{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["Instructions","SCHEDULE 1 - Premium Schedule","SCHEDULE 2 - Net Retention","SCHEDULE 3 - Reinsce Assumed","SCHEDULE 4 - Reinsce Ceded","SCHEDULE 5 - 3 Year Projections"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":1,"defined_names":4,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Instructions","index":0,"n_rows":6,"n_cols":17,"rows_kept":6,"cut":false,"hidden":false,"merged":[[0,0,2,3],[5,1,5,3]]}
["Captive Insurance\nFinancial Schedule",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2014-08-27T14:23:48"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2014-07-31"]
[]
[]
["Company Name:",null,null,null,"Year End (mm/dd/yyyy):"]

{"sheet":"SCHEDULE 1 - Premium Schedule","index":1,"n_rows":26,"n_cols":20,"rows_kept":26,"cut":false,"hidden":false,"merged":[[4,8,4,11],[4,15,4,18],[0,0,0,19],[2,11,2,12],[2,0,2,1]]}
["SCHEDULE 1 – PREMIUM SCHEDULE"]
[]
[]
[]
[null,null,null,null,null,null,null,null,"         Premiums written less return premiums",null,null,null,null,null,null,"  Claims incurred including adjustment expenses"]
[null,null,null,null,null,null,"Number","Number",null,null,null,null,"Net Unearned","Net Unearned","Net"]
["Line of Business",null,null,null,null,null,"of Policies","of Direct",null,"Reinsurance","Reinsurance","Net Written","Premiums at","Premiums at","Premiums",null,"Reinsurance","Reinsurance","Net Incurred","Claims"]
[null,null,null,null,null,null,"in Force","Claims","Direct","Assumed","Ceded","(01+02-03)","Beginning of","End of Year","Earned","Direct","Assumed","Ceded","(08+09-10)","Ratio %"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Year",null,"(04+05-06)",null,null,null,null,"(11 / 07)"]
[null,null,null,null,null,null,"(21)","(23)","(01)","(02)","(03)","(04)","(05)","(06)","(07)","(08)","(09)","(10)","(11)","(12)"]
["Accident and Sickness",null,null,null,null,"01",null,null,null,null,null,{"$f":"I11+J11-K11","v":0},null,null,{"$f":"L11+M11-N11","v":0},null,null,null,{"$f":"P11+Q11-R11","v":0},{"$f":"IFERROR(S11/O11, \"0\")","v":"0"}]
["Aircraft",null,null,null,null,"02",null,null,null,null,null,{"$f":"I12+J12-K12","v":0},null,null,{"$f":"L12+M12-N12","v":0},null,null,null,{"$f":"P12+Q12-R12","v":0},{"$f":"IFERROR(S12/O12, \"0\")","v":"0"}]
["Boiler and Machinery",null,null,null,null,"03",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Credit",null,null,null,null,"04",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Fidelity",null,null,null,null,"05",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Hail",null,null,null,null,"06",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Legal Expense",null,null,null,null,"07",null,null,null,null,null,{"$f":"I17+J17-K17","v":0},null,null,0,null,null,null,0,"0"]
["Liability",null,null,null,null,"08",null,null,null,null,null,0,null,null,0,null,null,null,0,{"$f":"IFERROR(S18/O18, \"0\")","v":"0"}]
["Life",null,null,null,null,"09",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Mortgage",null,null,null,null,"10",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Property",null,null,null,null,"11",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Surety (Reinsurance)",null,null,null,null,"12",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Title",null,null,null,null,"13",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Marine",null,null,null,null,"14",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Other",null,null,null,null,"15",null,null,null,null,null,0,null,null,0,null,null,null,0,"0"]
["Total",null,null,null,null,16,{"$f":"SUM(G11:G25)","v":0},{"$f":"SUM(H11:H25)","v":0},{"$f":"SUM(I11:I25)","v":0},{"$f":"SUM(J11:J25)","v":0},0,{"$f":"I26+J26-K26","v":0},0,0,0,0,0,0,0,"0"]

{"sheet":"SCHEDULE 2 - Net Retention","index":2,"n_rows":26,"n_cols":12,"rows_kept":26,"cut":false,"hidden":false,"merged":[[0,0,0,11],[6,9,6,11],[6,6,6,8],[6,0,9,0]]}
["SCHEDULE 2 – NET RETENTION SCHEDULE"]
[]
[]
[]
["Direct Written Premium"]
[]
["Line of Business",null,null,null,null,null,"Limits on Policy Issued by Captive",null,null,"Captive's Retention Limit Net of Reinsurance"]
[null,null,null,null,null,null,"Per Occurrence","Annual","Deductible","Per Occurrence","Annual","Deductible"]
[null,null,null,null,null,null,"Limit","Aggregate Limit",null,"Limit","Aggregate Limit"]
[null,null,null,null,null,null,"(01)","(02)","(03)","(04)","(05)","(06)"]
["Accident and Sickness",null,null,null,null,"01"]
["Aircraft",null,null,null,null,"02"]
["Boiler and Machinery",null,null,null,null,"03"]
["Credit",null,null,null,null,"04"]
["Fidelity",null,null,null,null,"05"]
["Hail",null,null,null,null,"06"]
["Legal Expense",null,null,null,null,"07"]
["Liability",null,null,null,null,"08"]
["Life",null,null,null,null,"09"]
["Mortgage",null,null,null,null,"10"]
["Property",null,null,null,null,"11"]
["Surety",null,null,null,null,"12"]
["Title",null,null,null,null,"13"]
["Marine",null,null,null,null,"14"]
["Other",null,null,null,null,"15"]
["Total",null,null,null,null,16,{"$f":"SUM(G11:G25)","v":0},{"$f":"SUM(H11:H25)","v":0},0,{"$f":"SUM(J11:J25)","v":0},{"$f":"SUM(K11:K25)","v":0},{"$f":"SUM(L11:L25)","v":0}]

{"sheet":"SCHEDULE 3 - Reinsce Assumed","index":3,"n_rows":31,"n_cols":13,"rows_kept":31,"cut":false,"hidden":false,"merged":[[6,10,6,12],[0,0,0,12],[6,0,9,0]]}
["SCHEDULE 3 – REINSURANCE ASSUMED"]
[]
[]
[]
[]
[]
["Line of Business",null,null,null,null,null,"Name of",null,"Limits on Policy Issued by Original Insurer",null,"Coverage Limits Assumed by Captive"]
[null,null,null,null,null,null,"Insurer","Per Occurrence","Annual","Deductible","Per Occurrence","Annual","Deductible"]
[null,null,null,null,null,null,null,"Limit","Aggregate Limit",null,"Limit","Aggregate Limit"]
[null,null,null,null,null,null,"(01)","(02)","(03)","(04)","(05)","(06)","(07)"]
["Accident and Sickness",null,null,null,null,"01"]
["Aircraft",null,null,null,null,"02"]
["Boiler and Machinery",null,null,null,null,"03"]
["Credit",null,null,null,null,"04"]
["Fidelity",null,null,null,null,"05"]
["Hail",null,null,null,null,"06"]
["Legal Expense",null,null,null,null,"07"]
["Liability",null,null,null,null,"08"]
["Life",null,null,null,null,"09"]
["Mortgage",null,null,null,null,"10"]
["Property",null,null,null,null,"11"]
["Surety",null,null,null,null,"12"]
["Title",null,null,null,null,"13"]
["Marine",null,null,null,null,"14"]
["Other",null,null,null,null,"15"]
["Total",null,null,null,null,16,{"$f":"SUM(G11:G25)","v":0},{"$f":"SUM(H11:H25)","v":0},0,0,0,0,0]
[]
[]
[]
[]
["                                          "]

{"sheet":"SCHEDULE 4 - Reinsce Ceded","index":4,"n_rows":35,"n_cols":12,"rows_kept":35,"cut":false,"hidden":false,"merged":[[32,6,32,7],[33,6,33,7],[34,6,34,7],[27,6,27,7],[28,6,28,7],[29,6,29,7],[30,6,30,7],[31,6,31,7],[19,6,19,7],[20,6,20,7],[24,6,24,7],[25,6,25,7],[26,6,26,7],[9,6,9,7],[22,6,22,7],[6,6,6,7],[0,0,0,11],[5,8,8,8],[5,9,8,9],[5,10,8,10],[5,11,8,11],[11,6,11,7],[12,6,12,7],[13,6,13,7],[14,6,14,7],[15,6,15,7],[16,6,16,7],[17,6,17,7],[18,6,18,7]]}
["SCHEDULE 4 – REINSURANCE CEDED"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,"Premiums ceded to assuming insurer ($)","Claims incurred by assuming insurer ($)","Unearned premiums ceded to assuming insurer ($)","Outstanding losses recoverable from assuming insurer ($)"]
[null,null,null,null,null,null,"Jurisdiction"]
["Name of Insurer",null,null,null,null,null,"Country","Province"]
[]
[null,null,null,null,null,null,"(01)",null,"(02)","(03)","(04)","(05)"]
["Affiliated"]
[null,null,null,null,null,"01"]
[null,null,null,null,null,"02"]
[null,null,null,null,null,"03"]
[null,null,null,null,null,"04"]
[null,null,null,null,null,"05"]
[null,null,null,null,null,"06"]
[null,null,null,null,null,"07"]
[null,null,null,null,null,"08"]
[null,null,null,null,null,"09"]
["Total Affiliated",null,null,null,null,"10",null,null,{"$f":"SUM(I12:I20)","v":0},{"$f":"SUM(J12:J20)","v":0},0,0]
[]
[null,null,null,null,null,null,"(01)",null,"(02)","(03)","(04)","(05)"]
["Non-Affiliated"]
[null,null,null,null,null,"11"]
[null,null,null,null,null,"12"]
[null,null,null,null,null,"13"]
[null,null,null,null,null,"14"]
[null,null,null,null,null,"15"]
[null,null,null,null,null,"16"]
[null,null,null,null,null,"17"]
[null,null,null,null,null,"18"]
[null,null,null,null,null,"19"]
["Total Non-Affiliated",null,null,null,null,"20",null,null,{"$f":"SUM(I25:I33)","v":0},{"$f":"SUM(J25:J33)","v":0},0,0]
["Total",null,null,null,null,"89",null,null,{"$f":"I34+I21","v":0},{"$f":"J34+J21","v":0},0,0]

{"sheet":"SCHEDULE 5 - 3 Year Projections","index":5,"n_rows":61,"n_cols":9,"rows_kept":61,"cut":false,"hidden":false,"merged":[[0,0,0,8],[8,0,9,4],[31,0,31,3],[60,0,68,8]]}
["SCHEDULE 5 – THREE YEAR FINANCIAL PROJECTIONS"]
[]
[]
[]
[]
[]
[]
[]
["Income Statement",null,null,null,null,null,"Year 1","Year 2","Year 3"]
[null,null,null,null,null,null,"(01)","(02)","(03)"]
["Insurance Revenue"]
[null,"Revenue from PAA Contracts",null,null,null,"01"]
[null,"Revenue from GMM Contracts",null,null,null,"02"]
[null,"Revenue from VFA Contracts",null,null,null,"03"]
[null,"Total Insurance Revenue",null,null,null,"04",{"$f":"G12+G13-G14","v":0},{"$f":"H12+H13-H14","v":0},{"$f":"I12+I13-I14","v":0}]
["Insurance Expenses:"]
[null,"Insurance Expenses",null,null,null,"05"]
[null,"Net income (expenses) from reinsurance contracts held",null,null,null,"06"]
["Insurance Service Result - Line 04 minus 05 and 06",null,null,null,null,"07",{"$f":"G15-G17-G18","v":0},{"$f":"H15-H17-H18","v":0},{"$f":"I15-I17-I18","v":0}]
["Investment Return",null,null,null,null,"08"]
["Net finance income (expenses) from insurance contracts",null,null,null,null,"09"]
["Net finance income (expenses) from reinsurance contracts held",null,null,null,null,"10"]
[null,null,null,null,null,"11"]
["Net Investment Result - Line 08 plus 09, 10 and 11",null,null,null,null,"12",{"$f":"SUM(G20:G23)","v":0},{"$f":"SUM(H20:H23)","v":0},0]
["Other Income",null,null,null,null,"13"]
["Other (Expenses)",null,null,null,null,"14"]
["Profit (Loss) Before Tax",null,null,null,null,"15",{"$f":"G19+G24+G25-G26","v":0},{"$f":"H19+H24+H25-H26","v":0},0]
["Current Taxes",null,null,null,null,"16"]
["Deferred Taxes",null,null,null,null,"17"]
["Net Income (Loss) - Line 15 plus 16",null,null,null,null,"18",{"$f":"G27-G28-G29","v":0},{"$f":"H27-H28-H29","v":0},{"$f":"I27-I28-I29","v":0}]
[]
["Balance Sheet",null,null,null,null,null,"Year 1","Year 2","Year 3"]
["Assets"]
[null,"Cash & Cash Equivalents",null,null,null,"19"]
[null,"Accrued Investment Income",null,null,null,"20"]
[null,"Investment Assets",null,null,null,"21"]
[null,"Accounts Receivables",null,null,null,"22"]
[null,"Insurance Contract Assets",null,null,null,"23"]
[null,"Reinsurance Contract Assets",null,null,null,"24"]
[null,"Deferred Income Taxes",null,null,null,"25"]
[null,"Other Assets",null,null,null,"26"]
["Total Assets - Lines 19 through 26",null,null,null,null,"27",{"$f":"SUM(G34:G41)","v":0},{"$f":"SUM(H34:H41)","v":0},{"$f":"SUM(I34:I41)","v":0}]
[]
["Liabilities"]
[null,"Insurance Contracts Liabilities",null,null,null,"28"]
[null,"Reinsurance Contracts Held Liabilities",null,null,null,"29"]
[null,"Accounts Payables and Accrued Liabilities",null,null,null,"30"]
[null,"Deferred Income Taxes",null,null,null,"31"]
[null,"Other Liabilities",null,null,null,"32"]
["Total Liabilities - Lines 28 through 32",null,null,null,null,"33",{"$f":"SUM(G45:G49)","v":0},{"$f":"SUM(H45:H49)","v":0},0]
[]
["Equity"]
[null,"Share Capital",null,null,null,"34"]
[null,"Contributed Surplus",null,null,null,"35"]
[null,"Retained Earnings",null,null,null,"36"]
[null,"Accumulated Other Comprehensive Income (Loss)",null,null,null,"37"]
[null,"Total Equity - Lines 34 through 37",null,null,null,"38",{"$f":"SUM(G53:G56)","v":0},{"$f":"SUM(H53:H56)","v":0},0]
["Total Liabilities & Equity - Line 33 plus 38",null,null,null,null,"39",{"$f":"G50+G57","v":0},{"$f":"H50+H57","v":0},0]
[]
["Notes"]
["Please provide underlying assumptions and/or calculations to support all material line items. "]