

3.1 First liens .................................................................................................................................................................................................... . .. 3.2 Other than first liens ...................................... .. .-

4. Real estate (Schedule A): .. 4.1 Properties occupied by the company ................................................................................. .

III 4.2 Properties held for the production of income ...................................................................... ..

4.3 Properties held for sale ..................................................................................................... ..

... 5. Cash (Schedule E-Part 1), cash equivalents (Schedule E-Part 2)

and short-term investments (Schedule DA) .................................................................................. .

3 Change in Total

No~admitted Assets tCol. 2 - Col. 11

.. ........................................... 0

.. ................................... 0

.. .......................................... 0

.. .......................................... 0

.. .......................................... 0

. ........................ 0

. ...................... 0

. .................................... 0

. ...................................... 0

6. Contract loans .................................................................................................................... . . ............................................................................................................................................ 0

... 7. Derivatives (Schedule DB) ..................................................................................................... . . .......................................... 0

III 8. Other invested assets (Schedule SA) ................................ . . ....................................... 0

9. Receivables for securities .................................... . .. .......................................... 0

.. 10. Securities lending reinvested collateral assets (Schedule Dl) ....................................................................................................... . . ........................ 0

.. 11. Aggregate write-ins for invested assets ........................................................ . .. .. .. .. .. .. .. .... f-=""''''''' '''-C'' ."" .... "" .. '''-C''' "" .... "" .. '''-C'' ."" .... "" ... "' ... ",-. 0 +C .. '''-C''' "" .... "" .. '''-C'' ."" .... "" .. '''-C'' • "" .... "" .. '''-C''' "" .... "" ... ", .. 0,--+-,"""" '''-C''' "" .... "" .. '''-C'' • "".. ."" .. '''-C'' • "" .... "" .. '''-C'' ."" .... "" ... ~O 12. Subtotals, cash and invested assets (Lines 1 to 11) .................................................................... . ............................................. 0 ........................................... 0 ............................................. 0 - 13. Title plants (for Title insurers only) .............................................................................................. .. . ........................................... 0

... 14. Investment income due and accrued ......................................................................................... .. .. .......................................... 0

15. Premiums and considerations:

15.1 Uncollected premiums and agents' balances in the course of collection .......... .. ........................................... 0 ... 15.2 Deferred premiums, agents' balances and installments booked but

- deferred and not yet due ..................................................................................................... . .. ........................................... 0

15.3 Accrued retrospective premiums and contracts subject to redetermination ...... . .. ........................................... 0

... 16. Reinsurance:

- 16.1 Amounts recoverable from reinsurers ............................................................................... .. .. ........................................... 0

16.2 Funds held by or deposited with reinsured companies ...................................................... .. .. ........................................... 0 ... 16.3 Other amounts receivable under reinsurance contracts ................................................................................ . .. ........................................... 0

_ 17. Amounts receivable relating to uninsured plans ............................................................................................................................................................ . . ..................................... 0

... 18.1 Current federal and foreign income tax recoverable and interest thereon ....... . ............................................ 0

18.2 Net deferred tax asset. ............................................................................................................... .. . ......................................... 0

- 19. Guaranty funds receivable or on deposi!.. .................................................................................... . . ........................................... 0

... 20. Electronic data processing equipment and software .................................................................... .. . ........................................ 0

21. Furniture and equipment, including health care delivery assets .................................................. .. ........................ ........... 19,010 .................................... 24,228 ............................ 5,218

~ 22. Net adjustment in assets and liabilities due to foreign exchange rates .............. " ........................ .. . ........................................... 0

... 23. Receivables from parent, subsidiaries and affiliates .................................................................... .. . ........................................... 0

24. Health care and other amounts receivable .................................................................................... . . ......................... 0 -25. Aggregate write-ins for other-than-invested assets ........................................................................ f"' ... ", ... ", ... ", .. ", ... ", ... ", ... ", ... ", ... ", .. ", ... ", ... ", ... ,-,.1-",2",25"-+-"-",,,,,,,,,,,."' ... "' ... "' ... "' ... "' .. "' .. ",.", ... ", ... ", ... ,-,.1-",2=2,,-5 -1--"-""''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' "' ... "' ... ;-....0

- 26. Total assets excluding Separate Accounts, Segregated Accounts and Protected

Cell Accounts (Lines 12 through 25).... ......................................................................................... . .................................. .20,235 ................................ 25,453 ...................................... 5,218 -27. From Separate Accounts, Segregated Accounts and Protected Cell Accounts............................. ................................................. ................................................. .. ........................................... 0

- 28. TOTALS (Lines 26 and 27).................................... ............................................. ........... .. .................................. 20,235 .................................... 25,453 ...................................... 5,218

DETAILS OF WRITE-INS

1101 .............................................................................................................. .. .. ........................................... 0 -1102 ................................................................................................ . .. ........................................... 0

_ 1103 ...................................................................................................................................................... .. .. ........................................... 0

_ 1198. Summary of remaining write-ins for Line 11 from overflow page .................................................. . ..................................... ....... 0 ............................................. 0 ............................................. 0

1199. Totals (Lines 1101 throuQh 1103 plus 1198) (Line 11 above).. .................................................... .. .................................... ........ 0 ............................................. 0 .......................................... 0

.. 2501. Foreign Tax Withheld........................................ .. ....................................................... . ................................ ..... 1,225 ...................................... 1,225 ............................................. 0

• 2502 ...................................................................................................................................................... .. . ............................................ 0

2503 ...................................................................................................................................................... .. .. ........................................... 0

.. 2598. Summary of remaining write-ins for Line 25 from overflow page.................................................. .. ........................................... 0 ............................................. 0 ............................................. 0

_ 2599. Totals (Lines 2501 throuQh 2503 plus 2598) (Line 25 above)......................................... .. .................................... 1 ,225 ...................................... 1 ,225 ............................................. 0

13 01/24/2017 7:57:00 AM

Annual Statementforthe year 2016 of the Pocahontas Mutual Insurance Association

NOTES TO FINANCIAL STATEMENTS

1. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

2.

3.

4.

BASIS OF PRESENTATION - The accompanying financial statements have been prepared in conformity with accounting practices prescribed or permitted by the Iowa Department of Commerce, Insurance Division and the statutory accounting principles which vary in certain respects from accounting principles generally I accepted in the United States of America. The more important differences are as follows:

a. Equity securities are valued at market with the unrealized gains or losses reflected in reserve for I policyholders' protection. Debt securities are valued at amortized cost. The securities are not classified .. as (1) held to maturity, (2) trading, or (3) available for sale securities.

b. Certain assets designated as "non-admitted assets" (agents' balances over ninety days old and equipment) I are subtracted from the financial statements and are charged to reserve for policyholders' protection. Non-admitted assets for December 31, 2016 consisted of the following: I

Automobile Furniture and Equipment Foreign Tax Withheld Total

$15,584 3,426 1,225

$20,235

c. Acquisition costs, such as commissions to agents, premium tax, and other items incurred upon the issuance of new business are charged to current operations as incurred rather than being deferred to future periods as the related premium income is recognized.

d. Income taxes are provided only for amounts which are currently reported for tax purposes on the statement of income-statutory basis. Deferred taxes are not reflected.

I I I I

DEPRECIATION OF PROPERTY AND EQUIPMENT- Property and equipment are depreciated over their estimated useful lives ranging from 5 to 40 years using the straight-line method of depreciation. I PREMIUM INCOME RECOGNITION - Premiums are recognized as income on a monthly pro rata basis over the life of each policy.

UNPAID LOSSES - Reported losses are estimated on an individual case basis. Incurred but not reported losses are estimated based upon past experience.

I I

MANAGEMENT'S ESTIMATES - The preparation of financial statements in conformity with accounting I practices prescribed or permitted by the Iowa Department of Commerce, Insurance Division requires . management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts I of revenues and expenses during the reporting period. Actual results could differ from those estimates.

SUBSEQUENT EVENTS - Subsequent events have been evaluated from January 1, 2017 through Februaryl 15,2017 which is the date these financial statements were issued. There are no subsequent events that materially affect these financial statements.

ACCOUNTING CHANGES AND CORRECTIONS OF ERRORS Not Applicable

BUSINESS COMBINATIONS AND GOODWILL Not Applicable

DISCONTINUED OPERATIONS Not Applicable

I I I I

5. INVESTMENTS Bonds are valued at amortized cost and stocks and mutual funds are valued at market. Changes in unrealized gains and losses resulting from investments in stock and mutual funds are reported as direct increases or decreases in surplus.

Realized gains or losses on disposition of investments are included in net investment income. Cost of investments sold are determined on a specific identification basis.

Market values were obtained from financial journals, brokers, or the best evidence available.

14 01/29/2017 1:16:58 PM

I

Annual Stalementfor the year 2016 of the Pocahontas Mutual Insurance Association

...

NOTES TO FINANCIAL STATEMENTS

6. JOINT VENTURES, PARTNERSHIPS AND LIMITED LIABILITY COMPANIES Not Applicable

7. INVESTMENT INCOME III All investment income is included and there is no investment income excluded and/or over 90 days

past due.

• 8. DERIVATIVE INSTRUMENTS

• ... .. -------------.. ----.. -.. --

Not Applicable

9. INCOME TAXES The current year's operations ending December 31,2016 resulted in taxable income of $103,942. The prior year's operations ending December 31, 2015 resulted in taxable loss of$174,270. The prior year's taxable loss has been carried forward to 2016, resulting in no Federal income tax in 2016. The amount of Federal income taxes incurred and available for recoupment in the event of future net losses is $0 for both 2016 and 2015, respectively. The Company has a $386,644 net operating loss carryforward. The two preceding and current tax years remain subject to examination by the Internal Revenue Service.

10. INFORMATION CONCERNING PARENT, SUBSIDIARIES, AND OTHER RELATED PARTIES Not Applicable

11. DEBT Not Applicable

12. RETIREMENT PLANS, DEFERRED COMPENSATION, POSTEMPLOYMENT BENEFITS AND COMPENSATED ABSENCES AND OTHER POSTRETIREMENT BENEFIT PLANS The Association has established a defined contribution profit sharing plan. All full-time employees participate in the plan after completing their first full year of service. The contribution to the plan for 2016 was $16,006.

13. CAPITAL AND SURPLUS, DIVIDEND RESTRICTIONS AND QUASI-REORGANIZATIONS Unassigned Surplus - The Association's surplus is held for the policyholders and there are no advances to surplus.

14. LIABILITIES, CONTINGENCIES AND ASSESSMENTS Not Applicable

15. LEASES The Association leases a portion of its home office on a year-to-year lease. Lease income was $5,700 in 2016.

16. INFORMATION ABOUT FINANCIAL INSTRUMENTS WITH OFF-BALANCE SHEET RISK AND FINANCIAL INSTRUMENTS WITH CONCENTRATIONS OF CREDIT RISK Not Applicable

17. SALE, TRANSFER AND SERVICING OF FINANCIAL ASSETS AND EXTINGUISHMENTS OF LIABILITIES Not Applicable

18. GAIN OR LOSS TO THE REPORTING ENTITY FROM UNINSURED PLANS AND THE PORTION OF PARTIALLY INSURED PLANS Not Applicable

19. DIRECT PREMIUM WRITTENIPRODUCED BY MANAGING GENERAL AGENTS! THIRD PARTY ADMINISTRATORS Not Applicable

20. FAIR VALUE MEASUREMENT Not Applicable

21. OTHER ITEMS Not Applicable

14.1 01/2912017 1:16:58 PM

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

NOTES TO FINANCIAL STATEMENTS

22. EVENTS SUBSEQUENT Not Applicable

23. REINSURANCE Not Applicable

24. RETROSPECTIVELY RATED CONTRACTS & CONTRACTS SUBJECT TO REDETERMINATION Not Applicable

25. CHANGE IN INCURRED LOSSES AND LOSS ADmSTMENT EXPENSES Not Applicable

26. INTERCOMPANY POOLING ARRANGEMENTS Not Applicable

27. STRUCTURED SETTLEMENTS Not Applicable

28. HEALTH CARE RECEIVABLES Not Applicable

29. PARTICIPATING POLICIES Not Applicable

30. PREMIUM DEFICIENCY RESERVES Not Applicable

3l. HIGH DEDUCTIBLE Not Applicable

32. DISCOUNTING OF LIABILITIES FOR UNPAID LOSSES OR UNPAID LOSS ADmSTMENT EXPENSES Not Applicable

33. ASBESTOS/ENVIRONMENTAL RESERVES Not Applicable

34. SUBSCRIBER SAVINGS ACCOUNTS Not Applicable

35. MULTIPLE PERIL CROP INSURANCE Not Applicable

36. FINANCIAL GUARANTY INSURANCE Not Applicable

14.2 01/29/2017 1: 16:58 PM

I I I I I I I I I I I I I I I I I I I

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

1.1

1.2

"'I .. ... 1.3

2.1 .. 2.2 - 3.1 .. 3.2

-3.3

... 3.4

-3.5 .. 3.6

4.1

...

4.2 --5.1

5.2

.--...

6.1 -6.2 -7.1

7.2 --... 8.1

- 8.2

8.3

GENERAL INTERROGATORIES PART 1· COMMON INTERROGATORIES

GENERAL Is the reporting entity a member of an Insurance Holding Company System consisting of two or more affiliated persons, one or more of which is an 'Insurer1 If yes, complete Schedule Y, Parts 1, lA and 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?

State regulating?

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 reporting entity?

If yes, date of change:

State as of what date the latest finanCial examination of the reporting entity was made or is being made.

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.

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 sheet date).

By what department or departments? Insurance Department of the State of Iowa

Have all financial statement adjustments within the latest financial examination report been accounted for in a subsequent financial statement filed with departments?

Have all of the recommendations within the latest financial examination report been complied with?

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?

4.12 renewals?

During the period covered by this statement, did any saleslservice 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?

4.22 renewals?

Has the reporting entity been a party to a merger or consolidation during the period covered by this statement?

If yes, provide the name of 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 memer or consolidation.

1

Name of Entity

Has the reporting entity had any Certificates of Authority, licenses or registrations (including corporate registration, if applicable) suspended or revoked by any govemmental entity during the reporting period?

If yes, give full infonmation:

Does any foreign (non-United States) person or entity directly or indirectly control 10% or more of the reporting entity?

If yes,

7.21 State the percentage of foreign control

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 attomey-in-fact and identify the type of entity(s) (e.g., individual, corporation, government, manager or attomey-in-fact).

2 1 Nationality Type of Entity

Is the company a subsidiary of a bank holding company regulated with the Federal Reserve Board?

If response to 8.1 is yes, please identify the name of the bank holding company.

Is the company affiliated with one or more banks, thrifts or securities finms?

Yesl] NoIX]

Yes I] No I] N/A I ]

Yesl] NoIX]

12/31/2012

12/31/2012

12/09/2013

Yes IX] Nol] N/AI ]

N/AI ] YeslX] Nol]

Yesl] NoIX]

YeslX] Nol]

Yesl] NoIX]

Yesl] NoIX]

Yesl] NoIX]

2 3 NAIC

Company State of Code Domicile

Yesl] NoIX]

Yesl] NoIX]

%

Yesl] NoIX]

Yesl] NoIX] _ 8.4

If the response to 8.3 is yes, please provide below the names and locations (city and state of the main office) of any affiliates regulated by a federal financial regulatory services agency U.e. the Federal Reserve Board (FRB), the Office of the Comptroller of the Currency (OCC), the Federal Deposit Insurance Corporation (FDIC) and the Securities ExchanQe Commission (SEC)] and identify the affiliate's primary federal reQulator.

1 2 3 - Affiliate Name Location (City, State) FRB

- 9. What is the name and address of the independent certified public accountant or accounting firm retained to conduct the annual audit?

...

... ..

... -

10.1

Hunzelman, Putzier & Co., PLC, P.O. Box 398, Stonm Lake, IA 50588

Has the insurer been granted any exemptions to the prohibited non-audtt services provided by the certified independent public accountant requirements as allowed in Section 7H of the Annual Financial Reporting Model Regulation (Model Audit Rule), or substantially similar state law or regulation?

10.2 If the response to 10.1 is yes, provide infonmation related to this exemption:

10.3 Has the insurer been granted any exemptions related to other requirements of the Annual Financial Reporting Model Regulation as allowed for in Section 18A of the Model Regulation, or substantially similar state law or regulation?

lOA If the response to 10.3 is yes, provide infonmation related to this exemption:

10.5 Has the reporting entity established an Audit Committee in compliance with the domiciliary state insurance laws?

10.6 If the response to 10.5 is no or nla, please explain:

4 5 6 OCC FDIC SEC

Yesl] NoIX]

Yesl] NoIX]

Yes I X] No I] N/A I ]

15 01/30/2017 10:37:18 AM

Annual Statement for the year 2016 afthe Pocahontas Mutual Insurance Association

GENERAL INTERROGATORIES PART 1· COMMON INTERROGATORIES

11. 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? Not applicable.

12.1 Does the reporting entity own any securities of a real estate holding company or otherwise hold real estate indirectly?

12.11 Name of real estate holding company

12.12 Number of parcels involved

12.13 Total book/adjusted carrying value

12.2 If yes, provide explanation

13. FOR UNITED STATES BRANCHES OF ALIEN REPORTING ENTITIES ONLY:

13.1 What changes have been made during the year in the United States manager or the United States trustees of the reporting entity?

13.2 Does this statement contain all business transacted for the reporting entity through its United States Branch on risks wherever located?

13.3 Have there been any changes made to any of the trust indentures during the year?

13.4 If answer to (13.3) is yes, has the domiciliary or entry state approved the changes?

14.1 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[ ]

(a) Honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and 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 govemmentallaws, rules and regulations;

(d) The prompt intemal reporting of violations to an appropriate person or persons identified in the code; and

(e) Accountability for adherence to the code.

14.11 If the response to 14.1 is no, please explain:

14.2 Has the code of ethics for senior managers been amended?

14.21 If the response to 14.2 is yes, provide infonmation related to amendment(s).

14.3 Have any provisions of the code of ethics been waived for any of the specified officers?

14.31 If the response to 14.3 is yes, provide the nature of any waiver(s).

15.1 Is the reporting entity the beneficiary of a Letter of Creditthat is unrelated to reinsurance where the issuing or confinming bank is not on the SVO Bank List?

15.2 If the response to 15.1 is yes, indicate the American Bankers Association (ABA) Routing Number and the name of the issuing or confinming bank of the Letter of Credit and describe the circumstances in which the Letter of Credit is tri~gered.

1 2 3 American Bankers Association (ABA) Circumstances That Can Trigger

Routing Number Issuing or Confirming Bank Name the Letter of CredR

BOARD OF DIRECTORS 16. Is the purchase or sale of all investments of the reporting entity passed upon either by the Board of Directors or a subordinator committee thereof?

17. Does the reporting entity keep a complete permanent record of the proceedings of its Board of Directors and all subordinate committees thereof?

18. Has the reporting entity an established procedure for disclosure to Rs 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 such person?

FINANCIAL 19. Has this statement been prepared using a basis of accounting other than Statutory Accounting Principles (e.g., Generally Accepted Accounting Principles)?

20.1 Total amount loaned during the year (inclusive of Separate Accounts, exclusive of policy loans):

20.11 To directors or other officers $

20.12 To stockholders not officers $

20.13 Trustees, supreme orgrand (Fratemal only) $

20.2 Total amount of loans outstanding at the end of year (inclusive of Separate Accounts, exclusive of policy loans):

20.21 To directors or other officers $

20.22 To stockholders not officers $

20.23 Trustees, supreme or grand (Fratemal only) $

21.1 Were any assets reported in this statement subject to a contractual obligation to transfer to another party without the liability for such obligation being reporting in the statement?

21.2 If yes, state the amountthereof at December 31 of the current year.

21.21 Rented from others $

21.22 Borrowed from others $ 21.23 Leased from others $

21.24 Other $ 22.1 Does this statement include payments for assessments as described in the Annua/ Statement Instructions other than guaranty fund or

guaranty association assessments?

22.2 If answer is yes:

22.21 Amount paid as losses or risk adjustment $ 22.22 Amount paid as expenses $

22.23 Other amounts paid $

23.1 Does the reporting entity report any amounts due from parent, subsidiaries or affiliates on Page 2 of this statement?

23.2 If yes, indicate any amounts receivable from parent included in the Page 2 amount: $

Yes [ ]

Yes [ ]

Yes [ ]

No[ ]

Yes [X]

Yes [ ]

Yes [ ]

Yes[ ]

4

Amount

Yes [X]

Yes [X]

Yes [X]

Yes [ ]

Yes [ ]

Yes[ ]

Yes [ ]

15.1 01/24/2017 7:57:19 AM

No[X]

0 I 0

I I

No[ ]

No[

~I N/A [

No[ ] , I

NO[X]I

NO[X]I

NO[X]I

I

No[ ]1

No[ ]

No[ ]1 No[X] E

0

0 I 0

0 I 0

0

NO[X]I

I No[X] E

I No[X]

0

,.,. __ ........ _,_~_. _"'i_ ... ,_,.;r ______________________________________ .. _______ ..

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

GENERAL INTERROGATORIES PART 1 . COMMON INTERROGATORIES

INVESTMENT 24.01 Were all of 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 24.03)?

24.02 .. .. 24.03

If no, give full and complete information, relating thereto:

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 altemative is to reference Note 17 where this information is also provided) .

Yes[] No[X]

.. 24.04

.III 24.05

24.06

... 24.07 .. Does the company's security lending program meet the requirements for a conforming program as outlined in the Risk-Based Capital Instructions?

If answer to 24.04 is yes, report amount of collateral for conforming programs.

Yes [ ] No[ ] N/A[X]

24.08

If answer to 24.04 is no, report amount of collateral for other programs

Does your securities lending program require 102% (domestic securities) and 105% (foreign securities) from the counterparty at the outset of the contract?

Does the reporting entity non-admit when the collateral received from the counterparty falls below 100%?

.. 24.09. Does the reporting entity or the reporting entity's securities lending agent utilize the Master Securities Lending Agreement (MSLA) to conduct securities lending?

.III 24.10 For the reporting entity's security lending program, state the amount of the following as of December 31 of the current year:

24.101 Total fair value of reinvested collateral assets reported on Schedule DL, Parts 1 and 2:

24.102 Total book adjustedlcarrying value of reinvested collateral assets reported on Schedule DL, Parts 1 and 2:

24.103 Total payable for securities lending reported on the liability page:

25.1 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 current in force? (Exclude

securities subject to Interrogatory 21.1 and 24.03.)

.. 25.2 If yes, state the amount thereof at December 31 of the current year:

- 25.21 Subject to repurchase agreements

25.22 Subject to reverse repurchase agreements ... 25.23 Subject to dollar repurchase agreements

25.24 Subject to reverse dollar repurchase agreements .... 25.25 Placed under option agreements

... 25.26 Letter stock or securities restricted as sale - excluding FHLB Capital Stock

....

-25.3 -

25.27 FHLB Capital Stock

25.28 On deposit with states

25.29

25.30

25.31

25.32

On deposit with other regulatory bodies

Pledged as collateral- excluding collateral pledged to an FHLB

Pledged as collateral to FHLB - including assets backing funding agreements

other

For cateQory (25.26) provide the foliowinQ:

1 Nature of Restriction

Does the reporting entity have any hedging transactions reported on Schedule DB?

2 Description

$

$

Yes [ ] No[ ] N/A[X]

Yes [ ] No[ ] N/A[X]

Yes [ No[ ] N/A[X]

$ 0

$ 0

$ 0

Yes [ ] No[X]

$ 0

$ 0

$ 0

$ 0

$ 0

$ 0

$ 0

$ 0

$ 0

$ 0

$ 0

$ 0

3 Amount

$

Yes [ .... 26.1

26.2 ... If yes, has a comprehensive description of the hedging program been made available to the domiciliary state? If no, attach a description with this statement.

Yes [] No [ ]

No[X]

N/A[ ]

- 27.1 ... 27.2

_28.

... -.. -... .. .... .. -...

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?

If yes, state the amount thereof at December 31 of the current year.

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 1, III - General Examination Considerations, F. Outsourcing of Critical Functions, Custodial or Safekeeping Agreements of the NAIC Financial Condftion Examiners Handbook?

28.01 For all aqreements that comply with the requirements of the NAIC Financial Condifion Examiners Handbook, complete the foliowinQ:

1 2

$

Name of Custodian(s) Custodian's Address

Wells Fargo Des Moines, IA

28.02 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

1 2 3 Name(s) Location(s) Complete Explanation(s)

28.03 Have there been any changes, including name changes, in the custodian(s) identified in 28.01 during the current year?

28.04 If yes, give full and complete information relatina thereto:

1 2 3 Old Custodian New Custodian Date of Chanae

28.05 Investment management - Identify all investment advisors, investment managers, broker/dealers, including individuals that have the authority to make investment decisions on behalf of the reporting entity. For assets that are managed internally by employees of the reporting entity, note as such. r".that have acoass to the investment accounts", "". handle securities"!.

1 2 Name of Firm or Individual Affiliation

TeaMiood Asset Manaaement U

Yes [ ] No[X]

Yes [X] No[]

Yes [] No [X]

4 Reason

15.2 01/24/2017 7:57:20 AM

Annual Sialemenifor the year 2016 of the Pocahontas Mutual Insurance Association

GENERAL INTERROGATORIES PART 1· COMMON INTERROGATORIES

28.0597 For those firms/individuals listed in the table for Question 28.05, do any firms/individuals unaffiliated with the reporting entity (Le. designated with a 'U') manage more than 10% of the reporting entity's assets?

28.0598 For firms/individuals unaffiliated with the reporting entity (i.e. deSignated with a "U') listed in the table for Question 28.05, does the total assets under management aggregate to more than 50% of the reporting entity's assets?

28.06 For those firms or individuals listed in the table for 28.05 with an affiliation code of "A' (affiliated) or 'U' (unaffiliated), provide the information for the table below

1 2 3

Central Registration Depository Number Name of Firm or Individual LeQal Enti~ldentifier (LEI)

105245 Tealwood Asset ManaQement

Yes[Xl No[ 1

Yes[] No[X]

4 5 I Investment

Management Registered Agreement

With (lMA) Filed I 29.1 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) (I)])?

29.2 If I th I II h d I Yes[] NO[X]I

r yes, complete e a oWing sc e u e:

1 2 3 II CUSIP Name of Mutual Fund Book/Adjusted Canrying

Value I 29.3

29.2999 TOTAL

For each mutual fund listed in the table above, complete the followino schedule: I 1 2 3 4

Amount of Mutual Fund's Book/Adjusted Canrying

Name of Mutual Fund Name of Significant Holding Value Attributable to the (from above table) of the Mutual Fund Holdino Date of Valuation

I 30. Provide the follOWing information or a I short-term an dl d ong-term bon s and all preferre stoc s. Do not su stitute amortized value or statement value for fair value. d k b I

1 2

Statement (Admitted) Value Fair Value

30.1 Bonds 1,948,060

30.2 Preferred Stocks 391,640

30.3 Totals 2,339,700

30.4 Describe the sources or methods utilized in determining the fair values:

31.1 Was the rate used to calculate fair value determined by a broker or custodian for any of the securtties in Schedule D?

31.2 If the answer to 31.1 is yes, does the reporting entity have a copy of the broker's or custodian's pricing policy (hard copy or electronic copy) for all brokers or custodians used as a pricing source?

31.3 If the answer to 31.2 is no, describe the reporting entity's process for determining a reliable pricing source for purposes of disclosure of fair value for Schedule 0:

32.1 Have all the filing requirements of the Purposes and Procedures Manual of the NAIC Investment Analysis Office been followed?

32.2 If no, list exceptions:

OTHER 33.1 Amount of payments to trade associations, service organizations and statistical or rating bureaus, if any?

33.2 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.

I Name

34.1 Amount of payments for legal expenses, if any?

34.2 List the name of the firm and the amount paid if any such payment represented25% or more of the total payments for legal expenses during~theQeriod covered by this statement.

1 Name

1,955,280

391,640

2,346,920

35.1 Amount of payments for expenditures in connection with matters before legislative bodies, officers or departments of govemment, if any?

35.2 List the name of the firm and the amount paid ~ any such payment represented 25% or more of the total payment expendttures in connection with matters before legislative bodies, officers or departments of govemment during the period covered by this statement.

1 Name

3 Excess of Statement over Fair Value (-), or Fair Value over

Statement (+) I 7,220

0

7,220 I Yes[X] NO[]I

Yes[X] No[]

I Yes[X] No[ 1

I $

5,501

1$ Amou~t Paid ,

5,50

$ I 2 I Amount Paid

$ • $ ,

2

I Amount Paid

$

I

15,3 01/24/2017 7:57:20 AM

UI. I

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

1.1

1.2

1.3

... 1.4 .. 1.5

... 1.6 ..

... ..

.. .. 1.7 ... ..

---.. 2. -..

'III .. -.. 3.1

3.2 -.. 4. --5. -

--I -6.1 ..

-6.2 .. .. 6.3 ..

6.4 -6.5 .. 7.1

GENERAL INTERROGATORIES PART 2- PROPERTY & CASUALTY INTERROGATORIES

Yes [] No [X] Does the reporting entity have any direct Medicare Supplement Insurance in force?

If yes, indicate premium earned on U.S. business only. $ 0

What portion of Item (1.2) is not reported on the Medicare Supplement Insurance Experience Exhibit? $ 0

1.31 Reason for excluding:

Indicate amount of earned premium attributable to Canadian andlor Other Alien not included in Item (1.2) above.

Indicate total incurred claims on all Medicare Supplement insurance.

$ 0 $ 0

Individual policies:

Most current three years:

1.61 Total premium eamed $ 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 eamed

1.65

1.66

Total incurred claims

Number of covered lives

Group policies:

Most current three years:

1.71 Total premium eamed

1.72 Total incurred claims

1.73 Number of covered lives

All years prior to most current three years:

1.74 Total premium eamed

1.75 Total incurred claims

1.76 Number of covered lives

Health Test:

2.1 Premium Numerator

2.2 Premium Denominator

2.3 Premium Ratio (2.1/2.2)

2.4 Reserve Numerator

2.5 Reserve Denominator

2.6 Reserve Ratio (2.4/2.5)

Current Year

$

$

$

$

Does the reporting entity issue both participating and non-participating policies?

If yes, state the amount of calendar year premiums written on:

3.21 Participating policies

3.22 Non-participating policies

FOR MUTUAL REPORTING ENTITIES AND RECIPROCAL EXCHANGES ONLY:

4.1 Does the reporting entity issue assessable policies?

4.2 Does the reporting entity Issue non-assessable policies?

0

0

0

0

4.3 If assessable policies are issued, what is the extent of the contingent liability of the policyholders?

$

$

$

$

4.4 Total amount of assessments paid or ordered to be paid during the year on deposit notes or contingent premiums.

FOR RECIPROCAL EXCHANGES ONLY:

5.1 Does the exchange appoint local agents?

5.2 If yes, is the commission paid:

5.21 Out of Attorney's-in-fact compensation

5.22 As a direct expense of the exchange

5.3 What expenses of the exchange are not paid out of the compensation of the Attorney-in-fact?

5.4 Has any Attomey-in-fact compensation, contingent on fulfillment of certain conditions, been deferred?

5.5 If yes, give full information:

2 Prior Year

0

0

0

0

What provision has this reporting entity made to protect itself from an excessive loss in the event of a catastrophe under a workers' compensation contract issued without limit of loss?

$

$

$

$

$

$

$

$

$

Describe the method used to estimate this reporting entity's probable maximum insurance loss, and identify the type of insured exposures comprising that probable maximum loss, the locations of concentrations of those exposures and the external resources (such as consulting firms or computer software models), if any, used in the estimation process:

What provision has this reporting entity made (such as catastrophic reinsurance program) to protect itself from an excessive loss arising from the types and concentrations of insured exposures comprising its probable maximum property insurance loss?

Does the reporting entity carry catastrophe reinsurance protection for at least one reinstatement, in an amount sufficient to cover its estimated probable maximum loss attributable to a single loss event or occurrence?

If no, describe any arrangements or mechanisms employed by the reporting entity to supplement its catastrophe reinsurance program or to hedge its exposure to unreinsured catastrophic loss:

Has the reporting entity reinsured any risk with any other entity under a quota share reinsurance contract that inCludes a provision that would limit the reinsure~s losses below the stated quota share percentage (e.g., a deductible, a loss ratio corridor, a loss cap, an aggregate limit or any similar provisions)?

o

o o o

o o o

o o o

Yes [ ] No[X]

0

0

Yes [X] No[ ]

Yes [ ] No[X]

%

0

Yes [ ] No[ ]

Yes [ ] No[ ] N/A[ ]

Yes [ ] No[ ] N/A[ ]

Yes [ ] No[ ]

Yes[] No[X]

Yes[] No[X]

16 01/24/2017 7:57:32 AM

Annual Sialemeni for the year 2016 of the Pocahontas Mutual Insurance Association

GENERAL INTERROGATORIES PART 2 - PROPERTY & CASUALTY INTERROGATORIES

7.2 If yes, indicate the number of reinsurance contracts containing such provisions.

7.3 If yes, does the amount of reinsurance cred~ taken reflect the reduction in quota share coverage caused by any applicable limiting provision(s)?

8.1 Has this reporting entity reinsured any risk with any other entity and agreed to release such entity from liability, in whole or in part, from any loss that may occur on this risk, or portion thereof, reinsured?

8.2 If yes, give full infonmation

9.1 Has the reporting entity ceded any risk under any reinsurance contract (or under multiple contracts with the same reinsurer or its affiliates) for which during the period covered by the statement: (i) it recorded a positive or negative underwriting result greater than 5% of prior year-€nd surplus as regards policyholders or it reported calendar year written premium ceded or year-end loss and loss expense reserves ceded greater than 5% of prior year-€nd surplus as regards policyholders; (ii) it accounted for that contract as reinsurance and not as a deposit; and (iii) the contract(s) contain one or more of the following features or other features that would have similar results:

(a) A contract tenm longer than two years and the contract is noncancellable by the reporting entity during the contract term;

(b) A limited or conditional cancellation provision under which cancellation triggers an obligation by the reporting entity, or an affiliate of the reporting ent~, to enter into a new reinsurance contract with the reinsurer, or an affiliate of the reinsurer.

(c) Aggregate stop loss reinsurance coverage;

(d) A unilateral right by either party (or both parties) to commute the reinsurance contract, whether conditional or not, except for such provisions which are only triggered by a decline in the credit status of the other party;

(e) A provision penmitting reporting of losses, or payment of losses, less frequently than on a quarterly basis (unless there is no activity during the period); or

(D Payment schedule, accumulating retentions from multiple years or any features inherently designed to delay timing of the reimbursement to the ceding entity?

9.2 Has the reporting entity during the period covered by the statement ceded any risk under any reinsurance contract (or under multiple contracts with the same reinsurer or its affiliates), for which, during the period covered by the statement, it recorded a positive or negative underwriting result greater than 5% of prior year-€nd surplus as regards policyholders or it reported calendar year written premium ceded or year-€nd loss and loss expense reserves ceded greater than 5% of prior year-€nd surplus as regards policyholders; excluding cessions to approved pooling arrangements or to captive insurance companies that are directly or indirectly controlling, controlled by, or under common control with (i) one or more unaffiliated policyholders of the reporting entity, or (ii) an association of which one or more unaffiliated policyholders of the reporting entity is a member where:

(a) The written premium ceded to the reinsurer by the reporting entity or its affiliates represents fifty percent (50%) or more of the entire direct and assumed premium written by the reinsurer based on its most recently available financial statement; or

(b) Twenty-five percent (25%) or more of the written premium ceded to the reinsurer has been retroceded back to the reporting entity or its affiliates in a separate reinsurance contract.

9.3 If yes to 9.1 or 9.2, please provide the following infonmation in the Reinsurance Summary Supplemental Filing for General Interrogatory 9:

(a) The aggregate financial statementimpact gross of all such ceded reinsurance contracts on the balance sheet and statement of income;

(b) A summary of the reinsurance contract tenms and indicate whether it applies to the contracts meeting the criteria in 9.1 or 9.2; and

(c) A brief discussion of managemenfs principle objectives in entering into the reinsurance contract including the economic purpose to be achieved.

9.4 Except for transactions meeting the requirements of paragraph 31 of SSAP No. 62R, Property and Casuafty Reinsurance, has the reporting entity ceded any risk under any reinsurance contract (or multiple contracts with the same reinsurer or its affiliates) during the period covered by the financial statement, and either:

(a) Accounted for that contract as reinsurance (either prospective or retroactive) under statutory accounting principles ("SAP") and as a deposit under generally accepted accounting principles ("GAAP"); or

(b) Accounted for that contract as reinsurance under GAAP and as a deposit under SAP?

9.5 If yes to 9.4, explain in the Reinsurance Summary Supplemental Filing for General Interrogatory 9 (Section D) why the contract(s) is treated differently for GAAP and SAP.

9.6 The reporting entity is exempt from the Reinsurance Attestation Supplement under one or more of the following criteria:

(a) The entity does not utilize reinsurance; or,

(b) The entity only engages in a 100% quota share contract with an affiliate and the affiliated or lead company has filed an attestation supplement; or

(c) The entity has no extemal cessions and only participates in an intercompany pool and the affiliated or lead company has filed an attestation supplement.

10. If the reporting entity has assumed risks from another entity, there should be charged on account of such reinsurances a reserve equal to that which the original entity would have been required to charge had it retained the risks. Has this been done?

11.1 Has the reporting entity guaranteed policies issued by any other entity and now in force?

11.2 If yes, give full information

12.1 If the reporting entity recorded accrued retrospective premiums on insurance contracts on Line 15.3 of the assets schedule, Page 2, state the amount of corresponding liabilities recorded for: 12.11 Unpaid losses

12.12 Unpaid underwriting expenses (including loss adjustment expenses)

12.2 Of the amount on Line 15.3, Page 2, state the amount that is secured by letters of credit, collateral and other funds?

12.3 If the reporting entity underwrites commercial insurance risks, such as workers' compensation, are premium notes or promissory notes accepted from its insureds covering unpaid premiums andlor unpaid losses?

12.4 If yes, provide the range of interest rates charged under such notes during the period covered by this statement:

12.41 From

12.42 To

12.5 Are letters of credit or collateral and other funds received from insureds being utilized by the reporting entity to secure premium notes or promissory notes taken by a reporting ent~, or to secure any of the reporting entity's reported direct unpaid loss reserves, including unpaid losses under loss deductible features of commercial policies?

12.6 If yes, state the amount thereof atDecember 31 of current year.

12.61 Letters of Credit

12.62 Collateral and other funds

13.1 Largest net aggregate amount insured in anyone risk (excluding workers' compensation):

13.2 Does any reinsurance contract considered in the calculation of this amount include an aggregate limit of recovery without also including a reinstatement provision?

13.3 State the number of reinsurance contracts (excluding individual facultative risk certificates, but including facultative programs, automatic

$

$

$

$

$

$

0

Yesl ] Nol ]

Yes I ] NoIX]

I I I I

Yes I ] NOIX]I

I I

Yesl ] NOIX]I

I I

Yes I ] NoIX]

I Yes I ] NoIX]

Yes I NOIX]I

Yesl ] NoIX]

NIAIX]I Yes I ] Nol ]

Yes I ] NoIX]

I 0 I 0

0 I Yes I ] Nol ] NIAIX]

% I %

Yes I ] NOIX]I

0

I 0

150,000

Yes I NoIX]

0

16.1 01/24/2017 7:57:32 AM

-....,..".,...,--.,"'-~.,.....,~--,«-,--------____ ._I----------------------------------

... til

.. til

"I)

til

...

...

... ..

...

... -..-.. .., ... .. -.-

... ..

... .. ~ ..

-----.. .. .. ..

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

14.1

14.2

14.3

14.4

14.5

15.1

15.2

16.1

17.1

18.1

18.2

18.3

18.4

GENERAL INTERROGATORIES PART 2 - PROPERTY & CASUALTY INTERROGATORIES

facilities or facultative obligatory contracts) considered in the calculation of the amount.

Is the reporting entity a cedant in a multiple cedant reinsurance contract?

If yes, please describe the method of allocating and recording reinsurance among the cedants:

If the answer to 14.1 is yes, are the methods described in item 14.2 entirely contained in the respective multiple cedant reinsurance contracts?

If the answer to 14.3 is no, are all the methods described in 14.2 entirely contained in written agreements?

If the answer to 14.4 is no, please explain:

Has the reporting entity guaranteed any financed premium accounts?

If yes, give full information

Does the reporting entity write any warranty business?

If yes, disclose the following infonmation for each of the following types of warranty coverage:

1 2 3 4 5

Direct Losses Direct Losses Direct Written Direct Premium Direct Premium Incurred Unpaid Premium Uneamed

16.11 Home $ 0$ 0$ 0$ 0$

16.12 Products $ 0$ 0$ 0$ 0$

16.13 Automobile $ 0$ o $ 0$ 0$

16.14 Other' $ o $ 0$ 0$ 0$

, Disclose type of coverage:

Does the reporting entity include amounts recoverable on unauthorized reinsurance in Schedule F-Part 3 that it excludes from Schedule F-Part 5.

Incurred but not reported losses on contracts in force prior to July 1, 1984, and not subsequently renewed are exempt from inclusion in Schedule F-Part 5. Provide the following infonmation for this exemption:

17.11 Gross amount of unauthorized reinsurance in Schedule F-Part 3 excluded from Schedule F-Part 5

17.12 Unfunded portion of Interrogatory 17.11

17.13 Paid losses and loss adjustment expenses portion of Interrogatory 17.11

17.14 Case reserves portion of Interrogatory 17.11

17.15 Incurred but not reported portion of Interrogatory 17.11

17.16 Unearned premium portion of Interrogatory 17.11

17.17 Contingent commission portion of Interrogatory 17.11

Provide the following information for all other amounts included in Schedule F-Part 3 and excluded from Schedule F-Part 5, not included above.

17.18 Gross amount of unauthorized reinsurance in Schedule F-Part 3 excluded from Schedule F-Part 5

17.19 Unfunded portion of Interrogatory 17.18

17.20 Paid losses and loss adjustment expenses portion of Interrogatory 17.18

17.21 Case reserves portion of Interrogatory 17.18

17.22 Incurred but not reported portion of Interrogatory 17.18

17.23 Unearned premium portion of Interrogatory 17.18

17.24 Contingent commission portion of Interrogatory 17.18

Do you act as a custodian for health savings accounts?

If yes, please provide the amount of custodial funds held as of the reporting date.

Do you act as an administrator for health savings accounts?

If yes, please provide the balance of the funds administered as of the reporting date.

Earned

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Yes[] No[X]

Yes [] No [

Yes [] No [ ]

Yes[] No[X]

Yes[] No[X]

0

0

0

0

Yes [ ] No[X]

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Yes [ ] No[X]

0

Yes[ ] No[X]

0

16.2 01/24/2017 7:57:33 AM

AnnuaiSIaiemenifortheyear2016oflhe Pocahontas Mutual Insurance Association

FIVE-YEAR HISTORICAL DATA Show amounts in whole dollars only, no cents; show percentages to one decimal place, i.e. 17.6.

Gross Premiums Written (Page 8, Part 1 B, Cols. 1,2 & 3) 1. Liabilily lines (Lines 11.1, 11.2, 16, 17.1, 17.2, 17.3, 18.1, 18.2, 19.1, 19.2 & 19.3, 19.4} .......

1 2016

2 2015

3 2014

4 2013

5 2012

2. Property lines (Lines 1, 2, 9, 12, 21 & 26}............................................................... .................. .. ......... 2,374,647 ........... 2,262,700 ........... 2,199,443 ........... 2,060,736 ........... 1,805,170

3. Property and liabilily combined lines (Lines 3, 4, 5, 8, 22 & 27)................................................ ........... ............................. ·.·.·.· .. ·.· .. · .. · .. · .. · .. · ................ 3·.·.,·0·.6·.·.9·.·.·. ..· .. ·.· ... · ..... · ... ·.·.·3 .. ,·3 .. 5 .. 0.. · .. · .. · .. · .. · .. · .. · .. · .. ·.· .. ·.·.·.·.·.·.· ... ·.3·.,.9·.·~.~·.·.I 4. All other lines (Lines 6,10,13,14,15,23,24,28,29,30 & 34) .................................................................................................. 250 5. Nonproportional reinsurance lines (Lines 31, 32 & 33}.............................................................. ............................. ............................. .. ......................... ..

:. ~:~i:;;~~~:;:~~1~~(~~i~·,~~:~~.~·~;·f.~::1~:~,·~~:·1,··1~·.·2·,··1·~:1·,·1·~:~·~··1·9~·,·1·~:~)::::::: :: ................ 2.,.~~~'~~~ ................ : .. 2,.262,~~~. . ................ 2,.~~~,~1.~ ............... : ... 2,.~~~,~~~ .................... 1.,.8.~~,~89. E 8. Property lines (Lines 1, 2, 9, 12,21 & 26) ........................................................................................... 1,658,821 ........... 1,572,034 ........... 1,547,416 ........... 1,451,030 ........... 1,397,012

9. Property and liabilily combined lines (Lines 3, 4, 5, 8, 22 & 27).......................................... ............................. ................ .. ................. ·.·.·.·.·.·.·.·.·.·.·.·.·.·.·.·.·.·.·3 .. ,·3 .. 5 .. 0 .. · ... ·.· ............................... 3 .. ,.9 ... 1·9 .• 10. All other lines (Lines 6, 10, 13, 14, 15, 23, 24, 28, 29, 30 & 34)................................................ ............................. .. ................... 250 .................. 3,069 • 11. Nonproportional reinsurance lines (Lines 31, 32 & 33).............................................................. ............................. ............................ ............................. .................... .. ......................... ..

12. ~;a~!~~~~ !:~~~.~~~.(.~~~~.~;............ ............................................................ ....................... . .......... 1,658,821 ........... 1,572,284 ........... 1,550,485 ........... 1,454,380 ........... 1,400,931 E 13. Net underwriting gain (loss) (Line 8) ........................................................................................................ (10,730) ............. (290,740) ............. (599,904) ............. (292,021) .............. 390,117 14. Net investment gain (loss) (Line 11)........................................................ .................................. .. ............ 146,994 .............. 154,827 .............. 186,707 .............. 186,567 .............. 112,512

~~: ~:~i:~::nE~~;~i:~~~x::·~~~~~e:~:(~i~~:;~;.·:·:·::·:·:·:.::.::::::::::::::: ..... :::::::::::::.:::::::::. ::::::::::: ............... : ............ :4:1':1:~~: .. : ...................... :<:9':~~~: .:.::.:.:.:' .• :.:'.:.:'.;::'.::: .. :.: ••. :.: ••. : ..•... : ... :.;::'.::: .. :'::':"':::::::::'.:::. E 18. Net income (Line 20) ................................................................................................................................. 177,446 ............ (96,031) ............. (344,067) ............... (27,604) .............. 467,576 ~

........... 4,879,836 ........... 5,156,522 ........... 5,463,953 .......... .4,779,470 Balance Sheet Lines (Pages 2 and 3)

19. Total admitted assets excluding protected cell business (Page 2, Line 26, Col. 3) .............................. 5,214,936 20. Premiums and considerations (Page 2, Col. 3):

20.1 In course of collection (Line 15.1 )........................................ ........................................... .. .............. 20,077 ....... 11,578 .................. 9,512 20.2 Deferred and not yet due (Line 15.2) ..................................................................................................................................................................... . 20.3 Accrued retrospective premiums (Line 15.3) ................................................................ ..

21. Total liabilities excluding protected cell business (Page 3, Line 26)........ ................................. .. ......... 1,205,794 ........... 1,221,726 ........... 1,180,899 ........... 1,348,260 .............. 893,736 r 22. Losses (Page 3, Line 1) ........................................................................................................................... 134,585 .............. 205,318 .............. 188,736 .............. 396,000 ................ 57,500 ~ 23. Loss adjustment expenses (Page 3, Line 3)............. ................................................................ .. ................ 6,505 .................. 4,044 .................. 3,996 .................. 3,598 .................. 3,638 24. Unearned premiums (Page 3, Line 9}........................................................... ............................ .. ............ 983,105 .............. 923,083 .............. 922,232 .............. 869,496 ............. .743,291 , 25. Capital paid up (Page 3, Lines 30 & 31).. .................... ........................................................... .. ......................................................................................................................................... . 26. Surplus as regards policyholders (Page 3, Line 37) .............................................................................. 4,009,142 ........... 3,658,110 ........... 3,975,623 .......... .4,115,693 ........... 3,885,734

Cash Flow (Page 5)

27. Net cash from operations (Line 11 ) ........................................................................................ .. Risk-Based Capital Analysis

.............. 111 ,366 ............... (58,520) ............. (520,873) .............. 281,390 .............. 593,324 ~

28. Total adjusted capitaL .............................................................................................................. .. 29. Authorized control level risk-based capital... ............................................................................ ..

Percentage Distribution of Cash, Cash Equivalents and Invested Assets (Page 2, Col. 3) (Item divided by Page 2, Line 12, Col. 3) x 100.0

. ........................................................................................................................ [

30. Bonds (Line 1)............................................................................................................................. .. .................. 37.7 .................... 38.1 .................... 38.1 31. Stocks (Lines 2.1 & 2.2) ................................................................................................................................ .49.9 ................... .45.7 ................... .46.8 32. Mortgage loans on real estate (Lines 3.1 & 3.2) ................................................................... ..

.................... 51.1 .................... 57.9 r .:::::::.:.::::::::::~~:~.:: .. :::::::::::::::~1.:~ .•

33. Real estate (Lines 4.1,4.2 & 4.3}.................................. .. ............................................. . .. ...... 1.2 ...................... 1.4 ........ 1.5 . . ......... 1.2 ...................... 1.5

.::::::::::: .. : .. :::: .. 1.~:~ .. ":':::::::'::::::::::~:~. k 34. Cash, cash equivalents and short-term investments (Line 5).................................................... .. .................. 11.3 35. Contract loans (Line 6) .......................................................................................................................................... ..

............... 14.8 .................... 13.6

36. Derivatives (Line 7) ................................................................................................................................................ .. 37. Other invested assets (Line 8)......................................................... ............................... ............................. .. .......................... . 38 Receivables for securities (Line 9)............................................................. .. ............................. ............................. . ............................................................................ . 39. Securities lending reinvested collateral assets (Line 10)........................................................... ............................. .. ..................................................... ..

.. .......... ::::::::::::::::~ 40. Aggregate write-ins for invested assets (Line 11 )...................................... ............................... ............................. ............................. ............................ .. ................. .. . ........... . 41. Cash, cash equivalents and invested assets (Line 12).............................................................. .. ................ 100.0 .................. 100.0 .................. 100.0 .................. 100.0

Investments in Parent, Subsidiaries and Affiliates ......... 100.0 I

42. Affiliated bonds (Sch. 0, Summary, Line 12, Col. 1) ............................................................................................................................................................................................................... ..

:!: :::::::: :::7: s~::~s (~::'~' :uu::aa;,' ~~n: 2~' g~1.11i::::::::::::::::::::·:::::::::::::::::::....... :::::::::.:::::::::::::::: :::::::::::::::::::::::::::: ............................. ::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::: ~ 45. Affiliated short-term investments

46. ~~~::~s~:~~:~: il::n~:~~:a~:~t~t:~i.fi~~~~~:.~~I~.~~.~:.~i~~.1~):::::::::::::::::::::::::::::::::::::: ::::::::::::::::..... :.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.: .. : .............................................. " ......................... : .... :.:.:.:.:.:.:.:.:.:.:.:.:.: .... : .... :.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:. k 47. All other affiliated ................................................................................................................................................... .

48. Total of above lines 42 to 47 ................................................................................................. " .... r""""'''''''''''''''''''''''''''''''''''''''''''''''''''''O+,,='''''''''''''''''''''''''''''''''O,+,''''''''''''''."" ... "" ... "" ... "" ... "" ... "" ... ",0+" ... ", ... ", ... ", ... ", ... ", ... ", ... ", ... ", .. 0,+,""""''''' ... "" ... "" ... "" ... "" ... "" ... "" ... ",O~

49. Total investment in parent included in Lines 42 to 47 above ..................................................... r""""'''''''''''''''''''''''''''''''''''''''''''''''''''''''''+,,''''''''''''''''''''''''''''''''''''''''''''''''"',-"" r""""'''''''''''''''''''''''''''''''''''''''''''''''''''''''''+,,'''''''''''''''''''''''''''''''''''''''''''''''' ... !!.. .. 1-"""""''''''''''''''''''''''''''''''''''''''''''''''''''''''''''-1'[ 50. Percentage of investments in parent, subsidiaries and affiliates to surplus •

as reQards policyholders (Line 48 above divided by Paqe 3 Col. 1 Line 37 x 100,0) .......... . .. .................... 0.0

17 01/24/2017 7:57:33 AM

,-----,---------------------------Annual Statement for the year 20t6 of the Pocahontas Mutual Insurance Association

51,

~ 52,

53, .. ... 54,

55, •• 56, .. 57,

58, .. 59,

FIVE-YEAR HISTORICAL DATA (Continued)

2

2016 2015

Capital and Surplus Accounts (Page 4)

3

2014

4

2013

5

2012

Net unrealized capital gains (losses) (Line 24),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, """",168,367 """,,,,,,,(205,706) """",,,,,,199,530 """"",,,,253,096 """""",,124,426

Dividends to stockholders (Line 35)"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "" "''''''',,''

Change in surplus as regards policyholders for the year (Line 38)""""""""""""""""""""""

Gross Losses Paid (Page 9, Part 2, Cols, 1 & 2)

Liability lines (Lines 11,1, 11,2, 16, 17,1, 17,2, 17,3, 18,1, 18,2, 19,1, 19,2 & 19,3,19,4)""",

Property lines (Lines 1, 2, 9,12,21 & 26), ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Property and liability combined lines (Lines 3, 4, 5, 8, 22 & 27) ,,,"""""""""""""""""''''''',''

All other lines (Lines 6, 10, 13, 14, 15,23,24,28,29,30 & 34)"""""""""""", """"""""",,"

",,,,,,,,,,,,351,032 """,,,,,,,(317,513) ",,,,,,,,,,,(140,070) "",,,,,,,,,,229,959 """",,,,,,581,784

,,,,,,,,,,,,,,921,349 ",1,093,171 ",,1,691,430 """",,981,769 """"""..441,059

Nonproportional reinsurance lines (Lines 31,32 & 33) "''',,'''''''','''''''''''''''''''''' """"""""",," f"-"""""''''''''''''''''''''''''''''''''''''''''''''''''P'''''''''''''''''''''''''''''''''''''''''''''''''',,"" I-'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''P''''''''''''''''''''''''''''''''''''''''''''''''"',,"' 1-'''''''''''''''''''''''''''''''''''''''''''''''''''''''=1 Total (Line 35)""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, , '''''''''''''''''''''''''''''''''''''''',,'' """""",,921,349 ,,,,,,,,,,1,093,171 '"'' "",1,691,430 """""",,981,769 """""",,441,059

.. Net Losses Paid (Page 9, Part 2, Col, 4)

... 60, Liability lines (Lines 11,1, 11.2, 16, 17,1, 17.2, 17,3, 18,1, 18,2, 19,1, 19,2 & 19,3, 19.4)""", ""'"'''''''''''''''''''''' ""","""""'''''''''''' """""""",,""""'" ""''''''',,'''' " " " " " "

61, Property lines (Lines 1, 2, 9, 12, 21 & 26)"""" """"''''''''''''''''''','''''''''''''''''''''''''''',,'''''''''''',''

.. 62, Property and liability combined lines (Lines 3, 4, 5, 8, 22 & 27)"" """""""",,"

"""""",,921,349 ",,1,092,967 """"",1,585,540 """""",,615,816 """""",,312,330

... 63, All other lines (Lines 6,10,13,14,15,23,24,28,29,30 & 34)"""""""""""""""""""""", '

64, Nonproportional reinsurance lines (Lines 31, 32 & 33)""""""""" """"""""""'" """'"'''''''''' ",""''''''''''''''''''''''''''''''''''''''''''''''''''''",,"='''''''''''''''''''''''''''''''''',,"'' f'-""''''==='' '''''' '''''''",,"''''''''''''''''''''''''''''''''''''' ="-f'-=====i .. 65, Total (Line 35)""""""""" """"""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, """",,", ""'" """"""""," """,,921,349 """"",1,092,967 ""'" ",1,585,540 """"",,615,816 """""",,312,330

... Operating Percentages (Page 4) (Item divided by Page 4, Line 1) x 100,0

... 66, Premiums earned (Line 1)"""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,",," """"""",100,0 """""""",,100,0 """""""",,100,0 '" """",,,,,,100,0 "",100,0

67, Losses incurred (Line 2)""""""""""""""""", """""""""""""",,,,, """"""'" "'''''''''','' "",,53,2 """"""""",,70,6 """""""",,,,92,0 """"",,,,,,,,,.71,9 """,,24,9

- 68, Loss expenses incurred (Line 3)""""""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,""""," "",,,,,,,,,,,,,,,,,,7,3 """""""""",,7,5 """,,,,,,,,,,,,,,,,8,2 """""""",,,,,,6,2 """""""""",,5,5

_ 69, Other underwriting expenses incurred (Line 4)""""""""""""""""""""""""""""""""""""" """"",,,,,,,,,.40,2 """",,,.40.4 """"",,,,,,,,,,39,8 """"""""",,44,0 """",,,,,,,,,,,.40,1

70, Net underwriting gain (loss) (Line 8)""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, """""""""",(0,7) """"""""",(18,5) """""""",,,(40,1) """"""""",(22,0) """",,29,4 .. Other Percentages

_ 71, Other underwriting expenses to net premiums written (Page 4, Lines 4 + 5 - 15 divided by Page 8, Part 1B, Col, 6, Line 35 x 100,0)""""""""""""""""""""", ",,",,",,""",,"

- 72, Losses and loss expenses incurred to premiums earned (Page 4, Lines 2 + 3 divided by Page 4, Line 1 x 100,0)""""""", ",,""""""""""''''''''''''''',,'' -73, Net premiums written to policyholders' surplus (Page 8, Part 1 B,

""""""""",,36,3

"",,,,,,,,,,,,,,,,60,5

- Col. 6, Line 35, divided by Page 3, Line 37, Col, 1 x 100,0)""""""""""""""""""""""""""" """"""""",,41.4

One Year Loss Development (OOO omitted) - 74, Development in estimated losses and loss expenses incurred prior

"""""",,37,8 """""""",,35,9 """"""""",,37,6 ,,,,,,,,,,,,,,,,,,,,35,4

""",..78,1 """"""""" 1 00,2 """"""""",,78,0 """"""""",,30.4

"""""",.43,0 """"""",,,,39,0 """"""""",,35,3 """",,,,,,,,,,,,36,1

to current year (Schedule P, Part 2-Summary, Line 12, Col, 11)""""""""""""""""""""""", '" """""""""""'" "",,""""""""""'" """"""",,"""""'" """""",,,,,,,,,,(30) """"""",,,,,,,(29) ... 75, -... 76,

Percent of development of losses and loss expenses incurred to policyholders' surplus of prioryear-end (Line 74 above divided by Page 4, Line 21, Col. 1 x 100)"""""""""

Two Year Loss Development (000 omitted)

Development in estimated losses and loss expenses incurred 2 years before the

""",,,,,,,,,,,,,(0,8) """"",,,,,,,,,,(0,9)

current year and prior year (Schedule P, Part 2-Summary, Line 12, Col. 12)""""""""""""",

Percent of development of losses and loss expenses incurred to

"""""""""'" "'" """"""""""""" " , """,,"""","""""" """"" """"",(29) """"""""""",,(2) -77. .. reported policyholders' surplus of second prior-year end

(Line 76 above divided bv Paae 4 Line 21 Col. 2 x 100,01""""""""""""""""""""""""""" _ If a party to a merger, have the two most recent years of this exhibit been restated due to a merger in compliance with the disclosure requirements of

SSAP No, 3, Accounting Changes and Correction of Errors? .. If no, please explain:

-----.. ---

"""""..10,9\ """"""""""JO,1'

Ves [J No [ J

18 01/24/2017 7:57:33 AM

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE F - PART 1 Assumed Reinsurance as of December 31, Current Year (000 Omitted)

1 2 3 4 5 Reinsurance On 9 10 11 12 13 14 15 6 7 8 Amount of Assets Amount of

Funds Held by Pledged or Assets NAIC Paid Losses and Known Case Contingent Assumed or Deposited Letters of Compensating Pledged or

ID Company Domiciliary Assumed Loss Adjustment Losses Cols. Commissions Premiums Unearned With Reinsured Credit Balances to Secure Collateral Number Code Name of Reinsured Jurisdiction Premium Expenses and LAE 6+7 Payable Receivable Premium Companies Posted Letters of Credit Held in Trust

NONE

- - - - - - - - - - - - - - - .. - - -

--~----,~ .. ~------------------------------

Annual Statement for ihe year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE F . PART 2 Premium Portfolio Reinsurance Effected or (Canceled) during Current Year

1 2 3 4 5 6 NAIC

10 Company Number Code Name of Company Date of Contract Original Premium Reinsurance Premium

.. '" ... '" .. '" .. '" .. '" -.. ------- NONE ----------------

21 01/24/2017 7:57:34 AM

N N

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE F . PART 3 Ceded Reinsurance as of December 31, Current Year (000 Omitted)

1 2 3 4 5 6 Reinsurance Recoverable on Reinsurance Pavable 18 19 7 8 9 10 11 12 13 14 15 16 17

Net Amount Funds Held Known Known Other Recoverable By Company

NAIC Reinsurance Case Case IBNR IBNR Cols. Ceded Amounts From Under 10 Company Domiciliary Special Premiums Paid Paid Loss LAE Loss LAE Uneamed Contingent 7 through 14 Balances Due to Reinsurers Reinsurance

Number Code Name of Reinsurer Jurisdiction Code Ceded Losses LAE Reserves Reserves Reserves Reserves Premiums Commissions Totals Payable Reinsurers Col. 15-r16+171 Treaties

Authorized Other U.S. Unaffiliated Insurers

42-0245840. 13897 ... 1 Fanners Mutual Hail Insurance Company ............................................. IIA ............. 1........... . ........... .716 ..................... ..................... ..................... ..................... ..................... ..................... . ................. 9 ..................... . .................... 9 ................ 16 ..................... . ................... (7\ .................... .

0999999. Total Authorized Other U.S. Unaffiliated Insurers ................................................................................................. 716 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 9 .................. 0 ..................... 9 ................ 16 .................. 0 .................... (7\ .................. 0

1399999. Total Authorized....................................................................................................................................... . ... .716 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 9 .................. 0 ..................... 9 ................ 16 ............. 0 .................... (7\ .................. 0

4099999. Total Authorized, Unauthorized and Certified ....................................................................................................... 716 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 9 .................. 0 ..................... 9 ................ 16 ............. 0 .................... (71 .................. 0

9999999. Totals ..................................................................................................................................................................... 716 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 0 .................. 9 .................. 0 ..................... 9 ................ 16 .................. 0 .................... (7) .................. 0

Note: A.

B.

Report the five largest provisional commission rates included in the cedan!'s reinsurance treaties. The commission rate to be reported is by contract with ceded premium in excess of $50,000.

2 3 Commission Ceded

Name of Reinsurer Rate Premium 1 ................................................................................................................................................. . ................... . 2 ..................... :.............................................................................................. . ....................................................... . 3 ....................................................................................................................................................................................... . 4 ...................................................................................................................................................................................... . 5 ...................................................................................................................................................................................... .

Report the five largest reinsurance recoverables reported in Column 15, due from anyone reinsurer (based on the total recoverables, Line 9999999, Column 1!i1 the amount of ceded premium, and indicate whether the recoverables are due from an affiliated insurer.

1

Name of Reinsurer 1 .................................................................................................................................................................. . 2 ................................................................................................................................................................. . 3 ....................................................................................................................... . ............................... . 4 ........................................................................................................................................................ . 5 ................................................................................................................................................................. .

- - -

2 Total

Recoverables

-

3 Ceded

Premiums

-

Yes Yes Yes Yes Yes

-

4

Affiliated No No No No No

- - - - .. ..

N Co)

, , .. . .. , l l j i l , • • I , , , i .. . .. . AnnuaiStatementfortheyear2016oflhe Pocahontas Mutual Insurance Association

SCHEDULE F - PART 4 Aging of Ceded Reinsurance as of December 31, Current Year (000 Omitted)

1 2 3 4 Reinsurance Recoverable on Paid Losses and Paid Loss Adiuslment Ex enses 5 Overdue

6 7 8 9 10 NAIC

10 Company Domiciliary Total Overdue Number Code Name of Reinsurer Jurisdiction Current 1 to 29 Days 30 to 90 Days 91 to 120 Days Over 120 Days Cols.6+7+8+9

NONE

.. . .. . 12 13

11 Percentage More Than

Total Percentage 120 Days Due Overdue Overdue

Cols. 5 +10 Col.10/Col.11 Col. 9/Col.11

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE F . PART 5 Provision for Unauthorized Reinsurance as of December 31, Current Year (000 Omitted)

1

ID Number

1. 2.

2 3

NAIC Company

Code Name of Reinsurer

Amounts in dispute totaling $ .......... 0 are included in Column 6.

Amounts in dispute totaling $ .......... 0 are excluded from Column 15.

4

Domi-ciliary Juris-diction

5 6 7

Reinsurance Recoverable Funds Held

all Items By Company Schedule F, Under

Special Part 3, Reinsurance Code Col. 15 Treaties

-

8 9 10 11 12 13

Total Trust Funds Collateral and

Issuing or and Offsets Allowed Confinning Other (Cols.7+8+10

Letters Bank Ceded Miscellaneous Allowed +11+12but of Reference Balances Balances Offset not in Excess

Credit Number (a) Payable Payable Items of Col. 6)

NONE

..

14 15 16 17 18 19 Total

Provision for Reinsurance

Recoverable Ceded to Provision for Paid Losses & 20% of Provision for Unauthorized Unauthorized LAE Expenses Amount in Overdue Reinsurers Reinsurance Over 90 Days 20% Dispute Reinsurance (Col. 14 plus (Col. 6 minus Past Due not of Amount Included in (Col. 16 plus Col. 18 but not in

Col. 13) in Dispute in Col. 15 Col. 6 Col. 17) Excess of Col. 6

i. Il' If Al 'J"" I l I l & I II • II. J II • .. . .. J II. •

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE F . PART 6 . SECTION 1 Provision for Reinsurance Ceded to Certified Reinsurers as of December 31, Current Year (000 Omitted)

1 2 3 4 5 6 7 8 9 10 11 Collateral Provided 18 19 20 21 12 13 14 15 16 17 Percent of Percent

Collateral Credit Allowed Provision for Net Provided on Net Amount of Reinsurance

Recoverables for Net Recoverables Credit with Certified Certified Percent Net Amount Subject to Dollar Total Recoverables Subject Allowed Reinsurers Reinsurer Effective Collateral Recoverable Catastrophe Collateral Amount of Funds Held Issuing or Collateral Subject to Collateral for Net Due to

Rating Date of Required from Recoverables Requirements Collateral by Company Confirming Provided to Collateral Requirements Recoverables Collateral NAIC (1 Certified for Full Reinsurers Qualifying for for Full Credit Required Multiple Under Bank Otller (Cols. 12 + Requirements (Col. 18/Col. 7, (Col 9 Deficiency

10 Company Domiciliary through Reinsurer Credit (Sch F Part 3 Collateral (Col. 8- (Col. 10 x Beneficiary Reinsurance Letters Reference Allowable 13 + 14 + (Col. 17 I not to exceed + (Col. 10 (Col 8 -Number Code Name of Reinsurer Jurisdiction 6) Ratil1!l 0% -100% Col. 18) Defenral Col. 9) Col. 7) Trust Treaties of Credit Number (a) Collateral 16) Col. 10) 100%) x Col. 19)) Col. 20)

NONE

N en

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE F . PART 6 . SECTION 2 Provision for Overdue Reinsurance Ceded to Certified Reinsurers as of December 31, Current Year (000 Omitted)

1 2 3 4 5 6 7 8 9 10 11 Amount of

Reinsurance Credit Allowed Recoverable on Total for Net Paid Loss and Reinsurance Amounts 20% of Amounts Recoverables

NAIC LAE More than Recoverable on Received Percent More 20% of in Dispute (Sch F Part 6 ID Company Domiciliary 90 Days Paid Lo~s(~~ Prior than 90 Days Amounts in Excluded from Section 1

Number Code Name of Reinsurer Jurisdiction Overdu~(a) and LAE b 90 Davs Overdue Col. 5 Col. 5 Col. 20)

(a) From Schedule F-Part 4 Columns 8 + 9, total certified, less $ .......... 0 in dispute.

(b) From Schedule F-Part 3 Columns 7 + 8, total certified, less $ .......... 0 in dispute.

NONE

.... .. .. .. .. .. ... ....

Complete if Column 8 is 20% or Greater 15 12 13 14 Provision for

Total Collateral Net Unsecured Overdue Reinsurance Provided Recoverable for Ceded to Certified

(Sch F Part 6 Which Credit is Reinsurers (Greater Section 1 Allowed 20% of of Col. 9 + Col. 10

Col. 17) not to (Col. 11 - Amount in or Col. 14) notto Exceed Col. 11 Col. 12) Col. 13 Exceed Col. 11

N .....

I J 'I II II I I (I I J AnnuaJ Statement fur the year 2016 of the Pocahontas Mutual Insurance Association • • I I I I I I

SCHEDULE F· PART 7

I • , , , I

Provision for Overdue Authorized Reinsurance as of December 31, Current Year 1 2 3 4 5 6 7

Reinsurance Recoverable on Total Reinsurance Announts

NAIC Paid Losses and LAE Recoverable on Received Col. 4 10 Company More Than 90 Days Paid Losses and Prior divided by

Number Code Name of Reinsurer Overdue (a) Paid LAE (b) 90 Davs (Cols.5 +6)

(a) From Schedule F-Part 4 Columns 8 + 9, total authorized, less $ .......... 0 in dispute.

(b) From Schedule F-Part 3 Columns 7 + 8, total authorized, less $ .......... 0 in dispute.

NONE

I j I • I , , ,

8 9 10 11 Amounts in Dispute Annount

Amounts in Col. 4 Excluded from Col. 4 Reported in for Companies for Companies 20% of Col. 8

Repornng less than Reporting less than Amount in x 20% 20% in Col. 7 20% in Col. 7 Col. 9 + Col. 10

N CO

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE F . PART 8 Provision for Overdue Reinsurance as of December 31, Current Year

1 2 3 4 5 6 7 Funds Held

NAIC Reinsurance by Company Letters Ceded ID Company Recoverable Under Reinsurance of Balances

Number Code Name of Reinsurer All Items Treaties Credit Payable

NONE

- - - - - - .. .. .. .. .. .. ..

8 9 10 11 12 Sum of Cols. 5

Other Other through 9 but Col. 4 Greater of Col. 11 or Miscellaneous Allowed Offset not in Excess Minus Schedule F - Part 4

Balances Items of Col. 4 Col. 10 Cols. 8 +9

- .. - .. - -

..

...

...

.. --... .. .... .. -

Annual Stalement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE F . PART 9 Restatement of Balance Sheet to Identify Net Credit for Reinsurance

1.

2.

3.

4.

5.

6.

7 .

ASSETS (Page 2, Col. 3)

Cash and invested assets (Line 12) .............................................................................................. .

Premiums and considerations (Line 15) ........................................................................................ .

As Reported

LNet of CedecJL

................. 5,172,418

................................... 20,077

Reinsurance recoverable on loss and loss adjustment expense payments (Line 16.1) ................................................................ .

Funds held by or deposited with reinsured companies (Line 16.2) ................................................ .

Other assets .................................................................................................................................. . .. ................................ 22,441

Net amount recoverable from reinsurers ................ ..

Protected cell assets (Line 27) .................................... ..

2 Restatement Adjustments

3 Restated

(Gross of Ceded)

. ............................. 5,172,418

. ...................... 20,077

.. .......................................... 0

.. .......................................... 0

.................. " ............... 22,441

.. .................................. (7,461) ................................... (7,461)

.. ......................................................................................... 0

8. Tota[s (Line 28) ......................................................................................................................................................... 5,214,936 .................................... (7,461) ............................. 5,207,475 r-------~~+---------~~--~--~~~

LlAB[LlTIES (Page 3)

9. Losses and loss adjustment expenses (Lines 1 through 3)............................................................. .. ............................... 141 ,090 ................... 141,090

10. Taxes, expenses, and other obligations (Lines 4 through 8) .............................................................................................. 25,174 .................................. 25,174

11. Uneamed premiums (Line 9) .................................................................................................. . . ................. 983,105 ..................................... 9,020 ................................. 992,125

12. Advance premiums (Line 10) ....................................................................................................................................................... . . ........................................... 0

13. Dividends declared and unpaid (Line 11.1 and 11.2).................... ................................................. .. .................................. . .. .......................................... 0

14. Ceded reinsurance premiums payable (net of ceding commissions) (Line 12) ...................... "....... .. ................................. 16,481 .............................. (16,481) ............................................ 0

15. Funds held by company under reinsurance treaties (Line 13) ........................................................ . .. .......................................... 0

16. Amounts withheld or retained by company for account of others (Line 14) .................................... . .. ............... 14,108 .................................. 14,108

17. Provision for reinsurance (Line 16) ........................................................................................ " ..................................................... . .. .......................................... 0

18. Other [iabilities.................................................................................................... . .................. " ....... f-""''' ."' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "''' .",.2",5 ,,,,83,,,6--1"''' ."' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' .. t'.", ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... "' ... ",.2",5 ,,,,83,,,6-1

19. Tota[ liabi[ities excluding protecied cell business (Line 26) ......................................... . . ............................. 1205,794 .................................... (7,461 .............................. 1,198,333

20. Protected cell [iabilities (Line 27)..................................................................................................... .. ............................ . . ................................... 0

21. Surplus as regards policyho[ders (Line 37) .................................................................................... f-""''''''''''''''''''''''''''''''''' ", ... ", ... ", ... ", .. 4",0",0",9 -,-14",2--1"'="'''''''''''''''''''''''-'XXX=.", ... ", ... ", ... ", ... ", ... ", .. t'.", ... ", ... ", ... ", ... ", ... ", ... ", ... ", ... ", ... ", .. 4""0",0",9,-,-14,,,2-1

22. Tota[s (Line 38)........................................ ....................................................................................... .. ............................ 5,214,936 .................................... (7,461) .............................. 5,207,475

.. NOTE: [s the restatement of this exhibit the result of grossing up balances ceded to affiliates under 100 percent reinsurance or pooling arrangements? .. Yes I I No [ X I

[f yes, give full explanation: ....

-....

-.. .. ...

..

...

29 01/24/2017 7:57:37 AM

Annual Slatementfor the year 2016 of the Pocahontas Mutual Insurance Association

SUMMARY INVESTMENT SCHEDULE

Investment Cateaories

1. Bonds:

Gross Investment Holdinas

1 2

Amount Percentaoe

3

Amount

Admitted Assets as Reported in the Annual Statement

4 5 Securities Lending Total

Reinvested (Col. 3 +4) Collateral Amount Amount

6

Percentaae

1.1 U.S. treasury securities ..................................................................................... .. .. ........... 0.0 ........................................................................................ 0 ............. 0.0 I 1.2 U.S. govemment agency obligations (excluding mortgage-backed

securities):

1.21 Issued by U.S. govemmentagencies ...................................................... ..

1.22 Issued by U.S. govemmentsponsored agencies ............ .

1.3 Non-U.S. govemment (including Canada, excluding mortgage-

backed securities) ............................................................................................ .

1.4 Securities issued by states, territories and possessions and political

subdivisions in the U.S.:

1.41 States, territories and possessions general obligations ......................... .

1.42 Political subdivisions of states, territories and possessions and

.. ........... 0.0

............. 0.0

.. ........... 0.0

.. ........... 0.0

political subdivisions general obligations ................................................. . .. .......... 1 ,539,564 ........... 33.5 ........... 1 ,539,564

1.43 Revenue and assessment obligations .............................. , ...................................... ,279,071 .......... , .. 6,1

1.44 Industrial development and similar obligations .................................................... , .... , .... , ...... , .. 0.0

1.5 Mortgage-backed securities (includes residential and commercial MBS):

1,51 Pass-through securities:

1,511 Issued or guaranteed by GNMA, ...... , .... , ........................ , ...................... , ........ , .. , ...... .. .. .......... ,0,0

1,512 Issued or guaranteed by FNMA and FHLMC ............................................ , ................ .. ............ ,0.0

1,513 All other, .. " ................. ,", ............ ,.,.,', .............................. " .............. ", .. ,"", .... , .. " ........ , ", .......... 0.0

1 ,52 CMOs and REMICs:

1.521 Issued or guaranteed by GNMA, FNMA, FHLMC or VA ........

1.522 Issued by non-U,S. Govemment issuers and collateralized

by mortgage-based securities issued or guaranteed

by agencies shown in Line 1,521 ............................ , , .................... ..

1,523 All other" .. , ............ ,""', .......... , .. , .................. ,"""""', .. ,, ................ ..

2. Other debt and other fixed income securities (excluding short-tenn):

2,1 Unaffiliated domestic securities (includes credIT tenant loans and

.. .......... ,0,0

.., .......... 0,0

.. .......... ,0,0

........... 279,071

hybrid securities) ........ , ............. , ..... , ......... " .. , .............. , .. ,'''', .......... , .................. . .. .. 129,425 ............ .2,8 .............. ,129,425

2.2 Unaffiliated non-U.S. securities (including Canada) ........................ " .. , ............ .. .. .......... ,0,0

2,3 Affiliated securities ............ ,"', .... ,,, ...... ,"', .. ,,,, .... ,', .. , .............. ,, ...................... , .. .. .. ........... 0,0

3. Equity interests:

3,1 Investments in mutual funds ................ , ............................................................ , .................. , ... .. .. ........... 0.0

3.2 Preferred stocks:

3.21 Affiliated .... , .... , .... , ........ , ..... ,., ................... , ........ , ............................... , ............ ,0,0 ,,, ........................ ..

3,22 Unaffiliated ..... ,." .............. " ........... , .. ,"'" .................... ,',.,""""", ........ "" .... , ........ ,,, .. ,391,640 .......... , .. 8.5 ,,, .... ,, ...... 391,640

3.3 Publicly traded equity securities (excluding preferred stocks):

3,31 Affiliated, .. " .. , ............. ,., .. , .. " ..... ,.," ...... , .. ,', .. ,',." .......... , ............ , .... , .. , .... ,.,. , .. , ........ " .. 0,0

3.32 Unaffiliated .. , .. .... , ...... ,2,188,617 .......... .47.7 .... , ....... 2,188,617

3.4 Other equity securities:

3,41 Affiliated .......... , .... ".,' ........ ,,, ....... ,' .............. ,' .............................. , .. , .. , .. , .. , ..

3,42 Unaffiliated ............ , .. ,"'" .... " .... , .... " .............. ,'" ............................ ,............ .., .. .

3.5 Other equity interests including tangible personal property under lease:

3,51 Affiliated, .............. ,", ............. ,", ................. " .............. , ................... ,

3,52 Unaffiliated ............ ,

4, Mortgage loans:

4,1 Construction and land development.. ...... , ........................................................ ..

4,2 Agricultural.. ........ ".,', ............ ,""'" .......... " .................. ,"""", .... " ...................... ..

4.3 Single family residential properties .............................................. ,", ................ ..

4,4 Multifamily residential properties ....... ,., .. , .......... , .. , .. " ... , ............................ , ....... ..

4,5 Commercial loans .... "", .................. "", .......... "" .......... " .................. , .. ,"""" 4,6 Mezzanine real estate loans ........

5, Real estate investments:

5.1 Property occupied by company ........ """ .......... """", ............................... .

5.2 Property held for production of income (including $ ........ ,,0 of

property acquired in satisfaction of debt) ....................... , .. , .. , .. , .......................... .

.., .. " ...... 0,0

.. .. " .... ",0,0

, ............ 0,0

............ ,0,0

.. ........ 0.0

.. .... , ...... 0,0

, ........ , ... 0.0

.. ........... 0.0

.... , ........ 0.0

.. .......... ,0,0

, ...... 61 ,571 .. , .......... 1 ,3 ............ , .... 61 ,571

.. .......... ,0,0

.............................. 0 ............. 0.0

.............................. 0 .. ........... 0.0 I ............. 0.0 .............................. 0

.............................. 0 ............. 0.0 I

................ 1,539,564

................... 279,071

................... , .......... 0

, .......... 29.B II ............ ,5,411 ............ ,0,0

.......................... , .. ,0 ............. 0.0 I

.............. " .............. 0 ............ ,0,0

.......................... , ... 0 .... , .. , .. , .. 0,0 I

...... ,." .................... 0 ....... 0.0

.. , .... , .................. ",,0 .......... , .. 0,0 I , ................. " .......... 0 """ .. , .... 0,0

I .................. ,129,425 ........ , .... 2.5

...................... "", .. ,0

........................ "",,0 ............. 0.0 I ............ ,0,0

.................. " ........................... 0 .. " ........ ,0.0 I " .. " ....................... 0 ............ ,0,0

.......... , ........ 391,640 ............. 7.6

............ , ........ ,0 ............. 0.0 I , .............. ,2,188,617 .......... .42,3

.............................. 0 ............ ,0.0 I ................ " ........ 0 .......... , .. 0.0

............................. ,0 ............. 0.0 I

.... " ................ , .... , .. 0 ............ ,0,0

"', .. " ...... , .............. ,0

", .. "., ........ , .... " ...... 0

" .. " .. , .......... , .......... 0 ........ " .............. , ..... 0

" .. ,', ............ , .......... 0 ., ...................... , .. , .. 0

............ ,0.0 ..

............ ,0.0.

." .......... 0,0

............ ,0,0 II

............ ,0,0 II

............. 0.0

.......... , .......... 61 ,571 .. , ...... , .. ,1.21

...... , ................ ",.",0 ........ , .. ,,0.0 5,3 Property held for sale (including $ ........ ,0 property acquired in

satisfaction of debt)" ............ ,""', ............ ,"', .............. , ... "., ... , ............ " .. , .......... ,

6, Contract loans ............ ,', ..................... , ........... ,., .............. , ... ,',.,.,', .............. " ............ ..

............ ,0,0 .... " .................. ".. .. .... , ..... ,............ .. ...................... "",0 " .......... ,0,0 I

.. .......... ,0,0 , ...... ,""""', ........ ,.. , .. ,", .......... , ........ , .............. ,." .. ,0 " .......... ,0,0

7. Derivatives ............................................................................................................... .. .. .......... ,0,0 ...................... " .. , .. ,0 ............ ,0.0

8. Receivables for securities ........ , .......... "" .... , ................. , .. " ...... " .... " .............. , .......... ,

9, Securities lending (Line 10, Asset Page reinvested collateral) ........................ , ...... , .. .

............ ,0,0 , .. , .... " ............ ,...... .. .. , .. ,', ... , .............. , ................... , .... , .... ,0 .......... , .. 0.0 I

.. .......... ,0,0 ", .. , ........ ,.............. .. .... ,' ,XXX ........ ,.... .., .. ". ,XXX ............ ,'" , ........ XXX .. ,

10. Cash, cash equivalents and short-tenn investments ................................................ .. .." ........ ,0,0 ........ , ...... 582,530 ........ ,,, ............ , .... , .................. ,582,530 .. , ........ 11.3

11, Other invested assets .... "".,", ............... , ............ , ... , ........................ ,"""", ........ " ...... , .......... " ................ , , ............ 0,0 .. ,""""',................ .. ......... ,................ .. ...... , .................. ",0 .. , ......... ,0,0 I 12. Total invested assets ...... , ............ " .... , .............................................................. , ........ , .. , ........ 4,589,888 """ .. ,100,0 ............ 5,172,418 " ........................ 0 , .............. ,5,172,418 ........ ,100,0

5101 01/24/2017 7:57:38 AM

m o ....

"I" I" '" I l j l l I • AnnuaiStatementfortheyear20160lthe Pocahontas Mutual Insurance Association

SCHEDULE A . PART 1 Showing all Real Estate OWNED December 31 of Current Year

Descnotion 01 Property

Properties Occupied by the Reporting Entity - Administrative

Land ................................................... .

Office Buildil1\l....... . ..................................................... .

0299999. Properties Occuoied by the Reporting Entity - Administrative ..... .

0399999. Total- Properties Occupied by the Reporting Entity ...

0699999. Totals ...

2

Code

laurens. Laurens.

Location 4

Date Date of last City Slate Acquired Appraisal

IA ...... 07/31/1985.

IA...... 11/01/1985.

8 10

Amauntof Actual Cost Encumbrances

. ......... 12.500

. ............ 191.580 ... .

.... 204.080 ......... 0

....... 204.080 ... 0

Book/Adjusted Carrying Value

Less Encumbrances

. ............. 12.500

............. .49.071

............. 61.571

............... 61.571

...... 204.080 ....... 0 .................. 61.571

FairVaJue Less Encumbrances

.0 ............ 0 ........... 0

J t , • J il • , • , I .. . Change in BooklAcl'usted Carrying Value Less Encumbrances 16 17

11 12 13 14 15

Current Year's Other-Than- Gross Income Temporary Current Year's Total Change in Total Foreign Earned less Taxes, Repairs.

Current Year Impairment Change in B.lAC.V. Exchange Change Interest on and Expenses Depreciatlon Recogn~ed Encumbrances (13-11-12) in B.lA.C.V Encumbrances Incurred

. ........... 0

. ......... 6,799 ........ (6.799) ........ 18.700 . .. 8.008

........... 6.799 ... 0 ............ 0 . ......... (6,799) ......... 0 ..... 18,700 . .. 8.008

.............. 6.799 ... 0 .......... 0 ................... 16.799) . ..... 0 ................. 18.700 ..8.008

........... 6.799 .......... 0 ...... 0 ................... (6.799) . .... 0 ......... 18.700 . ....... 8.008

m o N

-------------------------------------------------------_._---------------,----,----------_._--------------------_._-"-_ .. -------"-_.,,---

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE A . PART 2 Showing all Real Estate ACQUIRED and Additions Made During the Year

1 location 4 5 6 7 8 9 2 3

Oat. Actual Cost at Amount of Book/Adjusted Ccnying Additional Investment Made Description of Property C", Slale Acquired Name of Vendor Time of ACQuisition Encumbrances Value Less Encumbrances After ACQuisition

NONE

- - - - - - ... -

m o t.)

"II Ij a", Ii" , , • i • l • , . , , Annual Statemenl for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE A . PART 3 Sh oWing a ea sae unng t e ear, II R lEt t DISPOSED D ' h Y neu Ing I d' P ayments D ' th unng e Final Year on "S I aes un d C er

1 Locafion 4 5 6 7 8 Cha e in BooklAcfusted Carrying Value Less Encumbrances 2 3 9 10 11 12 13

Expended for Current Adcfrtions, Book/Adjusted Year's Other-Permanent Carrying Value Than- Total Foreign

Improvements Less Current Temporary Current Year's Total Change Exchange D~posal and Changes in Encumbrances Year's Impairment Change in in 8lA.C.V. Change in

Description of Property City State Dale Name of Purchaser Actual Cost Encumbrances Prior Year Deoreciation Recoanized Encumbrances (11-9-10\ B./AC.V.

NONE

.. , ill • , . , , , ,

t" on rae 14 15 16 17 18 19 20

Book/Adjusted Gross Income Carrying Value Foreign Earned Less Taxes,

Less Amounts Exchange Gain Realized Gain Total Gain Interest Repairs and Encumbrances Received (Loss) on (Loss) on (Loss) on Incurred on Expenses

on DisoosaJ Dunne Year Disoosal Disoosal Disoosal Encumbrances Incurred

-------------_.-------------------------------------

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE D - PART 1 Showing all Long-Term BONDS Owned December 31 of Current Year

Codes 4 5 F o r el g Bond

CUSIP Identification Description Code n CHAR U.S. Political Subdivisions of states, Territories & Possessions (Direct and Guaranteed) -Issuer ObI! ations

015714 BD 9 Algona IA Munl Utils Elec ...... .

030850 FM Ames IA Hospital Revenue ......................... .

087671 2T Bettendort IA Ser C GO.................. .. ...................... .. 12174P AT Burlington IA Community School District.. ....................... .. 15Q214 AP Cedar Falls IA Community School D~trict.. .................................... . 150539 AJ Cedar Rapids IA Community School District.. .................... .

15Q539 AB Cedar Rap~s IA Community School District... 462046 VI IA 8t HGR Education Loan Authority ......... .

222149 FB 7 Council Bluffs IA Community School District ................................ " ................ . 259230 276540

294389 462460

MT 4 Douglas County NE Hospital Authority #2 .. XG BG

3G 41266A CU

46246P MD 462460 3L

~ 462560 FP o 462560 FY

660460 CX

68417C CN 941660 AU 951564 AU

958366 G8 953837 FH

Eastern Iowa Community College ................................ .

Epworth, IA Go .......................... ..

Grand View College .......................... .. Hanan, IA Muni Utilities ......... " ............................. .

Iowa Finance Authority Hlth Care Fac ............................... . la High Ed Ln Auth, Wartburg.

Iowa State Hospital Rev Univ 1A..

Iowa State Hospital Rev Univ IA. .. .

North Liberty IA Water Rev ............ .

Orange City IA Hasp Revenue .............................................. .. Waterloo, IA Community SchOOl District ................... .

West Branch IA Community School District. ...................................................... . Western Illinois University .......................... " .... , ............. " ...................... . West Liberty IA Capital Loan Notes..... .. .................................... .

NAIC Desig­nation Actual Cost

Rate Used to Obtain Fair Value

... ll ................ 50,000 ... 101.795

... ll .................. 55,200 ... 102.696 .... ll .... .49,863 ..... 98.007

........ ll ...... 50,000 ... 109.027

Fair Value

Fair Value

...... 50,897

............ 51,348 ........ .49,004

........... 54,513

10

Par Value

11

BooklAdjusted Carrying Value

.... 50,000

... 55,070 . .............. 49,863

... ll ..... 107,299 ... 107.586 ........ 107,586

.......... 50,000 ................ 50,000

..... 50,000 ........... 50,000

............. 100,000

...50,000 ... 104,523

... ll ..... 54,697 ... 101.6n ................... 50,839 .. .... 50,000 .................. 52,664

... ll .................. 55,332 ... 105.446 ................... 52,723 .............. 50,000 .................. 54,065

... ll

... ll ........ ll

.. ll ........ ll

........ ll

..ll

.... 102,789 ... 106.532

..... 50,000 ... 104.529

..... 50,000 ..... 86.717 ......... 40,849 ... 100.283

...25,000 ... 100.230

..99,070 ..... 98.232 ......... 50,000 ... 103.259

.. ..... ll .... 99,020 ... 106.967

.. ll ............. 100,078 ..... 91.519 ........ ll ............. 109,803 ... 106.915

.. ll .................. 59,155 ... 102.651

.ll ..... 50,000 ... 100.224 ........ ll ..... 100,491 ... 102.972 ........ ll ........ 50,000 ... 107.238

.. ...... ll ......... 70,886 ... 104.752

........ ll ..... 50,000 ..... 96.936

........ ll ........ 29,344 ... 100.138

........ 106,532 ................. 100,000 ............... 101,440

...... 52,264 .......... 50,000 ........... 50,000 ..43,359 .............. 50,000 .... 50,000 ..40,113 ................... 40,000 .... 38,314

.. 25,057 ................... 25,000 ... 25,000

... 98,232 .............. 100,000 .... 99, 167 ... 51,630 ................... 50,000 .... 50,000

............... 106,967 .......... 100,000 ............... 99,335

............... 91,519 ...... 100,000 ................ 100,067 ..... 106,915 ................. 100,000 .......... 106,661

.... 61,591 ................... 60,000 ...... 59,294

.. 50,112 ....... 50,000 .................. 50,000 ...... 97,823 .......... 95,000 .................. 95,017

... 53,619

.. 68,089 .. .48,468

...... 30,041

...... 50,000 .................. 50,000 ..... 65,000 .................. 69,575

.50,000 .................. 50,000 .. 30 000 .................. 29,509

Change In Book/Adjusted Carrying Value 12 13 14 15

Unrealized Valuation Increase

(Decrease)

Current Year's (Amort~ation) 1

Accretion

............. (130)

.. ........... (537)

Current Year's Other-Than-­Temporary Impairment Recogn~ed

................ (421) .... ..

................ (354) .................... .. .. ........... (302)

.. .. (1,802)

.......... 53

.. ............... 102

.. ... (6)

.. .............. (754)

.. ... 40

.. ........ (392)

........ (366)

Total Foreig n Exchange Change in B.lA.C.V.

.... 47 ............................................ ..

1899999. U.S. Political Subdivisions of States TenitDries & Possessions -Issuer Obligations ......................................... . ... 1,558 676 XXX .. ............ 1,649,241 .............. 1,515,000 ............. 1,539,664 ....................... 0 ............ .14,822) .................. 0 ..................... 0

2499999. Total" U.S. Political Subdivisions of States, Territories & Possessions .............................................. . ..1,558,676 xxx .............. 1,649241 .............. 1,515000 ............. 1,539,664 ............ 0 ............. (4,822) .................. 0 ........ 0

U.S. Special Revenue & Special Assessment Obligations and all Non·Guaranteed ObliQations of AQencies and Authortties of Governments and Their U.S. PolHical Subdivisions • Issuer Obligations 180546 BV 4 Clarion, IA Hosptlal......................................................................................... .. .... ll .................. 25,419 ... 102.552 ................... 25,638 ....... 25,000 ................. 24,666 ................ (560) ............................................ ..

462517 AN 3 Iowa Public Power Agency..................................... .......................... .. ...... ll .................. 51,004 ... 104.248 ................... 52,124 ...... 50,000 .................. 50,592 ............... (60) ............................................ ..

751265 OG Ralston NE Txble Arena........................................................................... .. ...... ll ............ 103,888 ..... 85.810 ................... 85,810 .. 100,000 ................ 102,499 .......... (303) ............................................ ..

~ 218080 BF 5 CoralvllleIATaxabIeCoroPurooseSerB.................................. ..ll ... 101,444 ... 101.209 ................. 101,209 ....... 100,000 ................ 101,314 .......... (1301 ...................... ..

~ 2599999. U.S. Special Revenue & Assessment Obligations -Issuer Obligations. ...281,755 XXX ................. 264781 ...... 275,000 ........... 279,071 .0 ..... (1,053) .................. 0 ..................... 0

i'3 3199999. Total- U.S. Special Revenue & Special Assessment Obl~ations.... ... ................... .. ...... 281,755 XXX ................. 264,781 ...... 275,000 ................ 279,071

~ Industrial & Miscellaneous (Unaffiliated) • Issuer Obligations

... 0 .... (1,053) .................. 0 .................... 0

-..J 74254P WH 1 Principal Ufe Cprenotes .......................... . .. ....... 1 .................. 25,000 ... 103.667 ................... 25,917 .25,000 .................. 25,000

~ 61744Y AD 0 Morgan Stanley .......................................... . ........ 1 ........ 53,813 ... 104.083 ................ 52,041 .. 50,000 .................. 50,526 ................................. (526) ......

W 369604 BO 5 General Electric Cap Corp .................................................................... . ........... 1 ........ 53,683 ... 103.nO ................... 63,300 .. 61,000 .................. 53,899 ................. 215 ...................... ..

~ 3299999. Industrial & Miscellaneous (Unaffiliated) -Issuer Obl~ations......... ....................... .. . .................. .................................... .. .............. 132,496 XXX ................. 141258 ................. 136,000 ................ 129,425 ............. 0 ................ (311 ................... 0 ..................... 0

:s::

-- - - - ... - ... ... ... ... ... ...

16

Rate of

.... 3.250

.. .4.000 ...... 3.125

...... 5.125 ... 5.125

...... 4.250

...... 4.500

...... 3.500

...... 4.250

...... 3.000

...... 4.500

...... 3.850

...... 4.125

...... 3.800

...... 4.000

...... 4.000 .... 4.000

...... 4.000

...... 4.000

...... 5.500

...... 5.000

...... 4.400

...... 3.400

.. .... 3.300

XXX XXX

...... 6.750

...... 6.550

...... 4.150

...... 4.375

XXX XXX

...... 5.500

.. .... 5.950

...... 5.000

XXX

Interest Dates 17 18 19 20 21 22

Admitted Effective When Amount Due & Amount Rec.

Stated Contractual

Maturity Rate of Paid Accrued Dunne Year Acquired Date

JD... .. .. 134 ............ 1,625 09/1712013. 12101/2021 .

JD.. .. ... 88 ............ 1,000 06/1612016. 06115/2036 .

JD....... .. ... 39 1212212016. 0610112030 . JJ....... .. ...... 1,222 ..... 2,562 03130/2009. 07101/2028 . JD ..................... .421 ..... 5, 125 1012612011. 0610112025.

JJ....... .. .......... 1,065 ............ 2, 125 0310612012. 0710112023 . JJ....... .. .......... 1,128 ............ 2,250 0512212013. 0710112028 .

AO...... .. ........... 873 ............ 3,500 0612612012. 1010112021. AS...... .. .......... 1,065 ............ 2,125 0410712011. 07101/2024 . MN...... .. .......... 189 ............... 342 09/1612016. 05115/2035.

JD ...................... 148 ............ 1,800 0311012009. 0610112017 . JD....... .. .............. .79 ............... 962 0512912008. 0610112017 . AO...... .. ...... 1,028 ..... 4, 125 0212512015. 101012032 ..

JO..... .. .. 474 ...... 1,900 0610112010. 1010112020 . JJ....... .. .......... 2,005 ........ .4,000 1112712013. 07101/2026 . JO....... .. ....... 997 ............ 4,000 0410112015. 1010112027 . MS..... ...1,326 .... ..4,000 1012912012. 0910112025.

MS..... .. .. .796 ............ 2,400 07/1212013. 0910112034 . JD... .. ........... 164 ............ 2,000 09/1712008. 06101/2017 . MS..... .. ..... 1,732 ............ 5,225 0812212013. 0910112027 .

JJ ............ 1,253 ............ 2,500 04/2612011. 0710112028 .

JJ ................... 1,434 ............ 2,860 0512312013. 0710112029 .

AO...... .. .. .424 ...... 1,700 04/1912012. 04/0112023 . JD....... .. ............... 81 ............... 990 0711212013. 0610112027.

XXX XXX .......... 18165 .......... 59,116 XXX XXX XXX XXX .......... 18,165 .......... 59,116 XXX XXX

XXX XXX

XXX

JD ...................... 139 ............ 1,687 07/2612010. 0610112020.

JD....... .. ............. 269 ............ 3,275 01/1912010. 1210112026 . AS .................. 1,194 ............ 4,150 0512212012. 09/15/2024 .

JD....... .. ............. 360 ............ 6,210 0310412016. 0610112025.

XXX ............ 1,962 .......... 15,322 XXX XXX XXX ............ 1,962 .......... 15,322 XXX XXX

AO...... .. ............. 290 ............ 1 ,375 04/1612008. 04/1612018. JD ........................ 24 ............ 2,975 09/1612010. 1212812017 .

JD ...................... 134 ............ 2,753 0112012016. 1212912049 .

XXX ............... 448 ............ 7,103 XXX XXX

m .... o ....

II1I11IIIII1II Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

I I I • I • I •

SCHEDULE D - PART 1

I I I • I J • • • • Showing all Long-Term BONDS Owned December 31 of Current Year

1 2 Codes 6 7 Fair Value 10 11 Chan e in Book/Adjusted Canyin9 Value 3 4 5 8 9 12 13 14 15

F 0 Current Year's r Unrealized Other-Than- Total Foreign ei NAIC Rate Used Valuation Current Year's Temporary Exchange 9 Bond Des~- to Obtain Book/Adjusted Increase (Amortization) I Impairment Change in

CUSIP Identification Descnption Code n CHAR nation Actual Cost Fair Value Fair Value ParVaJue Carrvlna Value (Decreasel Accretion Recoon~ed B.lA.C.v. 3899999. Total-Industrial & Miscellaneous (Unaffiliated) ............ .................................... " ...... ......................... . ...... . ................. ............. 132,496 XXX .............. 141,258 ................. 136,000 ................ 129,425 .. ........ ........... 0 .. .............. (311) ................... 0 ..................... 0 Totals n99999. Total-Issuer Obli atians .......... ..

8399999. Grand Total- Bonds .................................... .

I J • J

Interest Dates 16 17 18 19 20 21 22

Stated Admitted Contractual

Effective When Amount Due & AmountRec. Matuniy RaJeof Rate of Paid Accrued DurinQ Year AC\luired Date

XXX XXX XXX ....... ...... 448 .. . ...... .7,103 XXX XXX

m .... ....

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE D - PART 2 - SECTION 1 Showing aI/ PREFERRED STOCKS Owned December 31 of Current Year

~~ Fair Value 11 DMdends 3 4 10 12 13 14 15

F Rate per Unrealized or Share Used Amount Nonadmitted Valuation el Number of Par Value Rate per Book/Adjusting to Obtain Declared but Received Declared but Increase

CUSIP Identification Description Code Ion Shares per Share Share Canying Value Fair Value Fair Value Actual Cost Unpaid Durinq Year Unpaid (Decrease)

Preferred Stocks • Industrial and Miscellaneous (Unaffiliated) 020002 85 3 Allstate Corp 6.25% PFD Senes F. ..................... ...... .4,000.000 ...... 25.650 ..... 102,600 ...... 25.650 ................ 102,600 ................ 100,000 ....... ~25O .. (4,680) 054937 60 BB & T Corporation 5.2% PFD .... .. ..... 2,000.000 22.760 ......... 45,520 .... 22.760 ...... 45,520 ...... ..49,172 ......... 2,600 ........... (4,680) 084423 40 Berkley (WR) Corporation ........... .................................... , .. ..................... ....... 2,000.000 ...... 22.610 ... ......... 45,220 ...... 22.610 ...... 45,220 ... 50,000 ............ 2,812 ........... (5,620) 12542R 80 3 CHS Inc. 7.5% ....... ............................................. ....... 2,000.000 ...... 27.140 ........ 54,280 ... 27.140 ...... 54,280 .......... 50,000 .......... 3,750 . ................. ............. 180 46637G 12 4 JP Moryan Chase & Co 5.45% .... .......... ., .......... ....... 2,000.000 ...... 24.650 ..... 49,300 ... 24.650 .......... .49,300 .......... 50,000 ............ 2,725 . ..................... ........ (1,180) 74460W 80 Public Storage 5.375% PFD. ....... 2,000.000 .................... ...... 22.600 .. .. .45,200 ...... 22.600 .................. 45,200 ..... 50,000 ............ 2,688 . ......... " .......... ........ (5,720) 744320 60 Prudential Flnanclallnc. ........................ ....... 2,000.000 ...... 24.760 .... .49,520 ... 24.760 .................. 49,520 .. 50,000 ............ 2,875 ......... (2,0001

8499999. Total- Prefenred Stocks -Indusllial and M~cellaneous (Unaffiliated) ..... ....................... ..................... .. .. 391,640 XXX ..... 391,640 .. 399,172 ............ 0 .......... 23,700 ................... 0 .. ..... (23,7001

8999999. Total- Prefenred Stocks ....................................................................... ...................... ....................................................... ................ 391,640 XXX ................ 391,640 ................ 399,172 ......... 0 ..... 23,700 ................... 0 .. ....... (23,700)

- - - - - - - - - - - - - .. ..

Chance in Book/Ad usted Carrvinq Value 20 21 16 17 18 19

Current Yea~s Other-Than- Total Foreign

Current Year's Temporary Total Change In Exchange NAIC (Amortization) Impairment B.lA.C.V. Change in Desig- Date

I Accretion Recoonized (15+16-17) B.lA.C.V. nation Acquired

.(4,680) . ....... ...... P1Ll 06/1212014 . ....... (4,680) ...... P1Ll 12126/2012.

.... (5,620) . ......................... ...... P1Ll 0510212013 .

...... 180 . ......................... ...... P1Ll 01/21/2015 .

.... (1,180) ...... P1Ll 0210512013 .

..................... (5,720) . ..................... ...... P1Ll 09/20/2012 .

..................... (2,000 .. ................. ..... P1Ll 12104/2012 .

...... 0 .......... 0 ................... (23,700 .... 0 XXX XXX

........... 0 ............ 0 ................... (23,700) .................... 0 XXX XXX

I J ll.f II I J I J I J Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

I • I • I • l I I I • SCHEDULE D . PART 2 • SECTION 2

• I • • • Showing all COMMON STOCKS Owned December 31 of Current Year

CUSIP Identification Descriotion Common Stocks -Industrial and Miscellaneous (Unaffiliated)

000000 00 0 Columbia Diversified Equity Fund ........................... .

000000 00 845333 10

20030N

00287Y 008252 02079K 021186 026874

031162 053332 075887

084670

Y09827 124857

151020 m 219350 ..... N 126650

24703L 25470F 278642 302290 31428X

31620M 410345 58933Y

589433 320878 60871R 628996

~ 68389X

~ 847560 C5 790849 ~ 857477

:-:' 863667 ~ 883556 ~ 887317

931142 ~ 963320

10 10 10

30 60 78

10 10

10

20 10 20 10

10 10 10 10

10 10 10

10 10 10 10

10

20 AA 10 10

10

10 10 10

30 10 10

Columbia Mid Cap Value Opportunity Fund

AT&T Corp ....................................... . Corneast. ...................... ,., ................. .

Abbvie Inc.

Affiliated Managers Group Inc ....

Alphabet inc ...... .

American International Group Inc ... 4 Ameriprise Financial Inc.

AMGEN Incorporated ..... Autozone inc ..

9 Becton Dickinson & Co ... .

Berl<shire Hathaway ..... .

Broadcom :LTD.

2 CBS Corporation .................... .

4 Celgene Corp ... .

Coming Inc ..................................... .

o CVS Health Corporation ...... " .......... .

3 Dell Technologies Inc .......................................... .

4 Discovery Communications Inc ..................... .,., ... ..

Ebay Inc... . .......................................... . Exxon MobiL ........ ..

FedEx Corp. Fidelity National Information Services Inc ........ .

Hanesbrand Inc.

Merck & Co. Inc ....

Meredith Corporation .. ..

Meta Financial Group .. .

Molson Coors Brewing Co ....... ..

NAMIC Insurance ................ ., ........... ..

Oracle Corporation.

Spectra Energy ....................................................... .

3 St. Jude Medical Inc ............ .

3 State Street Corporation .............. . Stryker Corporation ...................... .

Thermo Fisher Scientific Inc.

3 Time Warner ............. .

3 Waf-Mart Stores Inc. .. ..................... .

Whirtpool. .......................................................................... .

5 Fair Value 10

Rate per or Share Used el Book/Adjusted to Obtain Fair

Code I on Number a! Shares Carrvina Value Value Fair Value Actual Cost Declared but Unnald

. ........ 11,509.688 .................. 153,424 ......... 13.330 .................. 153,424

........... 3,292.297 ................... 32,396 ........... 9.840 ............. 32,396

. .......... 1,130.000 ................ 48,059 ......... 42.530 ................... .48,059

.............. 390.000 ............... 26,930 ......... 69.050

.............. 990.000 .................. 61,994 ..... 62.620

.............. 220.000 ................... 31,966 ....... 145.300

. ... 65.000

... 935.000 ... ..450.000

.. .435.000 ......... .78.000

........ 51,509 ...... .792.450

....... 61,065 ......... 65.310

............. 49,923 ....... 110.940 .......... 63,601 ....... 146.210

............ 61,604 ....... 789.790

. ...... 335.000 ................... 55,459 ....... 165.550

............. 26,930

............. 61,994 ..... 31,966

............ 51,509

............. 61,065 . .............. 49,923

. ......... 63,601

................. 61,604 ............. 55,459

.............. 500.000 .............. 81,490 ....... 162.980 ................... 81,490

. ........... 650.000 ........ 114,901 ....... 176.770 ........ 114,901

........... 1,030.000

............. .420.000

........... 2,740.000 ............. 495.000

.... 65,529 ...... 63.620 ............. 65,529

.... 48,615 ....... 115.750

...... 66,500 ......... 24.270

............... 39,060 ........ .78.910

.... 1,181.000 .............. 64,920 ......... 54.970

........... 2,345.000 ................... 64,276 ......... 24.410

........... 2,055.000 ......... 61,013 ......... 29.690 .......... 590.000 .................. 53,253 ......... 90.260

.............. 100.000 ................... 18,620 ....... 186.200

............. 48,615 ........ 66,500

............. 39,060

............. 64,920 .......... 64,276 ........ 61,013

. ...... 53,253 . .. 18,620

............. 123,581

... 28,359

...... 5,148 ..... 3,628 ... 55,026 ....

........ 22,271

.48,291

.............. 52,437 ... 51,711 ....

.. 35,860

.58,131 .......... 49,171 . ....... 33,308

.. 53,491

............... 55,299 ............. 9,945

............ ..46,322 . .49,465

.... 56,983 ............. 58,172

............... 51,950

............. .43,435 .............. 4,231

... 1,055.000 ................. 79,800 ........ .75.640 ...... 79,800 .................... 31,520

... 1,685.000 ." .......... 36,345 ......... 21.570 ... .

. .......... 960.000 ............. 56,515 ......... 58.870

.. 965.000 ............... 57,080 ......... 59.150

.. 300.000 ................... 30,870 ....... 102.900

. ............. 570.000 .............. 55,467 ......... 97.310

............... .40.000 .............. 11,487 ....... 287.185

........... 1,055.000 ........... .40,565 ......... 38.450

........... 1,290.000 ............ 53,006 ..... .41.090

........... 1,335.000 ................. 107,054 ......... 80.190

..... 36,345

..... 56,515 ............ 57,080

... 30,870

............. 55,467

............. 11,487 ............ 40,565

............ 49,670

.... .45,592 .............. 28,265

......... 2,000

............ 58,153 ....... 2,000

............... 24,951

. .... 53,006 ................... .40,385

... 107,054 ................... .71,809 .... 680.000 ............. 52,850 ......... 77.720 .......... 52,850 ........... 29,229

........... 630.000 ....... 75,480 ....... 119.810 ........ 75,480 ............... 35,424

.............. 390.000 ................... 55,029 ....... 141.100 .... 55,029 ................ 58,874

.............. 720.000 ....... 69,502 ......... 96.530 .................... 69,502 ......... 50,412

....... 300.000 ....... 20,736 ......... 69.120 ...... 20,736 ... 5,404 . ............... 59.000 .......... 10,724 ....... 181.770 .................... 10,724 ...................... 5,179

Dividends 11

Amount Received Durtng Year

.... .4,642

........ ..78

.... 2,170 ........... 419

............. 2,257

............ 1,709

............. 977 .... 1,740

....... 687

........... 1,638

............ 649

.......... 1,480 .......... 631

............. 1,181

...... 130 ........... 1,097 ........... 556

.. 1,766 ...... 1,911

........... 156 .................... 234

............ 633 ...... 2,090

.......... 1,110

.......... 952

.......... 958

12

Nonadmitted Declared but

Unoa~

............. 59 ...... .

...... 869 . ........... 597

........ 230

I • I • l • • •

Change in BookiAd"usted CalT'!ing Value 13 14 15 16

Unrealized Valuation Increase

(Decrease)

........ 14,939 .... 4,696

........... 9,176

..... 4,922 .................. 3,346

....... (3,181)

............... 3,218 ................. (6,017)

......... 2,034 ................. (7,012) .

....... 3,472

....... 6,268

..... 15,470 ........ 20,553

....... 16,985 ....... (1,684)

............. 16,413

........ (10,405) ................. 7,937 .................. 6,105

....... 4,542 .... ...... 2,473 .......... 3,721

................ 15,867 ........ (13,325)

........ 5,808 ......... 15,344 ....... 17,091 ...... (2,687)

....... 433 .... 2,026

............ 22,124

............ 16,925 ...... 7,725

Current Year's Dther-Than­Temporary Impairment Recognized

.................. 16,928 .. ' ......................... .

............. (3,845)

............... 19,090 . .. 2,346

............... 2,059

Total Change in B./A.C.V. (13-141

............... 14,939 .................... 4,696

........... 9,176 ............. .4,922

................ 3,346

Total Foreign Exchange Change

In B./A.C.v.

... (3,181) ..... . ........... 3,218 ...... .

.............. (6,017)

..... 2,034

.... (7,012) . .................. 3,472

...... 6,288 ......... 15,470

...... 20,553 ........ 16,985

... (1,684) ...... .

... 16,413

.. (10,405)

..... 7,937

..... 6,105 .......... .4,542

.... 2,473 ..... 3,721

......... 15,867 ............... (13,325)

..... 5,808

..... 15,344 ....... 17,091

.............. (2,687)

........ 433 .................... 2,026

............ 22,124

.................. 16,925 .............. .7,725

........... 16,928

.......... (3,845) .....

. ................ 19,090 ......... 2,346

..... 2,059

17

NAIC Market

18

Indicator Date (at Acouired

........... L 0711212002 . ......... L 03108/2006 .

.. L 0211511984 .

........ L 11/20/2002 .

............ L 0910312014 .

. ........... L 04/21/2011 .

.... L 05/2412013 .

............. L 11/2512015 .

............ L 11/15/2006 .

............ L 09/2612016 .

. ..... L 1011012014 . ........... L 1111512004 .

............ L 11/28/2014 .

............ L 0512712009 .

............ L 1210912013 .

............ L 08127/2015 .

........... L 09/15/1999 .

.......... L 07120/2000 .

.L 07119/2010 .

............ L 04/28/2014 .

.. L 08/2812013 .

....... L 05118/2012 .

...... L 09120/1993 .

... L 04/01/1987.

............ L 0410212007 .

.... L 01/0212007 .

.............. L 0312212013 .

............. L 05117/2012.

............. L 1212612012 .

..... L 05/15/2012 .

..... L 03/20/2013.

.. L 07/26/1993.

............ L 04/0112006 .

m .... N ....

Annual Statementforthe year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE D . PART 2 . SECTION 2 Showing all COMMON STOCKS Owned December 31 of Current Year

CUSIP Identification DescriDtion

9()99999. Total- Common Stocks -Industlial and Miscellaneous (Unaffiliated) .......... ..

9799999. Total- Common Stock ...

9899999. Total Common and Preferred Stock ....................................................................................... .

F or el

Code an Number of Shares BookiAdJusted Carryina Value

............... 2.188.617

............... 2,188.617

............... 2.580.257

Fair Value 7

Rate per Share Used

to Obtain Fair Value Fair Value

XXX ........ 2.188.617

XXX .... 2.188.617

XXX .. 2.580.257

(a) For all common stocks beanng the NAIC market indicator "U" provide: the number of such issues .......... O, the total $ value (included In Column 8) of all such Issues $ ......... 0.

- - - - - - - - - -

Dividends 10 11

Amount Received Actual Cost Declared but Unpaid DurinQ Year

........... 1.535.082 .... ...................... 0 ........... 33.606

............ 1.535.082 .................. 0 ..... 33.606

............... 1.934.254 ................... 0 .. .......... 57.306

- - - -

Change In BooklAd'usted Carrying Value 17 18 12 13 14 15 16

Current Year's Other-Than- NAIC

Nonadmitted Unrealized Temporary Total Change in Total Foreign Market Declared but Valuation Increase Impairment B.lA.C.v. Exchange Change Indicator Date

Unpaid (Decrease) Recogn~ed (13-14) in B.lA.C.V. (a) Acquired

................ 0 ......... 241900 ....... 0 .. .............. 241.900 ............. 0 XXX XXX .... 0 ...... 241.900 .. .... 0 ......... 241.900 ..................... 0 XXX XXX

............. 0 ... 218.200 ....... 0 ....... 218.200 ............. 0 XXX XXX

.. ..

m ..... W

IIIIIIIII1I111 Annual Statement for Ihe year 2016 oflhe Pocahontas Mutual Insurance Association

I 1 1 1 I I I I I

SCHEDULE D • PART 3

I • I J • J

Showing all Long-Term Bonds and Stocks ACQUIRED During Current Year

CUSJP Identification Desai lion

Bonds· U,S, Political Subdivisions of states

030850 FM Ames IA Hospital Revenue................... . ........................... .

087671 2T 9 Bettendorr IA Ser C GO ................................... .

259230 MT 4 Douglas Cnty NE Hopital AuIh #2 ............. .

2499999. Total- Bonds - U.S. Political Subdivisions of States ...................................... .

iar Assessments .. Bonds· Industrial and Miscellaneous

369604 BO 5 1 General ElectJic CaD Corv ......... .

3899999. Total - Bonds -Industrial and Miscellaneous" ............ .

8399997. Total- Bonds - Part 3.... . ..................... .

8399999. Total- Bonds ....................................................... .

Common Stocks - IndusbiaJ and Miscellaneous

000000 00 Columbia Diversified Equity Fund ............ .

000000 00 Columbia Mid Cap Value Opportunity Fund .....

02079K 30 Alphabet Inc ........... " .. " ........ .

053332 10 Autozone Inc.

075887 10 Becton DIckinson & Co .......... . 126650 10 CVS Health Corporation ............. ".

24703L 10 Dell Technologies Inc ........................................... ..

25470F 10 Discovery Communications Inc .. .

302290 10 Exxon Mobil .............................. .

410345 10 Hanesbrand Inc.

60871R 20 Molson Coors Brewing Co.

790849 10 S!. Jude Medical Inc ........... .

883556 10 Thenno Fisher Scientific Inc.

887317 30 Time Warner ..................... ..

9099999. Total· Common Stocks - Industrial and Miscellaneous.

9799997. Total- Common Stocks - Part 3.

9799999. Total- Common Stocks ....................... .

9899999. Total- Preferred and Common Stocks.

9999999. Total- Bonds, Preferred and Common Stocks .............. .

Name of Vendor

0611612016 ........ Wells Fargo ................................................................................................. .

12122120t6 ........ Wells Fargo ..................................................................... .

09/16/2016 ........ Wells Fargo ...................................................................................................... .

........... I.. . ........ 1 01/2012016 . ...... 1 Wells Fargo .................................. .

1211512016. ...... Columbia-Dividends Reinvested ..

12/1412016 . ...... Columbia-Dividends Reinvested

03/17/2016 ... ... Wells Fargo .. .

09/2612016 .... .. Wel~ Fargo.

03114/2016 . ...... Wells Fargo .......................... .

05109/1901.. ..... Wells Fargo

09107/2016... Wells Fargo ..... .

09/16/2016 ........ Wells Fargo .. .

0513112016 . ...... Wells Fargo ..................... .

0311712016 .. ..... Wells Fargo .... .

09/1612016 ........ Wells Fargo ..

10103/2016 ........ Wells Fargo .. .

09108/2016 ....... Wells Fargo.

03130/2016........ Wells Fargo.

Number of Shares of stock

.1 ...................... .

........... 356.074

........................ 7.834

..... 65.000

. ... 78.000

........................ 335.000

..... .495.000

..................................... 1,181.130

... 2,345.000

....... 390.000

. .... 1,685.000

......................... 570.000

......... .425.000

......... 390.000

.......... .720.000

I • . , • J , . Actual Cost p ... Value

. .......................... 55,200 .......................... 50,000

. ..................... 49,863 ........................................... 50,000

. .... 50,000 ..................... . .......... 50,000

. .................. 155,063 ..................................... 150,000

......................... 101,444

..................... 101,444

. ......... 53,683

. .... 53,683

....... 310,190

... 310,190

................ .4,642

........... .78

. ........................... 48,291 . ......................... 58,131

.... ..49,171

................... .49,465

. ....................... 39,918

. ................ 58,172

. .... 35,190

................................. 49,670

. ..... 58,153

. ............................. 33,918

. ........................ 58,874

......... 50,412

. .... 594,085

. .... 594,085

. ................................ 594,085

... 594,085

. ..... 904,275

..... 100,000

...................................... 100,000

...... 61,000

........... 61,000

............................... 311,000

xxx XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX

.... 311,000

Paid for Accrued Interest and Dividends

............ 6

........ 96

....... 102

............. 2,965

. ............... 2,965

........ 0

. ......... 3,067

. ................................... 3,067

............. 0

......................... 0 .......... 0

................ 0

......... 3,067

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE D - PART 4 Showing all Long-Term Bonds and Stocks SOLD, REDEEMED or Otherwise DISPOSED OF During Current Year

1 2 3 4 5 6 7 8 9 10

F 0

r ei Prior Year 9 Disposal Number of Book/Adjusted

CUSIP Identification DeSCription n Date Name of Purchaser Sharas of Stock Consideration Par Value Actual Cost Ca""ina Value .. ... Bonds - U.S. PolJtlcal SubdiVISions of States

02177P AE 7 Altoona, IA Urban Renewal.. .. 0610112016. Matured ........ 50,000 ............ 50,000 ........ 51,449 ........ 50,050

276540 XG 1 Eas1em Iowa Community College ........... . 06/01/2016. Called ..... . . ...... 10,000 .......... 100,000 ....... 10,000 ............ 10,000

419342 AM 2 HavelOCk, IA GO .................................................. . 0610112016. Matured. . ......... 10,000 ............ 10,000 ....... 10,000 ................ 10,000

462466 AP 8 Iowa Finance Authority Ref-Dev ........................... . 07/0112016. Called ...... . . ........... 15,000 ............ 15,000 ............ 15,378 ................ 15,233

684174 CK 9 Oranae CItv Elec1rie .............................................. . 08/0512016. Called ...... . . ........... 25,000 ........ 25,000 ............ 25,317 ................ 25,099

2499999. Total- Bonds - U.S. Polffieal Subdivisions of States...... ......................... . ........................ . .......... 110,000 .......... 200000 .......... 112,144 ........... 110,382

Bonds· U.S. Special Revenue and Special Assessment

Change In Book/Adjusted Carryin9 Value 11 12 13

Cunent Year's

Unrealized Current Other-Than-Valuation Year's Temporary Increase (Amortization) Impairment

(Oeerease) I Accretion Recoonized

............... (50)

............. (233) ................. .

............... (99) ..

... 0 ............. (382) ............... 0

14 15

Total Foreign Total Change Exchange in B./A.C.v. Change in (11+12-13J. B.lA.C.v.

.............. (50) ..... .

........... 0 ..

........... 0 .... (233)

. ................ (99)

............... j382) ................ 0

16 17 18 19 20 21

Bond Interest I

Foreign Stock Stated Book/Adjusted Exchange Realized Total Gain Dividends Contractual

Carrying Value at Gain (Loss) Gain (Loss) (Loss) on Received Maturity Disposal Date on D~JlOsal on Disposal Disposal DUring Year Date

..... 50,000 ................ 0 .... 1,250 0610112016 .

. ...... 10,000 .......... 0 ........ 225 0610112017.

. ............... 10,000 .......... 0 ........ 235 06101/2016 .

................ 15,000 .......... 0 ...... .750 0710112019 .

................ 25,000 ......... 0 ........ 828 11/0112019 .

. ....... 110,000 ................ 0 ................ 0 ........ 0 ......... 3,288 XXX

.............. 5,000 .............. 5,000 .............. 5,000

............ 30,000 ............ 30,000 ............ 30,000

....... 5,000

. ......... 30,000

180546 BV 4 1 Clanon, IA Hospital..······ .. · .. · ........ ·.· ... · ................... I .. 10610112016.1 Called ............ .

462602 LH 4 1 Iowa Valley College ............................................... I.. 0610112016.1 Matured ......... . :::::::::::::::1::::::::::::::::::::: .............. 0

............ 0 ............. 5,000

................ 30,000

... 0 ..... 169 0610112020 .

....... 0 ............ 938 0610112016 . 3199999. Totat - Bonds - U.S. Special Revenue and Special Assessments.... ...... . ................... . ............ 35,000 ... 35,000 ......... 35,000 . ....... 35,000 ................. 0 ...... 0 .......... 0 ..... 0 ........ 0 ................ 35,000 ....... 0 .............. 0 ..... 0 ......... 1,107 xxx Bonds -Industrial and Miscellaneous

369604 BM 4 I General Electric Cap Corp .................................... I .. I 01/2012016. I Called .. . .......... 1 ............ . ............ 54,418 ... 61 725 ............ 54 303 ....... 54,321 ..... 0 ................ 54,321 . .. 96 ................ 96 ............ 907 12/2912049 . 3899999. Total ~ Bonds -Industrial and Miscellaneous .................... , .. , .................. . . ........... 54,418 ........ 61,725 ............ 54,303 ................ 54,321 ......... 0 .............. 0 ............... 0 ... 0 .............. 0 ................ 54,321 ................ 0 .......... 96 .......... 96 ............ 907 xxx 8399997. Total- Bonds - Pan 4 ......................................................... . . ......... 199,418 ........ 296,725 .......... 201,447 ........ 199,703 ...... 0 ..... (382) ...... 0 ...... (382).. . ........ 0 .............. 199,321 ....... 0 ....... 96 ... 96 ......... 5,302 xxx 8399999. . ....... 199,703 Total- Bonds ....................................................................................... . ...... (382) .............. 0 xxx .......... 199,418 ..... 296,725 .......... 201,447 .......... 0 .. 96 ..... 96 ......... 5,302

~ Preferred Stocks -Industrial and Miscellaneous

......... (382) ... . ..... 0 ... 199,321 ................ 0

,j:>. 59021G 20 4 I Merrill Lvnch ..................................... . ........... 1..101129/2016.1 Called ....... . ......................... ............ 1 ......... 1,000.000 .... 25,000 ....... 25,000.00 ..... 25,000 ............ 25,110 . ....... (110) ..... (110) ..

......... (110)

..... 25,000 .............. 0 ............ 148 XXX 8499999. Total - Preferred Stocks -Industrial and Miscellaneous ........ ..

8999997. Totat - Preferred Stocks - Pan 4 ...... _ ..................................... .

8999999. Total - Preferred Stocks .................................. .

Common Stocks· Industrial and Miscellaneous

077853 10 Verizon .............................................................. .. 0611712016. Wells Fargo

021186 60 American International Group Inc ......................... .. 0311712016. Wells Fargo ...................................... .

037833 10 Apple Inc .............................................................. . 0412712016. Wells Fargo .. .

10 Dell Technologies Inc .......................................... .. 09/1912014. Wells Fargo .......................................... . 24703L

268848 10 2 EMC Corporation Mass ............................... . 0910712016. Wells Fargo.

370334 10 4 General Mills Inc..... . ......................... . 09123612016 Wells Fargo .......................................... .

C> ~

375558 10

83088M 10

92343V 10

~ 92553P 10 ;:;:; 9099999.

3 9799997.

...., 9799999.

(j, 9899999.

~ 9999999.

'" » s:

Gilead Sciences, Inc ............................................ . 02/24/2016. Wells Fargo ........................... .

Skywor1<s Solutions Inc ........................................ . 02/2912016. Wells Fargo ........... .

4 Venzon Communications, ................................... .. 0511712016. Wells Fargo ................. .

Viacom Inc CI A New ................................ . 0313012016. Wel~ Fartlo ...... .

Total- Common Stocks -Industrial and Miscellaneous ....................... ..

Total- Common Stocks - Part 4 ............................................... .

Total- Common Stocks .................................................. , ....................... .

Total - Preferred and Common Stocks ................................................... .

Total- Bonds, Preferred and Common Stocks ....................................... ..

- - - - - -

..... 25,000

..... 25000

.... 25,000

. ........... .400.000 ............ 20,557

. ............ 545.000 ............ 28,692

............. 665.000 ............ 70,442

................. 0.130 ..................... 6

. ......... 3,240.000 ............ 77,922

. ............ 880.000 ............ 56,980

........... 660.000 ............ 58,023

........... 695.000 ........... .42,629

............. 200.000 ............ 10,279

. ....... 1,460.000 ............ 62,889

-

......... .428,419

. ........ .428,419

........ ..428419

.......... 453,419

. ......... 652,837

-

xxx xxx xxx

xxx XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

..

.. 25,000 ... 25,110 ............ (110) .................. 0 ............... 0 . .... 0 ................ 25,000 ................ 0 .......... 0 .................. 0 ............ 148 XXX

............ 25,000 ... 25,110 ............ (110) .................. 0 ............... 0 ..... (110) ..

......... 25,000 . ...... 25,110 ............ (110) .................. 0 ........ 0 ........... (110)

....... 3,200 18,488 ....... (15,288) .................... . ................... (15,288)

............ 24,633 ................ 24,633 .................... . ...... 0

............ 36,320 ................ 69,998 ....... (33,678) .................... . ........... (33,678) .

................... ..4 ........................ .4 .................... 0

. ... 0 ............ 25,000 ................ 0

........... 0 ................ 25,000 .. 0

. ........... 3,200

. .......... 24,633

........... 36,320

........................ .4

..... 0 .......... 0 ...... 148

......... 0 ......... 0 ............ 148

....... 17,357 ...... 17,357 .... .454

........ .4,058 ........... 4,058

....... 34,122 ...... 34,122 ............ 346

................ 3 .................. 3

............ 80,529 ................ 83,203 ......... (2,674) ....... . ............ (2,674) . . ............... 80,529 ....... 14,461 ......... 14,461 ......... 1,118

............ 36,406 ............. 50,741 .... (14,335) ........... (14,335) ............ . ............... 36,406 ....... 20,574 ......... 20,574 ......... 1,214

............ 49,520 ............ 66,785 ....... (17,265) ..................... . .......... (17,265) .................... . .............. .49,520 ......... 8,503 ........... 8,503

. ........... 54,170 ............ 53,397 ............ .773 ..................... . ................ 773 .................................... 54,170 ...... (11,541) ........ (11,541) ............ 181

.............. 8,232 .................. 9,244 ......... (1,012) ..................... ..... . ............ (1,012) .................... . ............. 8,232 ......... 2,047 ........... 2,047 ............ 224

............ 97986 ...... 64,225 ........ 33,760 ..................... . ........... 33,760 ................ 97,986 ...... (35,0961 ........ (35096) ......... 1,168

.......... 391,000 .............. 440,718 ....... (49,7191 .................. 0 ............... 0 .......... .(497191 ..... 0 .............. 391,000 ......... 0 ....... 54,488 ......... 54,488 ......... 4,705

. ......... 391,000 ............. 440,718 ....... (49,719 .................. 0 ............... 0 ........... (49,719 .... 0 .............. 391,000 ...... 0 ....... 54,488 ......... 54,488 ........ .4,705

.......... 391,000 .............. 440,718 ....... (49719 .................. 0 ............... 0 ........... (49,7191 .... 0 .............. 391,000 ........ 0 ....... 54,488 ......... 54488 ......... 4,705

.......... 416,000 ......... .465,828 ....... (49,829 .................. 0 ............... 0 .......... .(498291 ................ 0 ............. .416,000 ...... 0 ....... 54,488 ..... 54,488 ....... ..4,853

. ......... 617,447 .............. 665,531 ....... (49,829) ............. (382) ............... 0 ........... (50,211) ................. 0 .............. 615,321 ................ 0 ....... 54,584 ......... 54,584 ....... 10,155

- - .. .. - .. - - .. -

xxx xxx

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

XXX

I J 'I II I J I J I J a j I , I J I J • j I I , . , I , I • I , I J l , Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE D . PART 5 Showing all Long-Tenn Bonds and Siocks ACQUIRED During Year and Fully DISPOSED OF During Current Year

1 2 3 4 5 6 7 8 9 10 11 Change in BookiAdjustO<l Canying Value 17 18 19 20 21 12 13 14 15 16

F Current Interest 0 Year's Total Foreign and P~d for r Par Value Unrealized Current Other-Than- Foreign Exchange Di~dends Accrued el (Bonds) or Book/AdjustO<l Valuation Year's Temporary Total Change Exchange Gain Realized Total Gain Received Interest 9 Date D~posal Number of Canylng Value at Increase (Amortization) Impainnent in 8./A.C.V. Change in (Loss) on Gain (Loss) (Loss) on Durtng and

CUSIP Identification Description n ACQuired Name of Vendor Date Name of Purchaser Shares (Stock) Actual Cost Consideration Disoosal (Decrease) I Accretion Recoonized (12+13-14) 8./AC.v. Disoosal on Disoosal Disoosal Year Dividends

m ..... en NONE

Annual Statement for the year 2016 of the Pocahontas Mutual Insurance Association

SCHEDULE D . PART 6 . SECTION 1 Valuation of Shares of Subsidiary, Controlled or Affiliated Companies

1 2 3 4 5 6 7 8 9 10 Stock of Such Company OWned by Insurer on Statement Date

11 12

NAiC Valuauon Method Do Insure~s Assets (See Purposes and Include Intangible

NAIC Procedures Manual of Assets Connected with Description Company the NAfC Investment Holding of Such Total Amount of Such Book/Adjusted Carrying

CUSIP Identification Name of Subsidiary, Controlled or Affiliated Company Foreign Code ID Number Analysis Office) Comoanv's Stock? Intanoible Assets Value Nonadmitted Amount Number of Shares % of Outstandina

1. Amount of Insurer's capita] and surplus from the prior period's statutory statement reduced by any admitted EDP, goodwill and net deferred tax assets included therein: $,,, ...... 0.

2. Total amount of intangible assets nonadmitted $ ......... 0.

NONE

m .... en

SCHEDULE D . PART 6 • SECTION 2 1 2 3 4 Stock in lower-l1er Company Owned Indirectly by Insurer on statement Date

5 6

Total Amount of Intangible Assets Name of Company Listed in Section 1 Included in Amount Shown In

CUSIP Identification Name of Lower-Tier Comoanv Wh~h Controls Lower-Tier Comoanv Column 8, Section 1 Number of Shares % of Outstanding

NONE

- - - - - - - .. .. - .. - - ... ... .. - .. ..

, .. _-_._---,_.--------_ ..... ,--_ .... __ ... ----------------------------,--..... ------AnnuaiSIaiemeniforiheyear2016oflhe Pocahontas Mutual Insurance Association

ODIn DeDosltories

West Iowa Bank ....

laurens State Bank ... Wells Fargo ...

Pocahontas Stale Bank ........... ..

SCHEDULE E· PART 1 . CASH 1

Deoositorv

................... .. .............. ........................... Laurens, IA. ..

Laurens, IA ...

Des Moines, IA

Pocahontas, IA ..

, 3

Raleof Cod. Interest

. ........ Variable .. .

......... Variable .. .

........... Variable ... ....... 0}50

4 5 6 7

Amount of Interest Accrued Amount of Inleresl December 31 of CUfFe!1i

Received Dunno Year Y.~ 8a1ance

. ............................ 101 ... . ....................... 23,267 XXX . ............ 15 ........ 167,689 XXX

. ... 1,033 ..................... 112 ................... 101,810 XXX ~ 0199999. Total· Onen DeDOsiories ................................ . XXX XXX .. .. 1638 ............................. 112 ... 582430 XXX ... 0399999. Total Cash on DeDOsL .. . - 0499999. Cash in Comoanys Olliee

0599999. Total Cash. .. .. ... .. .. -... -... -.. ---.. -... ---.. -.. -... --... -.. -.. -

1. January ...... . 2. February .. , .... " 3. March ............... ..

XXX xxx .......................... 1 638 XXX XXX XXX XXX XXX

TOTALS OF DEPOSITORY BALANCES ON THE LAST DAY OF EACH MONTH DURING THE CURRENT YEAR .... 614,389 4. April... . .................. 676,662 7. July.................... ......... .. ......... .756,642 10. October .... .

......... 803,548 5. May.... . .................. 820,420 8. AugusL ................... " ......... 824,944 11. November .. .. 668160 6. June... . ..................................... 1029625 9. Se lember... .. .......... 938513 12. December

.............. 112 XXX

.... 582430 XXX ....... 100 XXX

......... 582,530 XXX

.. .............................. 819,406

.............................. 532,003

.............................. 582530

E26 01/24/2017 7:57:44 AM