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{"sheet":"Instructions","index":0,"n_rows":32,"n_cols":2,"rows_kept":32,"cut":false,"hidden":false,"merged":[]}
["GENERAL INSTRUCTIONS"]
[]
[null,"The tabs of this workbook contain templates of the various Compulsory and Security Surplus Calculation forms. "]
[]
[null,"This workbook contains macros, if Macro Security is set to high or macros are disabled, the templates will not function properly. "]
[null,"Calculations will not function correctly if a tab is moved to a new workbook, Macros apply to the entire workbook, not a single tab. "]
[]
[null,"The print area is boxed off for visual reference, all templates print to a single page with the exception of the MPP calculation. "]
[]
[null,"Input cells are filled Yellow. "]
[]
[null,"There is an input cell to the right of the print area where the as of date can be entered. Use MM/DD/YYYY format. "]
[]
[null,"There is an input cell to the right of the print area where the company could change the Minimum Compulsory Requirement. "]
[null,"The standard Minimum Compulsory Requirement is 2,000,000, except for LHSOs and HMOs. "]
[null,"The standard Minimum Compulsory Requirement for LHSOs is 75,000."]
[null,"The standard Minimum Compulsory Requirement for HMOs is 750,000."]
[null,"There is not a minimum capital requirement for Mortgage Guaranty Insurers completing the Minimum Policyholder Position form. "]
[]
[null,"Most forms have a column titled \"Other\", this column provides an avenue where the WI OCI can adjust the factors higher or lower, or establish additional factors. "]
[null,"This column can be used freely in the template, but use of this column in formal filings will only be allowed by order of this office. "]
[]
[]
["Reference Guide"]
[null,"The reference guides provided below are periodically updated to align with changes to the statutory statements. "]
[]
[]
[]
[]
[]
[]
[null,"OCI 22-334 (R 11/2023)"]

{"sheet":"LIFE","index":1,"n_rows":63,"n_cols":22,"rows_kept":63,"cut":false,"hidden":false,"merged":[[10,16,10,17],[24,7,24,9],[24,10,24,12],[12,2,12,17],[19,7,19,9],[19,10,19,12],[21,7,21,9],[21,10,21,12],[10,2,10,9],[36,7,36,9],[36,10,36,12],[28,7,28,9],[28,10,28,12],[31,7,31,9],[31,10,31,12],[34,7,34,9],[34,10,34,12],[35,7,35,9],[35,10,35,12]]}
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"LIFE and FRATERNAL INSURERS"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"COMPULSORY AND SECURITY SURPLUS CALCULATION"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ref: Section Ins 51.80, Wis. Adm. Code",null,null,"DATE INPUT"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2023-09-30"]
[]
[null,null,"Company Name",null,null,null,null,null,null,null,null,null,null,null,null,null,"NAIC Number",null,null,null,null,"Minimum Compulsory Requirement"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000000]
[]
[null,null,{"$f":"UPPER(\"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING \"&TEXT(U8,\"MMMM DD, YYYY\"))","v":"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING SEPTEMBER 30, 2023"}]
[]
[]
[null,null,null,null,null,null,null,null,"[A]",null,null,"[B]",null,"[C]","[D]","[E]","[F]","[G]"]
[null,null," 1.",null,"Complete the following ",null,null,null,"Individual Life",null,null,"Group Life and",null,"Medicare Part D","Annuities, Other","Variable Life and","Other","Totals"]
[null,null,null,null,"for nationwide business:",null,null,null,"and A&H (including",null,null,"A&H (including ",null,"Prescription Drug","Considerations and","Annuity",null,"Columns"]
[null,null,null,null,null,null,null,null,"Credit)",null,null,"Credit)",null,"Plans","Deposit Type Funds",null,null," A + B + C + D + E + F"]
[null,null,null,"a.","Net Premiums Written",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H20:Q20)","v":0}]
[]
[null,null,null,"b.","Policyholder Dividends",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H22:Q22)","v":0}]
[]
[null,null,null,"c.","Premiums Ceded to"]
[null,null,null,null,"Unauthorized Reinsurers",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H25:Q25)","v":0}]
[]
[null,null,null,"d. ","Modified Coinsurance "]
[null,null,null,null,"Premium Ceded to "]
[null,null,null,null,"Authorized Reinsurers",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H29:Q29)","v":0}]
[]
[null,null,null,"e. ","Modified Coinsurance "]
[null,null,null,null,"Premiums Assumed",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H32:Q32)","v":0}]
[]
[null,null,null,"f.","Adjusted Premium"]
[null,null,null,null,"[Line 1a - 1b + 1c + 1d - 1e ]",null,null,{"$f":"H20-H22+H25+H29-H32","v":0},null,null,{"$f":"K20-K22+K25+K29-K32","v":0},null,null,{"$f":"N20-N22+N25+N29-N32","v":0},{"$f":"O20-O22+O25+O29-O32","v":0},{"$f":"P20-P22+P25+P29-P32","v":0},{"$f":"Q20-Q22+Q25+Q29-Q32","v":0},{"$f":"SUM(H35:Q35)","v":0}]
[null,null,null,"g.","Factor*",null,null,0.15,null,null,0.1,null,null,7.0000000000000007E-2,7.4999999999999997E-2,0.02]
[null,null,null,"h.","Totals (Line d X Line e)",null,null,{"$f":"MAX(0,H35*H36)","v":0},null,null,{"$f":"MAX(0,K35*K36)","v":0},null,null,{"$f":"MAX(0, N35* N36)","v":0},{"$f":"MAX(0, O35*O36)","v":0},{"$f":"MAX(0, P35*P36)","v":0},{"$f":"MAX(0,Q35*Q36)","v":0}]
[]
[null,null,2,null,"Calculation of Compulsory Requirement "]
[null,null,null,null,"Reserve for Annuities and Deposit Administration Funds"]
[null,null,null,"a.","Net Annuity Reserves"]
[null,null,null,"b.","Exhibit 5 Annuity Reserve Write-ins"]
[null,null,null,"c.","Deposit Type Funds"]
[null,null,null,"d.","Total Reserve for Annuities and Deposit Administration Funds [Line 2a + Line 2b + Line 2c]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R41+R42+R43","v":0}]
[null,null,null,"e.","Total Annuity and Deposit Administration Fund Reserve Component [Line 2d x .02]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R44*0.02","v":0}]
[null,null,null,"f.","Total Annuity and Deposit Administration Fund Premium Component [Line 1h, Cols. D]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"O37","v":0}]
[null,null,null,"g.","Compulsory Surplus Requirement [Greater of (Line 1h, sums of Cols. A + B + C + E + F) + (Greater of Line 2e or 2f) and Minimum Compulsory Requirement",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"MAX(V11,SUM(H37,K37,N37,P37,Q37) + MAX(R45,R46))","v":2000000}]
[null,null,3,null,"Total Adjust Premium [Line 1f, Col. G]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R35","v":0}]
[null,null,4,null,"Security Surplus Factor [Based on Line 3]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"secFactor(R48)","v":1.4}]
[null,null,5,null,"Security Surplus Requirement [Line 2g x Line 4]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R47*R49","v":2800000}]
[null,null,6,null,"Calculation of Adjusted Surplus"]
[null,null,null,"a.","Admitted Assets"]
[null,null,null,"b.","Invested Assets in Excess of Limitations"]
[null,null,null,"c.","Investments in Insurance Subsidiaries"]
[null,null,null,"d.","Security Surplus Excess of Insurance Subsidiaries"]
[null,null,null,"e.","Assets for Compulsory/Security Surplus [Line 6a - Line 6b - Line 6c + Line 6d]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R52-R53-R54+R55","v":0}]
[null,null,null,"f.","Liabilities"]
[null,null,null,"g.","Adjusted Surplus [Line 6e - Line 6f]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R56-R57","v":0}]
[null,null,7,null,"Compulsory Surplus Requirement [Line 2]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R47","v":2000000}]
[null,null,8,null,"Total Compulsory Surplus Excess (Deficiency) [Line 6g - Line 7]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R58-R59","v":-2000000}]
[null,null,9,null,"Total Security Surplus Excess (Deficiency) [Line 6g - Line 5]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R58-R50","v":-2800000}]
[]
[null,null,"OCI 22_009 (R 10/2023)"]

{"sheet":"LSHO","index":2,"n_rows":39,"n_cols":15,"rows_kept":39,"cut":false,"hidden":false,"merged":[[12,2,12,11],[9,14,9,16],[10,14,10,16],[10,2,10,8]]}
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"LIMITED SERVICE HEALTH ORGANIZATION"]
[null,null,null,null,null,null,null,null,null,null,null,"COMPULSORY AND SECURITY SURPLUS CALCULATION"]
[null,null,null,null,null,null,null,null,null,null,null,"Ref: Section Ins 51.80 Wis. Adm. Code ",null,null,"DATE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2023-09-30"]
[]
[null,null,"Company Name",null,null,null,null,null,null,null,null,"NAIC CODE",null,null,"Minimum Compulsory Requirement"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,75000]
[]
[null,null,{"$f":"UPPER(\"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING \"&TEXT(O8, \"MMMM DD, YYYY\"))","v":"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING SEPTEMBER 30, 2023"}]
[]
[null,null,1,null,"Complete the following ",null,null,null,null,"[A]","[B]","[C]"]
[null,null,null,null,"for nationwide business",null,null,null,null,"Incidental Indemnity ","LSHO","Total Premium "]
[null,null,null,null,null,null,null,null,null,"Premium ","Premium ","[A + B]"]
[null,null,null,"a.","Net Premiums Earned"]
[null,null,null,null,"(Page 4, Col. 2, Line 2 + 3)"]
[null,null,null,"b.","Factor"]
[null,null,null,null,null,null,null,null,null,0.1,0.03]
[null,null,null,"c.","Total [Line 1a x 1b]"]
[null,null,null,null,null,null,null,null,null,{"$f":"MAX(0,J19*J21)","v":0},{"$f":"MAX(0,K19*K21)","v":0}]
[]
[null,null,2,null,"Compulsory Surplus Requirement [Greater of (Line 1c, Cols. A + B) and Minimum Compulsory Requirement",null,null,null,null,null,null,{"$f":"MAX(O11,SUM(J23,K23))","v":75000}]
[null,null,3,null,"Net Premiums Earned ",null,null,null,null,null,null,{"$f":"L19","v":0}]
[null,null,4,null,"Security Surplus Factor",null,null,null,null,null,null,{"$f":"secFactor(R58)","v":1.4}]
[null,null,5,null,"Security Surplus Requirement",null,null,null,null,null,null,{"$f":"L25*L27","v":105000}]
[null,null,6,null,"Calculation of Adjusted Surplus"]
[null,null,null,"a","Admitted Assets (Page 2, Col. 3, Line 28)"]
[null,null,null,"b","Irrevocable Letter of Credit on file with OCI"]
[null,null,null,"c","Assets for Compulsory Surplus ",null,null,null,null,null,null,{"$f":"L30+L31","v":0}]
[null,null,null,"d","Liabilities (Page 3, Col. 3, Line 24)"]
[null,null,null,"e","Adjusted Surplus [Line 6c - Line 6d)",null,null,null,null,null,null,{"$f":"L32-L33","v":0}]
[null,null,7,null,"Compulsory Surplus Requirement [Line 2]",null,null,null,null,null,null,{"$f":"L25","v":75000}]
[null,null,8,null,"Compulsory Surplus Excess (Deficiency) [Line 6e - Line 7]",null,null,null,null,null,null,{"$f":"L34-L35","v":-75000}]
[null,null,9,null,"Security Surplus Excess (Deficiency) [Line 6e - Line 5]",null,null,null,null,null,null,{"$f":"L34-L28","v":-105000}]
[]
[null,null,"OCI 22_333 (R 09/2021)"]

{"sheet":"HMO","index":3,"n_rows":42,"n_cols":17,"rows_kept":42,"cut":false,"hidden":false,"merged":[[12,2,12,12],[10,16,10,18],[11,16,11,18],[10,2,10,8]]}
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"HEALTH MAINTENANCE ORGANIZATION"]
[null,null,null,null,null,null,null,null,null,null,null,null,"COMPULSORY AND SECURITY SURPLUS CALCULATION"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Ref: Ins 51.80 Wis. Adm. Code, Sections 623.11, 611.26(1), 609.97, and 609.98 Wis. Stat.",null,null,null,"DATE INPUT"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2023-09-30"]
[]
[null,null,"Company Name",null,null,null,null,null,null,null,null,null,"NAIC Code"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Minimum Compulsory Requirement "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,750000]
[null,null,{"$f":"UPPER(\"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING \"&TEXT(Q8, \"MMMM DD, YYYY\"))","v":"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING SEPTEMBER 30, 2023"}]
[]
[null,null,1,null,"Complete the following for",null,null,null,"[A]","[B]","[C]","[D]","[E]"]
[null,null,null,null,"nationwide business",null,null,null,"Incidental Indemnity","Standalone Medicare","Other","HMO ","Total "]
[null,null,null,null,null,null,null,null,"Premium","Part D Plans","Premium","Premium","Premium",null,null,0.03,"Compulsory Factor for HMO business is 3% for HMOs whose covered"]
[null,null,null,"a.","Net Premiums Earned ",null,null,null,null,null,null,null,null,null,null,0.06,"expense ratio is greater than 90% and 6% for those whose covered expense"]
[null,null,null,null,"(Page 4, Col. 2, Line 2 + 3)",null,null,null,null,null,null,null,{"$f":"SUM(I19+J19+K19+L19)","v":0},null,null,null,"ratio is less than 90%, but greater than 65%. There is a dropdown list to "]
[null,null,null,"b.","Factor",null,null,null,null,null,null,null,null,null,null,null,"select either 3% or 6% in cell L21."]
[null,null,null,null,null,null,null,null,0.1,7.4999999999999997E-2,null,0.06]
[null,null,null,"c.","Total [Line 1 * Line 2]"]
[null,null,null,null,null,null,null,null,{"$f":"MAX(0,I19*I21)","v":0},{"$f":"MAX(0,J19*J21)","v":0},{"$f":"MAX(0,K19*K21)","v":0},{"$f":"MAX(0,L19*L21)","v":0}]
[]
[null,null,2,null,"Compulsory Surplus Requirement [Greater of (Line 1c., Cols. A + B + C + D) and Minimum Compulsory Requirement]",null,null,null,null,null,null,null,{"$f":"MAX(750000,SUM(I23+J23+K23+L23))","v":750000}]
[null,null,3,null,"Net Premiums Earned [Line 1a., Col. D]",null,null,null,null,null,null,null,{"$f":"M19","v":0}]
[null,null,4,null,"Security Surplus Factor [Based on Line 3]",null,null,null,null,null,null,null,{"$f":"secFactor(M26)","v":1.4}]
[null,null,5,null,"Security Surplus Requirement [Line 2 * Line 4]",null,null,null,null,null,null,null,{"$f":"M25*M27","v":1050000}]
[null,null,6,null,"Calculation of Adjusted Surplus"]
[null,null,null,"a.","Admitted Assets (Page 2, Line 28, Col. 3)"]
[null,null,null,"b.","Invested Assets in Excess of Limitations"]
[null,null,null,"c. ","Investments in Insurance Subsidiaries"]
[null,null,null,"d. ","Security Surplus Excess of Insurance Subsidiaries"]
[null,null,null,"e.","Security Fund Deposits under s. 609.98, Wis. Stat., Included in Line 6a"]
[null,null,null,"f.","Assets for Compulsory Surplus [Line 6a - Line 6b - Line 6c + Line 6d - Line 6e]",null,null,null,null,null,null,null,{"$f":"M30-M31-M32+M33+M34","v":0}]
[null,null,null,"g.","Liabilities (Page 3, Col. 3, Line 24)"]
[null,null,null,"h.","Adjusted Surplus [Line 6f - Line 6g]",null,null,null,null,null,null,null,{"$f":"M35-M36","v":0}]
[null,null,7,null,"Compulsory Surplus Requirement [Greater of (Line 1c., Cols. A + B + C + D) and $750,000]",null,null,null,null,null,null,null,{"$f":"M25","v":750000}]
[null,null,8,null,"Compulsory Surplus Excess (Deficiency) [Line 6h - Line 7]",null,null,null,null,null,null,null,{"$f":"M37-M38","v":-750000}]
[null,null,9,null,"Security Surplus Excess (Deficiency) [Line 6h - Line 5]",null,null,null,null,null,null,null,{"$f":"M37-M28","v":-1050000}]
[]
[null,null,"OCI 22_061 (R 09/2021)"]

{"sheet":"HEALTH","index":4,"n_rows":42,"n_cols":16,"rows_kept":42,"cut":false,"hidden":false,"merged":[[12,2,12,12],[10,2,10,7],[11,15,11,17],[10,15,10,17]]}
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"LIFE and HEALTH INSURERS FILING ON THE HEALTH BLANK"]
[null,null,null,null,null,null,null,null,null,null,null,null,"COMPULSORY AND SECURITY SURPLUS CALCULATION"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Ref: Section Ins 51.80 Wis. Adm. Code",null,null,"DATE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2023-09-30"]
[]
[null,null,"Company Name",null,null,null,null,null,null,null,null,null,"NAIC CODE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Minimum Compulsory Requirement"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000000]
[null,null,{"$f":"UPPER(\"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING \"&TEXT(P8, \"MMMM DD, YYYY\"))","v":"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING SEPTEMBER 30, 2023"}]
[]
[null,null,1,"Complete the following",null,null,"[A]","[B]","[C]","[D]","[E]","[F]","[G]"]
[null,null,null,"for nationwide ",null,null,"Individual Life, ","Group Life","Medicare Part D","Annuities, Deposits, and","All Other ","Other ","Totals Columns "]
[null,null,null,"business:",null,null,"Accident & Health","Accident & Health","Prescription Drug Plans","Other Considerations","Insurance",null,"[A + B + C + D + E + F]"]
[null,null,null,"a.","Net Premium"]
[null,null,null,null,"Income "]
[null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"G20+H20+I20+J20+K20+L20","v":0}]
[null,null,null,"b. ","Factor"]
[null,null,null,null,null,null,0.15,0.1,7.0000000000000007E-2,7.4999999999999997E-2,0.2]
[null,null,null,"c.","Totals "]
[null,null,null,null,"[Line 1a x Line 1b]",null,{"$f":"MAX(0,(G20*G22))","v":0},0,0,0,0,0]
[]
[null,null,2,null,"Compulsory Surplus Requirement [Greater of (Line 1c, Cols. A + B + C + D + E + F) and Minimum Compulsory Requirement",null,null,null,null,null,null,null,{"$f":"MAX((G24+H24+I24+J24+K24+L24),P12)","v":2000000}]
[null,null,3,null,"Net Premiums Written [Line 1a, Col. G]",null,null,null,null,null,null,null,{"$f":"M20","v":0}]
[null,null,4,null,"Security Surplus Factor [Based on Line 3]",null,null,null,null,null,null,null,{"$f":"secFactor(M27)","v":1.4}]
[null,null,5,null,"Security Surplus Requirement [Line 2 x Line 4]",null,null,null,null,null,null,null,{"$f":"M26*M28","v":2800000}]
[null,null,6,null,"Calcualtion of Adjusted Surplus"]
[null,null,null,"a.","Admitted Assets"]
[null,null,null,"b.","Invested Assets in Excess of Limitations"]
[null,null,null,"c.","Investments in Insurance Subsidiaries"]
[null,null,null,"d.","Security Surplus Excess of Insurance Subsidiaries"]
[null,null,null,"e.","Assets for Compulsory Surplus [Line 6a - Line 6b - Line 6c + Line 6d]",null,null,null,null,null,null,null,{"$f":"M31-M32-M33+M34","v":0}]
[null,null,null,"f.","Liabilities"]
[null,null,null,"g.","Adjusted Surplus",null,null,null,null,null,null,null,{"$f":"M35-M36","v":0}]
[null,null,7,null,"Compulsory Surplus Requirement [ Line 2]",null,null,null,null,null,null,null,{"$f":"M26","v":2000000}]
[null,null,8,null,"Compulsory Surplus Exces (Deficiency) [Line 6g - Line 7]",null,null,null,null,null,null,null,{"$f":"M37-M38","v":-2000000}]
[null,null,9,null,"Security Surplus Excess (Deficiency) [ Line 6g - Line 5]",null,null,null,null,null,null,null,{"$f":"M37-M29","v":-2800000}]
[]
[null,null,"OCI 22_310 (R 02/2023)"]

{"sheet":"MPP","index":5,"n_rows":69,"n_cols":17,"rows_kept":69,"cut":false,"hidden":false,"merged":[[10,2,10,8],[40,10,41,10],[40,11,41,11],[40,12,41,12],[24,10,25,10],[24,11,25,11],[24,12,25,12],[26,12,27,12],[26,11,27,11],[26,10,27,10],[12,2,12,13],[38,10,39,10],[38,11,39,11],[38,12,39,12],[22,12,23,12],[22,11,23,11],[22,10,23,10],[48,10,50,10],[48,11,50,11],[48,12,50,12],[48,13,50,13],[42,12,43,12],[42,11,43,11],[42,10,43,10]]}
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"MORTGAGE GUARANTY INSURERS"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"REPORT ON MINIMUM POLICYHOLDER POSITION"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Ref: Section Ins 3.09, Wis. Adm. Code and Section 623.11, Wis. Stat.",null,null,"DATE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2023-09-30"]
[]
[null,null,"Company Name",null,null,null,null,null,null,null,null,null,null,"NAIC Code"]
[]
[]
[null,null,{"$f":"UPPER(\"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING \"&TEXT(Q8, \"MMMM DD, YYYY\"))","v":"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING SEPTEMBER 30, 2023"}]
[]
[null,null,null,null,null,null,null,null,null,null,"[A]","[B]","[C]","[D]"]
[null,null,"FIRST LIENS - [Ins. 3.09(5)(c),(d)]",null,null,null,null,null,null,null,"Direct","Assumed","Ceded","[A + B - C]"]
[null,null,1,null,"Individual Loans [Ins 3.09 (5)©] "]
[null,null,null,"a.","Loan-to-value more than 75%",null,null,null,null,null,null,null,null,{"$f":"K18+L18-M18","v":0}]
[null,null,null,"b.","Loan-to-value more than 50-75%",null,null,null,null,null,null,null,null,{"$f":"K19+L19-M19","v":0}]
[null,null,null,"c.","Loan-to-value more than 50%",null,null,null,null,null,null,null,null,{"$f":"K20+L20-M20","v":0}]
[null,null,null,"d.","Total Individual Loans [Line 1a + Line 1b + Line 1c]",null,null,null,null,null,{"$f":"K18+K19+K20","v":0},{"$f":"L18+L19+L20","v":0},{"$f":"M18+M19+M20","v":0},{"$f":"N18+N19+N20","v":0}]
[null,null,2,null,"Group Loans [Ins 3.09 (5)(d)]"]
[null,null,null,"a.","Equity 20-50%, or equity plus prior insurance or a "]
[null,null,null,null,"deductible 25-55%",null,null,null,null,null,null,null,null,{"$f":"K24+L24-M24","v":0}]
[null,null,null,"b.","Equity less than 20%, or equity plus prior insurance or a "]
[null,null,null,null,"deductible less than 25%",null,null,null,null,null,null,null,null,{"$f":"K26+L26-M26","v":0}]
[null,null,null,"c.","Equity more than 20%, or equity plus prior insurance or a "]
[null,null,null,null,"deductible less than 25%",null,null,null,null,null,null,null,null,{"$f":"K28+L28-M28","v":0}]
[null,null,null,"d.","Total Group Loans [Line 2a + Line 2b + Line 2c]",null,null,null,null,null,{"$f":"K24+K26+K28","v":0},{"$f":"L24+L26+L28","v":0},{"$f":"M24+M26+M28","v":0},{"$f":"N24+N26+N28","v":0}]
[null,null,3,null,"Total First Liens [Lines 1d + 2d]",null,null,null,null,null,{"$f":"K21+K29","v":0},{"$f":"L21+L29","v":0},{"$f":"M21+M29","v":0}]
[]
[null,null,"JUNIOR LIENS - [Ins 3.09 (5)(f),(d)]"]
[null,null,4,null,"Individual Loans [Ins 3.09 (5)(f)]"]
[null,null,null,"a.","Loan-to-value more than 75%",null,null,null,null,null,null,null,null,{"$f":"K34+L34-M34","v":0}]
[null,null,null,"b.","Loan-to-value more than 50-75%",null,null,null,null,null,null,null,null,{"$f":"K35+L35-M35","v":0}]
[null,null,null,"c.","Loan-to-value less than 50%",null,null,null,null,null,null,null,null,{"$f":"K36+L36-M36","v":0}]
[null,null,null,"d.","Total Individual Loans [Line 4a + Line 4b + Live 4c]",null,null,null,null,null,{"$f":"K34+K35+K36","v":0},{"$f":"L34+L35+L36","v":0},{"$f":"M34+M35+M36","v":0},{"$f":"N34+N35+N36","v":0}]
[null,null,5,null,"Group Loans [Ins 3.09 (5)(d)]"]
[null,null,null,"a.","Equity 20-50%, or equity plus prior insurance or a "]
[null,null,null,null,"deductible 25-55%",null,null,null,null,null,null,null,null,{"$f":"K40+L40-M40","v":0}]
[null,null,null,"b.","Equity less than 20%, or equity plus prior insurance or a "]
[null,null,null,null,"deductible less than 25%",null,null,null,null,null,null,null,null,{"$f":"K42+L42-M42","v":0}]
[null,null,null,"c.","Equity more than 20%, or equity plus prior insurance or a "]
[null,null,null,null,"deductible less than 25%",null,null,null,null,null,null,null,null,{"$f":"K44+L44-M44","v":0}]
[null,null,null,"d.","Total Group Loans [Line 5a + Line 5b + Line 5c]",null,null,null,null,null,{"$f":"K39+K41+K43","v":0},{"$f":"L39+L41+L43","v":0},{"$f":"M39+M41+M43","v":0},{"$f":"K45+L45-M45","v":0}]
[null,null,6,null,"Total Junior Liens",null,null,null,null,null,{"$f":"K37+K45","v":0},{"$f":"L37+L45","v":0},{"$f":"M37+M45","v":0},{"$f":"N45+N37","v":0}]
[]
[null,null,7,null,"Leases [Ins 3.09 (5)(g)]",null,null,null,null,null,null,null,null,{"$f":"K48+L48-M48","v":0}]
[null,null,8,null,"Deduction of individual or group loans for which the insurer ",null,null,null,null,null,null,null,null,{"$f":"K49+L49-M49","v":0}]
[null,null,null,null,"has established a Loss and LAE reserve is greater than or "]
[null,null,null,null,"equal to the MPP for said loan."]
[null,null,9,null,"Total Minimum Policyholders Position [Line 3 + Line 6 + Line 7 + Line 8]",null,null,null,null,null,{"$f":"K30+K46+K48+K49","v":0},{"$f":"L30+L46+L48+L49","v":0},{"$f":"M30+M46+M48+M49","v":0},{"$f":"K52+L52-M52","v":0}]
[null,null,null,null,"EXCESS POLICYHOLDER POSITION"]
[]
[null,null,10,null,"Surplus as Regards Policyholders "]
[null,null,null,"a.","Admitted Assets"]
[null,null,null,"b.","Invested Assets in Excess of Limitations"]
[null,null,null,"c.","Investments in Insurance Subsidiaries"]
[null,null,null,"d. ","Excess Security Surplus/Minimum Policyholder Position of Subsidiaries"]
[null,null,null,"e.","Assets for Total Policyholder Position [Line 10a - Line 10b - Line 10c + Line 10d]",null,null,null,null,null,null,null,null,{"$f":"N56-N57-N58+N59","v":0}]
[null,null,null,"f.","Liabilities"]
[null,null,null,"g.","Adjusted Surplus",null,null,null,null,null,null,null,null,{"$f":"N60-N61","v":0}]
[null,null,11,null,"Deferred Risk Premium Maintained in Unearned Premium Reserve [Ins 3.09 (13)(a)]"]
[null,null,12,null,"Contingency Reserve [Ins 3.09 (14)]"]
[null,null,13,null,"Loss Reserves on Specified Loans"]
[null,null,14,null,"Total Policyholder Position",null,null,null,null,null,null,null,null,{"$f":"N62+N63+N64-N65","v":0}]
[null,null,15,null,"Excess of Policyholder Position over Minimum Policyholders Position, Redundancy or (Deficiency) [Line 14 less Line 9]",null,null,null,null,null,null,null,null,{"$f":"N66-N52","v":0}]
[]
[null,null,"OCI 22_091 (R 09/2021)"]

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[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PROPERTY AND CASUALTY INSURERS (excluding Mortgage Guaranty)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"COMPULSORY AND SECURITY SURPLUS CALCULATION"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ref: Section Ins 51.80, Wis. Adm. Code",null,null,"DATE"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2023-09-30"]
[]
[null,null,"Company Name",null,null,null,null,null,null,null,null,null,null,null,null,null,"NAIC Number",null,null,null,"Minimum Compulsory Requirement"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000000]
[]
[null,null,{"$f":"UPPER(\"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING \"&TEXT(U8, \"MMMM DD, YYYY\"))","v":"NATIONWIDE BUSINESS FOR 12 MONTHS ENDING SEPTEMBER 30, 2023"}]
[]
[]
[null,null,null,null,null,null,null,null,"[A]",null,null,"[B]",null,"[C]","[D]","[E]","[F]","[G]"]
[null,null," 1.",null,"Complete the following ",null,null,null,"Individual",null,null,"Group",null,"Medicare Part D","Medical Malpractice","All Other","Other","Totals"]
[null,null,null,null,"for nationwide business:",null,null,null,"Accident & Health",null,null,"Accident & Health ",null,"Prescription Drug",null,null,null,"Columns"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Plans",null,null,null,"[ A + B + C + D + E + F]"]
[null,null,null,"a.","Net Premiums Written"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H22:Q22)","v":0}]
[null,null,null,"b.","Policyholder Dividends"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H25:Q25)","v":0}]
[null,null,null,"c.","Premiums Ceded to"]
[null,null,null,null,"Unauthorized Reinsurers"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(H28:Q28)","v":0}]
[null,null,null,"d.","Adjusted Premium"]
[null,null,null,null,"[Line 1a - 1b + 1c]",null,null,{"$f":"H22-H25+H28","v":0},null,null,{"$f":"K22-K25+K28","v":0},null,null,{"$f":"N22-N25+N28","v":0},{"$f":"O22-O25+O28","v":0},{"$f":"P22-P25+P28","v":0},{"$f":"Q22-Q25+Q28","v":0},{"$f":"SUM(H30:Q30)","v":0}]
[null,null,null,"g.","Factor*",null,null,0.15,null,null,0.1,null,null,7.0000000000000007E-2,0.3,0.2]
[null,null,null,"h.","Totals (Line d X Line e)",null,null,{"$f":"MAX(0,H30*H31)","v":0},null,null,{"$f":"MAX(0,K30*K31)","v":0},null,null,{"$f":"MAX(0, N30* N31)","v":0},{"$f":"MAX(0, O30*O31)","v":0},{"$f":"MAX(0, P30*P31)","v":0},{"$f":"MAX(0,Q30*Q31)","v":0}]
[]
[null,null,2,null,"Compulsory Surplus Requirement [Greater of (Line 1f., Cols A + B + C + D + E + F) and Minimum Compulsory Requirement]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"MAX(U11,SUM(H32+K32+N32+O32+P32+Q32))","v":2000000}]
[null,null,3,null,"Total Adjusted Premium [Line 1d., Col G]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R30","v":0}]
[null,null,4,null,"Security Surplus Factor [Based on Line 3]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"secFactor(R35)","v":1.4}]
[null,null,5,null,"Security Surplus Requirement [Line 2 x Line 4]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R34*R36","v":2800000}]
[null,null,6,null,"Calculation of Adjusted Surplus"]
[null,null,null,"a.","Admitted Assets"]
[null,null,null,"b.","Invested Assets in Excess of Limitations"]
[null,null,null,"c.","Investments in Insurance Subsidiaries"]
[null,null,null,"d.","Security Surplus Excess of Insurance Subsidiaries"]
[null,null,null,"e.","Assets for Compulsory/Security Surplus [Line 6a - Line 6b - Line 6c + Line 6d]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R39-R40-R41+R42","v":0}]
[null,null,null,"f.","Liabilities"]
[null,null,null,"g.","Non-Tabular Reserve Discounting"]
[null,null,null,"h.","Adjusted Surplus [Line 6e - Line 6f - Line 6g]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R43-R44-R45","v":0}]
[null,null,7,null,"Compulsory Surplus Requirement [Line 2]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R34","v":2000000}]
[null,null,8,null,"Total Compulsory Surplus Excess (Deficiency) [Line 6g - Line 7]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R46-R47","v":-2000000}]
[null,null,9,null,"Total Security Surplus Excess (Deficiency) [Line 6g - Line 5]",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"R46-R37","v":-2800000}]
[]
[null,null,"OCI 22_008 (R 10/2023)"]