S.D. Admin. R. tit. 20, art. 20:06, ch. 20:06:37, app A
APPENDIX A
ASSET ADEQUACY TESTED AMOUNTS - RESERVES AND LIABILITIES
Asset Adequacy Tested Amounts - Reserves and Liabilities | |||||
Statement Item | Formula Reserves (1) | Additional Actuarial Reserves (a) (2) | Analysis Method (b) | Other Amount (3) | Total Amount (1)+(2)+(3) (4) |
Exhibit 5 A Life Insurance | - | - | - | - | - |
B Annuities | - | - | - | - | - |
C Supplementary Contracts Involving Life Contingencies | - | - | - | - | - |
D Accidental Death Benefit | - | - | - | - | - |
E Disability - Active | - | - | - | - | - |
F Disability - Disabled | - | - | - | - | - |
G Miscellaneous | - | - | - | - | - |
Total (Exhibit 5, Page 3, Line 1) | - | - | - | - | - |
Exhibit 6 A Active Life Reserve | - | - | - | - | - |
B Claim Reserve | - | - | - | - | - |
Total (Exhibit 6, Page 3, Line 1) | - | - | - | - | - |
Exhibit 7 Premium and other Deposit Funds | - | - | - | - | - |
Guaranteed Interest Contracts | - | - | - | - | - |
Other | - | - | - | - | - |
Supplemental Contracts and Annuities Certain | - | - | - | - | - |
Dividend Accumulations or Refunds | - | - | - | - | - |
Total Exhibit 7 (Page 3, Line 3) | - | - | - | - | - |
Exhibit 8 Part 1 1 Life (Page 3, Line 4.1) | - | - | - | - | - |
2 Health (Page 3, Line 4.2) | - | - | - | - | - |
Total Exhibit 8, Part 1 | - | - | - | - | - |
Separate Accounts (Page 3 of the Annual Statement of the Separate Accounts, Lines 1, 2, 3.1, 3.2, 3.3) | - | - | - | - | - |
TOTAL RESERVES | - | - | - | - | - |
IMR (General Account, Page _____ Line _____) | - | ||||
(Separate Accounts, Page _____ Line _____) | - | ||||
AVR (Page _____ Line _____) | (c) | ||||
Net Deferred and Uncollected Premium | - | ||||
S.D. Admin. R. tit. 20, art. 20:06, ch. 20:06:37, app A