ll!lll~lll~lllljlll~IIIIJIII ~llljlllljllllllll~llljiiiiJ ......ll!lll~lll~lllljlll~IIIIJIII...
Transcript of ll!lll~lll~lllljlll~IIIIJIII ~llljlllljllllllll~llljiiiiJ ......ll!lll~lll~lllljlll~IIIIJIII...
ll!lll~lll~lllljlll~IIIIJIII ~llljlllljllllllll~llljiiiiJ~I!IIIIjlllljlllljlllljllll!ll
ANNUAL STATEMENT For the Year Ended becember31, 2013
of the C'ondiUon and Affairs of the-
Mid-Atlantic Vision Service Plan, Inc. NAIOGroup Cc>d~ ..... 1189, 1189 NAIC Company Code ..... o3031 Employer's 10 Number ..... 23-7089668
(CUrrelll Period) (Prior P~rlod) Organized under lhe Laws of VA Licensed as lluslness Typa ..... Other Incorporated/Organized ..... Aprll26, 1960 Statutory Home Office
Stale of Domicile or Port of Entry VA Country of Ponilcile us Is HMO Federally Qualified? Yes I I No I X I OonimeMed Su;loess ..... APHI26,196o
Main Admintstra_tiva Office
Mall Mdress
Prlni_ary Localloh of Bob~$ an-d Rec6rds
Internet Web Site Address Statutory Stf!tement Contact
Nai1Je 1. Jarnas Roblnsonlynoh 3. Lester Earl Passt~ello
11 South 121h Street ..... Richmond ..... VA ... , us .... 23219 (Sirr~ru and Number) (City or Town, St~le, Coun/fY end tip Ctlde) 3333 Ciuali~ Pdve ..... RanchO Cordova ..... OA ..... US .... 956/0 ($/(M/ olid Mjm~§r) {City oiT oWil, Slate, Co/miry ltnd Zip Oode] 3333 Quality Drive ..... Ranch; Cordova ..... CA ..... US .... 95670 {Street Md Numb&r or P, 0, Box) (City or rowrr, Sl<!fe, Country alld zip Cod~) 3333 Quality Drive ..... Rancho Cordova ..... CA ..... US .... 95670 ($lreel1md Number) (Cliyor ·rown, Sl<rre, (icunlty Md Zip Cod~J www.vsp.com Laura Olson (Nt~mr:J) laur~;[email protected] (E-Man Addresr;)
PreSJder11 Treasurer/b'FO
Title OFFICERS
Name 2. James Michael McGrann 4.
OTHER
DIRECTORS OR TRUSTEES J::Jriles RObinS6n Lynch James Michael McGrann DOhilld Joseph Saltf_Jr,
State of....... Callfonila Collhty of ... , Slloralnento
916-851-5000 [Area Code) (Tele{JhOiie NwnMr)
s16-a51-500D '(Anw !))de) (Tt~kJphone Number)
916·851-0000 (Afell (Adl;l) (te/eph6/!e Nlimbef) (EX/eiJSjOIJ)
916·858·5388 (Fax Number}
Title Secrotary
The olfJcers of ltiis reporting en!lty beln,(l duly swom, eat:h dCpos~ ~hd liay !hat they 'i'r'e the dailt:flbed officers of _said repurtlhg enU(Ji, tmd that on the reporting period st~tcd J(ibove, all of ll1_e hereil\ 'desMbed ass~ts were the abs6lule prop-e~y afth!'l said reporting en lily, free and cleadrom ilny liens o~ claims _U1.eroon, except as heteln s:tated1 and lhat lhis $la!etnent, logetherwtth related exhibits, schedules atld explanations therelrl contained, annexed or referred t6, Is a full and troe skiternent of -all the assets and liabflldes and of the oondi!ion and affairs of the Sf.lid reporting fl:MIIy ae of jh8 1'&~6/Ung ·pertdP Stated above, a~d of Its lhcOmtltii1dr!educllons thete'from forthr;t period ended, and MYe Men compiSt~ in- f!CCofflatiCe with the NAlC Annual Sratem&nt lnitruclltms and Accounling Praotloos and Proooduras manual except to thtJ ilxl~JM that: (1) Stale law rtiay differ: Or; (2) thai stale rules or regulations require differences In reporting not related to ~ccounling praCtices and_ proc:edutes, according to the best ofthtdr lnforma\ion1 knowledge and bellef, respectively. Furthermor~. the &COjlo of this tlltM!a'tlon by th_.e Qesc(!bed officers also Includes !he related corresponding electronic filing w_ lth the NAitl_, Wb_en required, that is an ex. _9Ct copy {ext;epl for formatting differences dlf' to ele'ct. rolllcjlling) of the enclosed · tfiiYient The ~le.ctronlo filing may be requesTed bY various regu)atoi'sln lieu ·bf orin add ilion to tM enolosed statement. /1,.
1 /
----'~~L"'...~- . "\,.-\. "'4'~ . ,pL/ (Sif10hturti) (Slgnaluta} • ____ _jjf'(s";g:::;,'"atu=ro') -~---
mes RobiMbn Lyncl1 James MtGha~l McGrnnn Lester Earl PasSUI)I_[o 1, (Prfnted Narre) z. {PJinted Nama) 3, {flriilter1Nrime}
Pr~aldont Secretary 1'reasurer/CFO (TIUa) ~tno) {Titial
SubMribed and swam lo befom me
Thi' Q)C\re '''or ~NI.Ai'@Y 2014 By: James Robln$0r'! Lynoh rJumes Mk:hael McGrnn11,
a. Is Ollfl an wigtnql Wl~g? b. lf no 1. -6-ta!(;l lhijflmGndmentnumber
Yes (X] No I l
2. Dalel!l(ld
,Od;: .Qo. ~-6 3. N~mber o~ pagos attached
statementasofDec(lmber31,2013o!the MidRAtlantic Vision Service Plan, Inc.
ASSETS
1. Bonds (Schedule D) ...
2. Stocks (Schedule D):
2.1 Preferred stocks .••
2.2 Common stocks
3. Morlgage loons on real estate (Schedule 8):
3.1 Firstllens ...
3.2 Other \han firs! liens ...
4. Real estate (Schedule A):
4.1 Properties occupied by \he company (less$ •......• 0 encumbrances) ...
4.2 Properties held for the production of Income (less$ ..•...... 0 encumbrances)......... . ..•.•........•...............•....
4.3 Properties lleld for sale (less $ .......... 0 encumbrances) .. .
5. Cash ($ ..... 504,580, Schedule E-Part 1), cash equivalents ($ ..•....... 0, Schedule E-Part 2) and short-te!Tll bwestmenls ($ ..... 8,129,367, Schedule DA) ....
6. C_ontra~tl~a~s (including$. . ... 0 premium notes) ••...
7. Derilllllives (Schedule DB)
8. Other Invested assets (Schedule BA) ... ,.
9. Receivables for securiijes ......
10. Securities lending reinllllstad collateral assets (Schedule DL) ...
11. Aggregate write-Ins for Invested assets.
- -12 . .-Subtotals,-cash and invested assets (Lines 1 lo-11).
13. Title plants less$... . .. 0 chal"f)ed off(for Title Insurers Ollly) .. , ....
14. Investment income due and accrued ...
15. Premiums and considerations:
15.1 Uncollected premiums and agents' balanoos In the course of collection •...
15.2 Deferred premiums, agents' balances and lnslallmenls booked but deferred and not yet due (including$ ......... 0 oorncd but unbllted premiums) ... .
15.3 Accrued retrospective premiums .. .
16. Reinsurance:
16.1 Amounts recoverable from reinsurers ...
16.2 Funds he!d by or deposited with reinsured companies ............................ .
16.3 Other amounts receivable under reinsurance contracts ....
17. Amounts recel~ab!e relating to uninsured plans ...
18.1 Current federal and foreign income tax recoverable and interest thereon.
18.2 Net deferred tax asset...
19. Guara11ty funds receivable or on deposit... ..
20. Electronic data processilg equipme11tand software
21. Fumlture and equipment, l11cludlng health care delivery assets($. . 0)
22. Net adjustment in assets a11d liabilities due to foreign exchange rates .....
23. Receivables from parent, subsidiaries and affiliates ....•.
24. Health care($. ........ 0) and other amounts receivable
25. Af)9regatewrite-ins lor other than Invested assets ........................ .
26. Total assets excluding Separate Accou11ts, Segregated Accoul\ts and Protected Cell Accounts (Lines 12\o 25)
27. From Separate Accounts, Segregated Accounts alld Protected Cell Accounts ..
28. TOTALS (Lines 26 and 27). . ....................... .
Assets
....... ,.,..23,076,704
. .................... 51,389
......... 41,678,445
................. 8,633,947
.... 7,16~,000
. ..... 30,447
.............................. 0
Current Year
Nonadmitted Assets
... 7,168,000
....... 0
. ....... 80,638,932 ........ 7,166,000
....... 244,287
............. 2_,032,224 ...... .7,229
······
..... 2,233,522 ...... 108, 195
.... .440,620 ..................... .440,620
..... ~ .. ............ 0 ................... 0
.......•.. 85,589,565 .......... 7,724,044
............... 85,589,585 ................. 7,724,044
DETAILS OF WRITE-INS
1101.
1102.
1103_ .......................... ···············••··············· ....... . 1198. Summary of remallling write-Ins for Line 11 from Ollllrflow page ..... .
1199. Totals /Lines 1101 thru 1103 Ius 11981 fline 11 above\ ..
2501. . ...................... .
25[)2. •·····•· 2503 ....
2596. Summary of remaining write-Ins for Line 25 from overl1ow page ..•....
2599. Totals lllnes 2501\hru 2503 Ius 2598) (Line 25 above) ..
2
.......... 0
....... 0
.... 0
.... 0
.. 0
................. 0
....... 0
....... 0
NetMmiUed Assets
fCols. 1 ~21
PriorY ear
Not Admitted Assets
. ....••.........• 23,076,704 .......••........ 28,123,469
...•......••••.......•. 51,389
. .41,678,445
. ....... 0
. ............ 0
. ... 0
.0
. ...... , ... 0
..... 8,633,947
. ................... 0
.............................. 0
......•.. ., . .,0
... 30,447
. . .,0
.o .t3.470,©2
. .................... 0
. ...... 244,287
........ 2,024,995
..... 21,659
.... 10,329,297
. .... 36,130,400
.................. 11,545
........... 0
... 313,536
. .....• 2,250,421
.0 ................... .
..0
..0
. ..... 0
. .............. 0
.2, 125,327
. ... 0
........ 0
. .. 0
.0
.......... 0
. .. 0
. ............. 0
..... 0
. .................... 0
...... 77,865,541
. ........ 0
. ........ 2, 128,008
..... 1,256,042
......................... 0
......•..... 80,566,377
. .. 77,865,541 ................. 80,566,377
.................. 0
.............................. 0
.0
.... 0 . .. 0
.0 ........... 0
............ 0
. .......... 0
. .................. 0
. ............ 0
0
............................. [) .... 0
statementasorDecember31,2013orlhe Mid-Atlantic Vision Service Plan, Inc.
LIABILITIES CAPITAL AND SURPLUS
1. Claims unpaid (less$ ......... 0 reinsurance ceded).
2. Accrued medical incen!lve pool and boriUs amounts ...
3. Unpaid claims adjustment e~penses
4. Aggregate health policy reserves, including the liability of$ ........ 0 for medical loss ratio rebate per the Public Health SaiVIce Act.
5. Aggregate life policy reseiVes ....
6. Property/casualty unearned premium reserve.
7. Aggregate health claim reserves ................................ .
8. Premiums received in advance ....................... ..
9. General expenses due or ae<:rued ...
10.1 Current federal and foreign Income tax payable and interest thereon (including $ .......... 0 on realized capital gains (losses)} ...
10.2 Net deferred tax liability
11. Ceded reinsurance premiums payable.
12. Amounts withheld or retalne<J for the account of others ..
13. Remiltances and items not allocated ............................ ..
14. Borrowed money (including$ ......... 0 current) and Interest thereon $ .......... 0 (Including$ ......... 0 current)
15. Amounts due to parent, subsidiaries and affiliates.
16. Derivatives ...
17. Payable for securiUes
18. Payable for securities lending ..
19. Funds held under reinsurance treaties with ($ .......... 0 authorized reinsurers, $ .......... 0 unauthorized and $ .......... 0 certified reinsurers}
20. Reinsurance In unauthorize<J and certified ($ ......... 0) companies ...
21. Nel adjustments In assets and llabl!ltlas due to foreign exchange rates ....
22. Liability for amounts held under uninsured plans .... .
23. Aggregate wrl!e-lns for other liabilities (including$ ......... 0 current).
24. Total liabilities (Lines 1 !o 23) ........................ ..
25. Aggregate write-Ins for special surplus funds .......
26. Common capital stock.
27. Preferred capital stock.
28. Gross paid In and contributed surplus
29. surpus notes ....
30. Aggregate wrlte~ns for other than special surplus funds.
31. Unassigned funds (surplus) ...
32. Less treasury stock at cost:
32.1 ..... 0.000 shares common (value included in Line 26 $.. .0) ..
32.2 .. , .. 0.000 shares preferred (value Included In Line 27 $ ........ 0) ........
33 Total capital and surplus (Lines 25 to 31 minus Une 32) .....
34. Total liabilities, capital and surplus (Lines 24 and 33) ...
2301. Insurance taxes, licenses, and lees, excluding federal income taxes ...
2302. Escheatable Checks
2303.
2398. Summary of remaining write-ins for Line 23 from o~erflow page ....
2399. Totals (Lines 2301 thru 2303· Ius 23981 rune 23 above} .....
2501.
2502.
2503.
2598. Summary of remaining write-ins for Line 25 from overflow page ........ .
1 Covere<J
................. 4,108,384
....... 56,674
.. ..................... 283,616
........... .92,992
... 38,110
....................... 727,434
............................. 104,395
.. ......... 1,298,311
........... 25,203
.................. 321,077
..... 103 805
.. .... .7,160,001
......... .XXX
............. XXX .... .
... ........ XXX. .. .
.... ........ XXX .. .
.XXX.
.XXX ...
.......... XXX.
.... XXX ...
.. XXX ..
... XXX.
............ .XXX ...
DETAILS OF WRITE-INS
....................... ..46,859
..................... 56,946
.. .... ... 0
........ 103 805
.. .......... XXX. ... .
........... XXX
...XXX.
.. ... XXX.
2599. Totals (Lines 2501 thru 2503 Ius 2598) (Line 25 above) ............................ . ............ XXX ...
3001. Statutory reserve ...
3002.
3003.
3098. Summary of remaining writ~lns for Line 30 from overflow page
3099. Totals (Lines 3001 thru 3003 Ius 3098)/Line 30 above) ......... .
3
...... XXX ...
...... XXX.
.. ...... XXX.
........ XXX
.......... XXX. ....
Current Period 2
Uncovered 3
Total
PriorY ear 4
Total
.. ................. .4,108,384 .................... 3,670,333
.. ............................................................ .0
.............. 0
............... 0
..... XXX. ...
........................ 55,574 ....... 46,725
................................. 0 ......... 2,862,660
.. ............................ 0
.... o .. ... 0
.... 283,616 ......... 164,720
.. ....................... 92,992 ....................... 133,624
.. .... 38,110 .................... 2,313,863
...... .727,434
.. .............................. 0
.. .......................... 0
......... 104,395 .. . ..489,372
..................... 0
.................... 1,298,311 .................... 1,099,884
.. ............. 0
......................... 25,203
.. ......................... 0
..... 0
.. .............................. 0
.. ...... 0
...... 321,077
.. ....... 103805
...... 7,160,001
............................... 0
.. ....... 333,913
......... 130822
........ 11,245,916
.. ....................... 0
.. .XXX ...................... ..
.. ... .XXX ...
...... XXX .
.. ..... XXX.
...... XXX ..
...... XXX ...
.. .... XXX .
.. ... XXX .
...... XXX.
.. ........... xxx. ..
.......................... 0
........................... 0
.... .XXX.
.. .... XXX .......
.. ..... XXX .
.. ... XXX
.. ... XXX.
.. .... XXX.
.. .... XXX .. .
.. .... XXX .... .
.XXX .. ..
.. ..... XXX .. .
. ................... 8,998,075 .7,572,348
. ................ 61,707,465 .................. 61,748,113
...70 705 540 ... 69 320 461
.. ................ 77,865,541 ............... 80,566,377
............... ..46,859
......................... 56,946
................ 0
.. ....... 57,183
................... 73,639
.......... . , ..... 0 ............................... 0
.. .... 103805 ....................... 130822
.. .............................. o ............................. 0
................. 0 .. ........................... 0
.. , ........ 8,998,075 .................... 7,572,348
...... 0 ............ 0
. .... 8 998 075 ............... 7 572 348
statementasofDeoomber31,20\3Qf~la Mid .. Atlantic Vision Service Plan, Inc.
STATEMENT OF REVENUE AND EXPENSES
t Member months .•
2. Nel premium Income (irlcluding-$ .0 non-health premium income) ...•...
3. Change in unearned premium reserves and reserve for rate credits.
4. Fee-for-service (nel of $ ..... 11,981,622 medical expenses),.
5. Risk revenue .•.....•
Current Year 1 2
Uncovered Total
...... XXX .•.....
... XXX ...
.. ... XXX
..................... 13 871248
•.......•.•.... 78,515,942
PriorY ear 3
Total
. ......... 11 768 371
. ....•.•••......... 65,840,939
...................... XXX .......
................ XXX
. ... 2,f535,888 .... 2,320,787
'"""'"93,084 ........... (44,128)
6. Aggregate wrile·ii1S for other health care related revenues .... ................................. XXX .. , ............ 0
................ 0
. ....... 0
7. Aggregate write-Ins for other non-health revenues.
8. Total revenues (Lines 2to 7).
Hospital and Medical:
9. Hospltalfmedical benefits .................................. .
10. Other professional services ....
11. Outside referrals .....
12. Emergency room and out-of-area ...
13. Prescrlp~on drllf]s ...
14. Aggregate_ write.-Jns fQr o!h(lr hosplt(ll and medical.
.. .. XXX. ......... 0
.... XXX .. 81,244,914 .. .. 88,117,598
.. 64,040,124 .54,292,245
................................ 0 .. 0 ............ 0
15. Incentive pool, withhold adjuslments and bonus amounts. ~;::;;::;;::;:::;t:::::;;:;;;j::::;;;~;;~ ----------I-16:-Sublotal·(~lnes 9to-15)•c. ================.~!; ...... 0 ................ ~ .... 64;ll4(},1Q.4-I--=,~ ... ~ ... ·54;2-92,:245-f=----------
Less:
17. Net reinsuranC€ recoveries .....
18. Tolal hospital and medical (Lines 1e minus 17)
19. Non-11ealth claims (net) ...
20. Claims adjustment expenses, Including$ ........ 0 rost containment expenses
21. Geneml admlnlstratl~e expenses
22. Increase in reserves for life and accident and health contracts including$: ••...... 0
.......................... 0 .. ....... 64,040,124 ........................ 54,292,245
... 808,799
. ' ........ 8,135,463
64:l,181
........ 6,484,727
Increase In reserves for life only) ...•..........••........••.. . ............ ""'""l""~~~===t=~~===j~=·~ .. ·~·---~ .. ·~-----"""'"'""'"'-1 23. Total underw(lting deductions (Lines 18 through 22) ................................. 0 ....... 72984386 ....... 63f:l22662
24. Nel undeiWriling gain or (loss) (lines 8 minus 23) ... ... .. .................................... f= .. ·~·· , .. 0 .. ~ ... ,.xx,x, .. ~ .. ·==9-'··~· .. ~----~···~----~ .. ~···~----"' """' "'""'f"'==~·· ·~· .. ,c .. -4"'"""'"''-1' 25. Net Investment Income earned (Exhibit of Net Investment Income, Line 17) .. .. ........ 948,846 ....... 1,282,297
26. Net reaiiLBd capital gains or(losses) less capital gains lax of$ ..... 388,046 .... .. ............... ~ .. ~ .. =~===+===~"·"-·""''"''"'-t====··~"'""'""''"''"-1' 27. Net lnvestmenl gains or (losses) (lines 25 plus 26) ................................... ..
28. Net gain or (loss) from agents' or premium balances charged off[(amount raoo\1€1red $ ......... 0) (amount charged off$ ..... 2,369)]....... . ......................... ..
2g. Aggregate wrile-lns for other income or expenses
30, Net Income or ~oss) after capital gains lax aru:l before all other federal income Ia xes (Lines 24 plus 27 plus 28 plus 29)..... . . ......................... .. ............. XXX ...
31. Federal and foreign income taxes IRoorre\1 .. XXX.
32. Net income Uoss) (Lines 30 minus 31).. .... ..XXX
.... 0 .. .. 1669503 ........ 1388317
.. (2,3t19)
... 0 ...................................... 0
.. ................. 9,927,662
...... 1749122
.8,178,540
.. ........ (1,175)
.................................... 0
.5,882,058
..... 14 580258
........ 10,462,316
DETAILS OF WRITE-INS
0601.
0602.
0603.
0698. Summary of remalnirtg write-Ins for Line 6 from overflow page .... ,
0699. Totals (Lines 0601\hru 0603 nlus 0698) (Line 6 above I ...
0701.
0702 ..................................... ..
0703.
07{)8. Summary of remaining write-ins for line 7 from O\lerllow page ...
0799. Totals (lines 07011hru 0703 Ius 0798) (line 7 above) .... .,
1401. . .. .................... ..
1402 .......................... ..
1403 ............................... .
1498. Summary of remaining write-Ins for Line 14 from overflow page ............................ .
1499. Totals /Lines 1401 thru 1403 Ius 1498) /Line 14 above) ....
2901.
2902.
2903.
2{)98. Summary of remaining wrile~ns for line 2{) from O\lerflow page.
2999. Totals (lines 2901 thru 2903 Ius 2998\ (line 29 above).. ..
4
,, ........ XXX .. .
.......... XXX. .. .......... XXX,.
...... XXX .. .. .......... 0
...XXX .. . . ... 0 .... XXX ................................... ..
................ XXX ....
.. ............. XXX.
.. .... XXX. .. XXX ....
.. ..................................... 0 .................. 0
....... 0
. ...... 0
' ...................... 0
.................. 0
............... 0
..... 0
.. ................... 0 ................ 0
.. ..................... ., ........... 0
...................................... 0
.. ............... 0
.. .......... ,,,0
............... 0
.. ....... 0
.......... 0 ....... 0
Statementasofoscembsr~1,2013oflhe Mid-Atlantic Vision Service Plan, Inc.
STATEMENT OF REVENUE AND EXPENSES Continued)
CAPITAL AND SURPLUS ACCOUNT
33. Capital and surplus prior reporting period.
34. Nellncome or Ooss) from Line 32 .....••.
35. Change in valuation basis of aggregate policy and claim reseiVes.
36. Change In net unrealized capital gains and (losses) less capital gains tax of$ ... 169,310 ...
37. Change In net unrealized foreign excllange c:apitalgain or (loss) ••.
36. Change In nel deferred Income tax.
39. Change in nonadml!led assets.
40. Change In unauthorized and certified reinsurance.
41. Change in treasury stock .•.•.
42. Change In surplus notes ...
43. Cumulative effect of changes In accounting principles.
44. Capital changes:
44.1 Paid in
44.2 Transferred from surplus (Stock Dividend) .................................................... .
44.3 Transferred to surplus ...
45. Surplus adjustments:
45.1 Paid in ......................... .
45.2 Transferred to capital (Stock Dividend) ................................................... .
45.3 Transferred from capital..
46. Dividends to stockholders ....•...
47. Aggregate write-ins for gains or (losses) In surplus.
48. Net change In capital and surplus (Lines 34 to 47).
49. Capital afld sur Jus end of reporllnQ period (Line 33 Plus 48) ........................................ .
4701.
4702.
4703.
DETAILS OF WRITE-INS
4798. Summary of remaining write-ins for Une 47 from overflow page ........................................................................ .
47gg, Totals (Lines 47(11 thru 4703 Ius 4798) (Line 47 above) .•
5
Current Year PriorY ear
............ 69,320,461 . ........ 51 ,301,325
. ......... 8,178,540 .••••.............••.... 10,462,316
. ........ 1,860,729
. .... 314,432 ..•.••.......• 702,129
. ....... (1,375,646) .............................. 790,253
.....•.. 2,406,924
. ...••. (10,1}00,000)
........................ 0
. ................... 1,385,079
......... 70,705,540
......................................... 0
. ...... 6,064,438
. .............. 0
.... 18,019,136
. .. 69,320,461
. ..••... ··•···· ..•..........• 0
. ......•. 0 ........................................ 0
SllltemsntasofDaoomOOr3t,20t3oflhe Mid-Atlantic Vision Service Plan, Inc.
CASH FLOW
CASH FROM OPERATIONS 1. Premiums collected net of reinsurance
2. Net lnvestmenllncome ........ .
3. Miscellaneous income
4. Total (Lines 1 through 3) ................................... .
5. Benefit and loss related paymenls .....
6. Net transfers lo Sepllrale Accounts, Segregated Accounts and Protected Cell Accounts.
7. Commissions, expenses paid and aggregate write-ins for deductions.
8. Dividends paid to policyholders.... . ..................................... .
S Federal and foreign Income taxes paid (recovered) nel of$ ........ 0 tax on capital gains (losses) ............................. .
10. Total (Lines 51hrough 9).
11. Nel cash from operations (Line 4 minus Line 10).... .......••............•.•.. . .................•...
CASH FROM INVESTMENTS 12. Proceeds from investmenls sold, malured or repaid:
12.1 Bonds ................................... .
12.2 Stocks .....
12.3 Mortgage loans ......................................................................... .
12.4 Real estate .......... .
1_2.5 Other_ invested assets,,
12.6 Net gains or (losses) on cash, cash equivalents alld short-term investments.
12.7 Miscellaneous proceeds .....................•.
12.8 Total investment proceeds (Lines 12.1 to 12.7).
13. Cost of investmenls acquired (long-term only):
13.1 Bonds .. ,
13.2 Stocks ..• ------
13:3 Mortgage loans.
13.4 Real estate ........................................... .
13.5 Othar hwested assets., ........................... .
13.6 Miscellaneous applications ............................. .
13.7 Total investments acquired (Lines 13.1 to 13.6) ....
14. Net Increase (decrease) in contract loans and premium notes.
1b. Net cash from Jnvestmants (Line 12.8 minus Lines 13.7 minus Line 14). . .......................................................... .
CASH FROM FINANCING AND MISCELLANEOUS SOURCES 16. Cash provided (applied):
16.1 Surplus notes, capital notes .................................................. .
16.2 Clpital and paid In surplus, less treasury stock.. ...
16.3 Borrowed funds ........................... .
1().4 Net deposits on deposll-type 00111racls alld other insurance liabilities.
16.5 Di~idends to slockholders
16.S Other cash provided (applied) •...
17. Net cash from financing and mlscenaneous sources (Lines 16.1to 15.4 minus line 16.5 plus line 16.6).
RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT·TERM INVESTMENTS 18. Net change in cash, cash equlvalenls and short-term Investments (Line 11 plus Line 15 plus Line 17) .....
19. Cash, cash equivalents and short-term Investments:
19.1 Beginning of year... . ......................... .
19.2. End of year (Line 18 plus Line 19.1) ..
Note: Su Iemen tai disclosures of cash flow lnformaijon for non-cash trensactions: 20.0001 ........••.....•.•... . . .................................................. .
6
Current Year
...... 78,854,952
.................... 1,5:);l,185
... 2728 S72
...................... 83,117,109
. ........ 63,602,073
.... S,122,157
Prior Year
............ .,.65,325,716
............. 1,S28,176
........ 2 276 659
............... 69,530,551
............ 53,687,230
. ...... 6,934.,358
.5414852 .......•.......•......... 2507713
....................... 78,139,082 ....... 63,129,301
.. 4,978,027
......••••. 5,543,473
.16,359,601
. .... 25 203
•..........• 24,898,803
.....•. 994,185
. ...... 6,401,250
..•.... 7,569,965
. ............ 7,857,155
... ~.871,528
.... 21,298,748
...••.........•... 958,124
. .... .45,173,646 ...................... 7,SS7,267
. ... 18 902
...••..... 47186 733
..... (22,287,930)
. ..... 10,000,000
........•.•.... 1186 550
. ................. 10443
........ 8,965,834
.. ....... 12,332,914
... 524 4(14
············ ........ 10 186 550 ............................ 524 4(14
........• (27,496,453) ..................... 19,258,568
• ...................... 36,130,400 ................•.• 16,871,832
. ... 8,633,947 ..•.......•......... 36130 400
stotemsntasofDecember31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
ANALYSIS OF OPERATIONS BY LINES OF BUSINESS
1. 2.
Net premium income ......•••..••••..•••...•••...••...••.•.•..• Change in unearned premium reserves and reserve for ;ate ~redit ...
Total .. ..................... , ............ .78,515,942
. ......................... 0
2
Comprehensive (Hospital
and Medical) Medicare ~men!
Dental O.D!Y_
Vision Ol})y_ .78,515,942
6 Federal
Employees Health
Benefits Plans
Title XVIII
Medicare
TiUe X~
Medicaid Other Health
10
Other Non-Health
3. Fee-ior-service (net of 5 ..... 11,981,622 medical expenses) ... 4. Risk revenue .... ____ ......................... ..
5. Aggregate write-Ins for other health care related revenues ... ....................... ···---··-------2·~:~:~~: I::::::::::::::::~:~ .... :~+::::: .:::: __ :::::::::::::::·~::1::··-- --------------:::::::::1
... 0
. ... ~~:~::~:: I::: ----------------·-·::::~::::! . .... .0 .n
...... ··I .... ················- ... ··--···-··· ·················· ··········=···· . .................................................. .XXX ... .
r ............... 81.244 914 ........ _ .................... 0 ........ :·~~~~~:~~::·~:~· 1 ·::~~:::·~_::::~ ·:::-.:~·I :~ ... :::~~2~.~~~- ·:.·::::.·.·:.~. : .. ·~ .. ::::~· :::.·:::::.~ . .-.::~::·.:~~~-! :.- ::::::~:::·_--~~~----~0 ::_:::::.~_::::::::::::.~~- :~~: ___ -;;_:::·:~:::~:::~ 8. Aggregate write-insforothernon-health care relatad revenues ...
7. Total revenues (Unes 1 to 8) ······-·--··-.. ·-··· B. Hospilalfmedical heneftts .•. 9. Other professional services ..... 10. Outside referrnls .. 11. Emergency room and out-of-area ............... . 12. Prescripfion drugs .......................... .
. .. .XXX ....
. .. f;\4,040,1241-·····················- ·-······1 .............. ] ....... .XXX ... . ..XXX ... .
I ::;;;:;;;;;~ •••••••••••••••••••••••••••••··•••• • ••••••••••••••••••••••••••!• •• ••••••I••••• om •••••••••••• ••••••••••I· • .1 ... ••••••• m•m ••••• )(X)(
0 ............................ ..
. ... ·-·t::: ...... 0
. .... 0 ··········-·······-········ •..•• ... .. .. -·····\ 13. Aggregate write-ins for other hospital and medicaL I·········· ............... o •... • 0 ..... 0 ......... 0 ... ..0 ............ 0 . .. .XXX .. 14. lncenfive pool, wlthhold adjustments and bonus amounts ... 15. Subtotal(Lines8to 14) .................... _ ..................... ..
~ .• Q I ......... .xxx .. . 1 ....... --::::~:~:;;;-.·~;~-~-~·:::::.~::::.~::::::::::::::::~·1 ::~. ;:=.~:~·1·::·: .... _.::::::.·::::::::~:::~--1 ~~~~~:::::;~:-~;~·1·: ................. ·--·::::::~
16. Net reinsurance recoveries .• ···········-- ........................ . 17. Toia! hospital and medical (Lines 15 minus 18) .................... . 18. Non--heslth claims (net}-.. . ........................................... .
.. ....................... 0 64.040,124
0 ..... 0
.. . ..XXX. ...
-...([ 19. Claims adjustment expenses including $ .......... 0 cos! containment expenses... .. ............................ 808,8()0 ..... 1
~~: ~:::~ ~~:::s::re=~~:: a~d .. ~~~;~-~~~~~::. ::::::::::::~::: ............................ ~::: .... =--:::::·:::::::~:.~~~~~~~ :::::::=::: ................ ::::: 22. Increase in reserve ior life contracts.................... ............... ............................. ....... ........ • ............... 0 .......... .XXX. __ 23. Total underwriting deductions (Lines 17to 22).................... .. ............. 72,984,387 24. Net undeJWrffing gain or (lossj_(Une 7 minus Line 23)... . . ................ 8,280.527
............................... 0
...... 0
... 0
0501. 0502. 0503 ....
• .............. o I I 0598. Summary of remaining write-ins for Line 5 from overflow page ... 0599. Total (Lines 05011hru ()503 plus 0598) (Llne 5 above)... .. 0601. -· ........................................................................ .. 0602. 0603.
. 0
. ... 0 ... 0
............... .. ....... r .............................. 0 . .............................. 1 .............................. 0
.. .. 0 0698. Summary of remaining write-ins fur Line 6 from overflow page ..................................... .. 0
0699. Total !Lines 0601 thru 06()3 plus 0698) (Line 8 above)... .. 1301. 1302. 1303. 1398. summary of remaining write-ins for Line 13 from overflow page ... 1399. Total (Lines 1301 thru 1303 olus 1398) (Line 13 abovel.. ....
.............................. 0 ................... , ............................. 0
.0 ...0 ... 0
..... ................ ... 0
.. .... ..XXX.. ... XXX. .. .. ... XXX .. . . .. XXX. .. .. ... .XXX. .. .
.0 ... 0
=
... .XXX .....
... .XXX ........ 0
............. 0
.. .... .XXX ...
.XXX ..........
DETAILS OF WRITE-INS
..XXX. .. . .. . .XXX .. .. • ......... .XXX .. .. .. .. .XXX .. .. .. ........ .XXX .... .. .XXX .. .. .. ........ .XXX ... . .. . .XXX. ... . .. ........ .XXX .. .. .. . .XXX. .. ..
.......... .XXX ... . ... 0 ... 64.040, 124
.... Jooc. .........•.•••• l... . .... :me. .. .. .... m.~.·-·_·:::.·:~:~.l.::~ __ :::m·::: ......... o . ..... XXX. ......... o I ......... .xxx .. ..
843,178 ... 8,485,054 :::::::::. ------------::::::::::1:: .:::::::::::::::::::::::::I:::::::::::::· .::::::::::::::::::\ .. :::::::::::.::::(~~·.!~j
•·•l•m•m•=••mm••O•OOOI : :ro._m •• ml mmmmmmmml•m•m mmmml• mmm••l - .... 73,368,350
... 7,876,558
•• .XXX. m••::; I••••••••=•••> ... .XXX ............. ..
... (383,969)
... 383,969
.. .XXX .......
... 0
...0
. .. 0
... 0
............................ 0
.......... .XXX ... . ,.XXX. .. .
.0 :·t : :': : , .... -- .... 0 ... 0
XXX. .......... .. ,XXX. .. . . .XXX ...
..... .XXX ...... .. ...... .XXX ...... ..
.xxx ....... . ... .XXX. ..... ..
.. .... .XXX ............. .
.. . .XXX. ..
.. . .XXX. ... .. .. .. .XXX .. . . .. .XXX .. . . .. .XXX. .. .
...... 0 ...0
.. ...... .XXX. .... .. . .XXX..
. ........ XXX ............... . . .. XXX. ............ ..
.. .... .XXX. ... ..
......... 0
.. . .XXX ....
.. . .XXX. ... ...XXX ...
.XXX .. .. • ... .XXX .. ..
... 0_ I ............... ..
--------------- -----·---·-
.. . .XXX .. .. . ........ .XXX. .. .
.XXX .. ...XXX. ... . • ............................ 0
XXX. .. .. .. .... 0 • ......... .XXX .. .
...................... .XXX. .. .
I·· - - :;[ :~: ..... .XXX ......... ..
C>
' "
statementasom~er31.2013oflhe Mid-Atlantic Vision Setvice Plan, Inc.
UNDERWRITING AND INVESTMENT ExHIBIT
1. Comprehensive (hospiiEI and mecfJCal) ..... ·-·····-·····-···
2 Medit:are supplement... .••••..••.••••.••••.
3. Denial only ......................... .
4. Vtsion only ................ - ......... ,,. ___ _
5. Federal employees health benefits plan ..................... .
6. Tille XVI!l- Medicare .......
7. nle XIX- Mecticald ...
B. Other health ...
PART 1 ·PREMIUMS
Line of Business
···················
!
Direct Business
. . ···········- ······-··-·········· .......... ....... .................................... ........................................... .............. ........... I········+,·_ .................................. .
Reinsurance Assumed
Reinsurance Ceded
Net Premium Income
(Cols.1 +2-3)
n
. ........... 0
_,,, ''''''"'' ''''''''''"'••• ''''''''''''" ''''''''''''"''"'''''-•••• •• •••••••"-'''" '''''''"''' ooooooooMo ... •• •••••••-••• • •••••+ ,,,,,,,,,,,,,,,,78,515,942 •••••••ooo "'""'' ,,,,.,_,_,,_,,,,, .. ,,, .78,515,942
+············································ ................................................... ·············· .... 0
::·-- .::: : .. ::::::::":": .: :::::: ::· ::: ~- : .. :::::::::1 9. Health subtotal (lJntJ<; 1 ibruuyh 8) ••. ..................... .......................... ············· .............. ... . ········- ········-··· . 78,51."i.~42 ............................................ 0 .. ······- .............. 78 515 942
10. Life .......... .
11. Prnperty/~suatty ............ ..
12. TotaJs(Llnes9to11 . ............ 78,515,942
I ·.I·········· . ... 0
................................................ 0 ... 78.515,942
statementasofoeeember31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
I 1. Payments during the year:
1.1 Diract......................................... ..................... . ........................... .. 12 Reinsurance assumed ...
1.3 Reinsurance ceded ...
1.4 Net .................................................................... . 2. Paid medical incenwe pools and bonuses ...
3. Claim liability December31, current year from Part 2A:
3.1 Diraci ............... - ............ .. 32 Reinsurance assumed... . .............. _ ........................................................... ..
3.3 Reinsurance ceded .... ..
3.4 Net ......................... .
4. Claim reserve December 31, current year from Part2D:
4.1 Direct... • .................................... .
42 Reinsurance assumed ..
4.3 Reinsurance ceded ...
4.4 Net. ................. ..
(01 5. Accrued medical inGentive pools and bonuses. current year ... ..
6. Nethealthcare receivables (a) .............................................. ..
7. Amounts recoverable from reinsurers December31, current year ......
8. Claim r~abUity December31, prior year from Pari 2A: 8.1 Direct..... .. ........... ..
82 Reinsurance assumed ...
Tot>l
...63,602,073
. .. 0
..... 63,602,073
... 0
.. ....... ..4,108,384
.. ........................... 0
...4,108,384
... 0
. .. a .. ..... 0
.. ............... 0
... 3,670,333
.. .............. 0
8.3 Reinsurance ceded .. . ...................... "'"""""'"I'""" ............. 0 &4 NeL. ...... - ................... _ ....... - .. . ........ 3,670,333
9. Claim ~rve December31, prioryearfrom Part2D:
9.1 Direct. ....................... ~--· 92 Reinsurance assumed ...
UNDERWRITING AND INVESTMENT EXHIBIT PART 2 ·CLAIMS INCURRED DURING THE YEAR
' Comprehensive
(Hospital and Medical)
Medicare Suoolemen!
Dental oow
. .. 0 1: - ; !••••• ·····················I ... 0
Vision Onlv
................ 63,602,073
.. 63,602,073
.. .4,108,384
6 Federal
Employees Health
Benefits Plan
7
TOe XVIII
Medicare
r•e X~
Medicaid Olhec Health
10
othec Non-.HeaHh
·············ml ··································I····· ················I
•m ••••I " ••••••••••••••I••·••• ·I··-• •O•m••••
...0 ..................... 0 .................. 0 1 ................................. 0 ... 0
····-· ····················1- ········I ··································I
m•••••••••• ••••••••••••••••••••••••••••••••• • ••••••••••••••I ••••••••••••••••••••••••••••••••••I
I ·I " ••••••••••••••••••I " • • ••m•• ••••••••••••••••••••••I••••• ••••••••••••I ••••••••••••••••••••••••••••••••••l•••••m•••••
..... 0 .............................. . ...0 .. .4,108,384 ................. 0 ... 0 _ ................. 0
I····· ·············I ··································1···-···-·····•········· ······························I········ ·················I
.. ... 0 ................ 0 . .. 0 1 ................................. 0 ... 0
..................................... ·········· ··············I ·································I· ·······························I ........ 3,670,333
.. .... 0 ..,,n..,O . .... 3,670,333 ....... 0 ...... 0
I····· ·········I ··································1···-········· ·
9.3 Reinsurance ceded... .. ......... ..._ ............................. 1.. . .0 , ... .. ······ ··············I ·································I - ····1-··m·· ············I····· ··········I ··································I···-······· 94
Net................................. . ... ··-· --- -- I ..... O I I I I I I I I I I ~~: =~~ :=~~~:~: :i~:u~:~ ~~::::;~;,:~:;·~ear... ::::::::::::::::::~: ::--- ...... -~ ............. ................... . ................................. ............................... .. .. .. ... . ........ ................... .................................... .. ................................ .. . ................... .. . .... -.... .. 12. Incurred benefits:
.............. 0 ...................... . ... 0 .0 ... 0 ................ 0 ..... .0 .0 .0
12.1 Direct ................ .
12.2 Reinsurance assumec! .......
12.3 Reinsurance ceded ...
12A NeL ..
13. lncurretl medical incen!i~ols and bonuses ...
(a) Excludes$ ........ 0 loans or advances to providers not yet expensed.
. .. 64,040,124
................. 0
.. ,0 ...64.040,124
_o
............................... 0
...... 0
... 0 ... 0 .. 0
... 0
.......................... 0 ..... 0
....... 0
..... 0
...... . ................. 0
.0
... 0
.64,040,124-
... 0
.............. 0 . .. 64,040.124
....... 0
............ 0
....... 0 .0
... 0
........... ~ .................... 0
... 0
.0
... 0
......... 0
......... 0
............ 0
.... 0 ........ ~ ..................... 0
...... 0
................................ 0
... 0
. .. 0
~~
0
I II
statementasofDecember31,201Jofthe Mid-Atlantic Vision Service Plan~ Inc. I
1. Reported in process of adjustment
1.1 Direct ................... ..
Total
UNDERWRITING AND INVESTMENTiEXHIBIT PART 2A • CLAIMS LIABILITY END OF CURRENT YEAR
2
Comprehensive (Medical
and Hospital)
s 4 5 1
Medicare S~men!
Dental oow
I
Vision 1
1 Only
6 Federal
Employees Health
Benefits Plan
-"'"·'" 1 ····-·- ......................... ,... .. .............. --------1------------·------------- , ______ _ 858,036
.. ........... 0
7
Ti~e XVJII
Medicare
B
Ti~e XIX
Medicaid Olh" Health
TO
Other Non-Heareh
12 Reinsurance assumed ...
1.3 Reinsurance ceded ... .. .............. 0 -~=~-~. ~;' =-- _, ---·-- • • ··-·---···--··1 ················-- ···············I 1.4 Net.. ..................................... . .. .................................. 858,630 .... 0 j ................... .
2. Incurred but unreported:
2.1 Direct. ............................................................................................ 1 ................... 3.249,748
22 Reinsurance assumed ............... -.... . ....................................... , ·· .0 .................... - --- i ··- - ..................... ..... .... - ......................... .
----- -- ,_ ········--·-········-········0
..•... ···········--·- ......... ....... ·----·-·········- . o I•__ :.. : : : ··~-- ~· ::,~·~'' --- - .... ••• :to ... ...... ................ o ................•...... o . I
3. Amounts withheld from paid claims and capitations:
3.1 Direct. ........
~:~ :::~~-::c:.:~:~::::::::::.::::::......... . ·:::::::::::::::::::::::::::::::::~:::::::I ::::::::::: ::~::~;:~~:;~
32 Reinsurance assumed ...
3.3 Reinsurance ceded ...
3.4 Net...
4. Totals:
4.1 DirecL ................ .
42 Reinsurance assumed ...
4.3 Reinsurance ceded ............... .
4.4 Net ............................... .
... 4,108,384
...................................... !... .. ......... 0
......... .0
... 4.108.384
.... 0
.............................. .0
.. ........................ 0
... 0
0
.. ........................... .0
..... 0
..... 0
... .0 ................. .0
.-4._108,384
.• 0
l.o
.0
................... .0
.................. 0
.. ............................... 0 ...... 0
.......................... --I ................................... ..
.0 j .......... .
.0 1------------------· ...... 0 ..... 0
............................. .0
.. 0
...... .0
................... 0
sta:emem:aoofDecemt~sr~1.2013oflhe Mid .. Atlantic Vision Service Plan, Inc.
UNDERWRITING AND INVESTMENT EXHIBIT PART 28- ANALYSIS OF CLAIMS UNPAID· PRIOR YEAR· NET OF REINSURANCE
Line of Business
1. Comprehensive (hospital and medica~ ...
2. Medir:are supplemant .••• , .•.•••..
3. Dental only ........................................... ..
4. Vision only ........ .
5. Federer employees health benelits plan ...
6. Trtle XVIII- Medicare ................... ..
7. Trtle Xtx- Medicaid_. ..
8. Other health ...
9. Health subtotal (Lines 1 to 8) ..• ~
~1 10. Healti1care receivables (a) ...
11. Other non--h&alth .............. .
12. Medical inceniive pools and bonus amounts ......
13. Tolal!Jl,ines 9 -10 + 11 + 121... .............................. ...
(a) Excludes $ .......... 0 loans or advances to providers not yet expensed.
Claims Pald During the Year
On Claims Incurred Prior to January 1 aiCurrentYear
2 On Claims
Incurred During !he Year
Claim Resem and Claim Liability December31 of Curren! Year
-,-- 4 On Claims Unpai1:l On Claims December 31 of Incurred During
PriorY ear the Year
Claims Incurred ln Prior Years
(Columns 1 + 3)
j ................................................ j ••••.••••...••....................•.............. l....... - ........ ···········1·... . . ................ .
1 ..... ·································1 .. -·- ...0
.. ............ -... . ... 0
.. 3,323,111 . ....... 60,278.962 1 ............. ........................ ·······I ... ..4,108,384 ...... 3,323,111
.. ......... 0
. ......................... ' .................................... ·····I
Estimated Claim Resem and Claim UabiTJ!y
December31 of Prior Year
......... .3,670,333
. ........ 1·--·-·· ............ .. .. I····· ............. 1 ............ -1- .............. 1 .................................... o I .... .. .......... 1 . .. 3.323,111 ............................. 60,2.78,962 ........ .. . .. 0 ........................ 4,108,384. 3,323,111 .. ............................ 3,070,333
...0
.. ........ 1.... ...........1-.. ........ ..I.. ...... ..1 ··.. .. .......... 1 .............................. o I .................... ! ..... M23,111 60,2.78,962 . ..4,108.384 ... .3,323,111 ... 3,670,333
statementa5ofDecember31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
1. Prior ...... .
Year in Which Losses Were Incurred
' "
UNDERWRITING AND INVESTMENT EXHIBIT PART 2C- DEVELOPMENT OF PAID AND INCURRE~ CLAIMS
(DOD Omitted) /
SECTION A- PAID HEALTH CLAIMS- GRAND TOTAL Cumulative NetAmounts Paid ,
2009 2 , I I ' 2010! ' 2011 2012
.34,396
5 2013
... 34,396
2. 2009 .... . ................................... ~::::::::: ::::::··::~~~:::·· ···:~_:::::::::::::~:: :::~:::~~:~. ·t::~::~ ·····:~ .. :::::::!:: ................... . .41,160 • .......................................... .41,160
.)()()(.., .... _ ...
3. 201L .... .
4. 2011... ·········- .............................. .
5. 2012 ..................... ·----
. .. .XXX .................................................................. 41,119 ................. .1...... .. ......... 43,788 ·················- ··•·••·• ...... .43,788
··=·· ......... ·····················:::: .. ········-···· ~ . I :: ~~6~9 • ~:•~:.:. ~·~~ •... ··-··· ....... XXX .. .
6. 2013- ················-·····
SECTION B-INCURRED HEALTH CLAIMS- GRAND TOTAL Sum of Cumulative Net Amount Paid and Claim LiaOilitv,_ Claim ReserveBnd MediGallncentive Pool and Bonuses OutslandinQ at End o!Year
L YearlnWhichLosses 1 2 I 3 4 = -- - ~0 ~, -
______ 43,788
. ..... _ ... , .. , ............ 45,497
5 2013
. ... 54.172
. .. 60,279
~I~ ~;~~~~~=-~~}~=-~~-~~~: ==~~~~ ==~~~ =~~-~1 =~~~~ ;;~5=~ 6. 2013 .................................. ······················-·········-··· ··············-··· .............. . ...................... xxx .......... ·····-·····- .. ···-··-· ........ .xxxL .................................... l. .. .xxx... . ........... ; ....................... .:xxx.... ···················"·· .................. 64,387
Years in Which Premiums were Earned and
Claims were Incurred
1. 2009........................... .. .....
2. 2010 ...
3. 2011 ................................... ..
4. 2012 ...... ..
5. 2013 .. .
Premiums B>mM
............ 51,019
.53,m
.. . .55,896
_ ..... 65,841
..... .. ... 78,516
'
SECTION C -INCURRED YEAR HEALTH CLAIM AND CLAIM ADJUSTMENT 'EXPENSE RATIO- GRAND TOTAL 2
Claim ~nts
........ . ............... ..41,160
............. .. .......... .43,788
45,497
.. .................. 54,1n
....................... 60,279
Claim Adjustment Exoense Pavments
... 163
............................ 213
921
.................. 526
................................. .754
4
Percent (Col. 312)
... 0.4
.................... 0.5
.............................. 2.0
Claim and Claim Adjustment
Expel!% Payments (Col.2 +3)
.. 41,323
.. 44,001
.•• 46,418
1.0 1 ............................. 54,698
.............. 1.3 ..... 61,033
' 6
' Percent ~(Col. 5111
..... 81.0
I ,
I
Claims Unpaid
......... L .
Unpaid Claim Adjustment
Expense
........ ............... n.1
.:: .. :::I :j••m:;,~~;l--m ~- -ml ......................... 83.1
.............................. 57
Total Claims and Claims Adjusbnent Expense Incurred
(COI.5+7+8)
......... 41,323
44,001
......... .46,418
... 54,698
...... ,65,198
10
Percent (CoL 911)
_ .... 81.0
81.8
.... 83.0
.......................... 83.1
. ......... 83.0
statamantasofDecembor3t,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
U & I Ex.-Pt.2C-Sn A-Paid Claims-Hospital & Medical NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Hospital & Medical NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Hospital & Medical NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Medicare Supp. NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Medicare Supp. NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Medicare Supp. NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Dental NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Dental NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Dental NONE
12.HM, 12.MS, 12.00
' "
statamentasofDecember3t,2013ofthe Mid-Atlantic VIsion Service Plan, Inc. I
1. Prior ..... .
2_ 2009 .. .
3. 2010 .. .
4. 2011 ..
Year In Which Losses Were Incurred
UNDERWRITING AND INVESTMENT EXHIBIT PART 2C- DEVELOPMENT OF PAID AND INCURRED CLAIMS
(DOD Omitted)
SECTION A- PAID HEALTH CLAIMS- VISION ONlY
2009
............. . ...... 34,39B
.... 38,820
.XXX .. .
.... .XXX ..... .
2 2010
......................... I .............. 34,396
41,160
• ........ .41,119
XXX-...
6. 2013 ........................................ . ···············-········
5. 2012.., ...
_______ ... ____ ------------.................... . .............................. ______ ,__ _ ___ :~:: ·:::::::::::::: ::::::~I:::··- _______ :::~:-·.
SECTION B -INCURRED HEALTH CLAIMS- VISION,ONLY
Curtiul<itive Net Amounts Paid 3
2011
l ····---------- ......... 34,396
.... ...1 ············ ........... .41,160
. .. .42,B59
..! ........................ <3,788 I
' I ••• .XXX.--~-~---.!xxt.
4 2012
___ .xxx ______ _
....... 34,395
.. .41,160
.••...• 43,788
... 45.497
. ...... 50,849
Sum of Cumulative Net Amount Paid and Claim LtabTiitv, Clairr\ ReServe and Medical Incentive Pool and Bonuses Olllstanding at End of Year
5 2013
... 34,396
... .41,160
.... 43,788
45,497
... ..54,172
.... 60,279
Year in Which Losses I 1 ~ [ 3 j 4 N Ware Incurred 2009 _2010 2011 2012 I 2013 • . I' I I
~ ~ ~~~~~;~=~~~=;~= =~=-~~~ ~:5~~~ ~~~~ ~=Ji~~ ~-~Ig~ Years in Which
Premiums were Earned and Claims were Incurred
1. 200L.. ······-···
2. 2010 .. oHoooooo.,ooooooooo•••
3. 2011. ..
4. 201L-------
5. 2013 ............. .
Premiums &moo
51,019
.53,m
... 55,896
··········- ····--· ...... 05,841 78,516
SECTION C -INCURRED YEAR HEALTH CLAIM AND CLAIM ADJUSTMENT EXPENSE RATIO- VISION ONLY
Claim ~ments
•.. .41,160
·······----43.788
.••••.••................... 45,497
.......................... 54.172
.... 60,279
Claim Adjustment Expense Payments
·····-······ ... 163 ... .213
·········--····---~ ............ 921
·····-······'"·····- ..... 526 .754
Percent
@I. 3/n_
Claim al'ld Claim Adjustment
Expense Payments (Col.2+3)
.0.4 I •••..•... . .... , .. .41 ,323
0.5 .. 44,001
···········-····· .......... 2.0 ----··· .. ···---46,418
1.0 1---------······ ........... 54,698
... 1.3 ··--···-··· -- 01,033
. Percent ~
81.0
·:--81.8
.•.. 83.0
...... 83.1
--------- _________ 77_7
-1 i Total Claims and
1
- Unpaid Claim I Claims Adjustment piaims Adjustment Expense lnCLrred Unpaid Expenses (Col. 5 + 7 + 8)
.. t: -·~~ =· : ············· ••.••. , : :::: 46,418
54,698
.65,198 .... J.. ........... <,ios ..... 57
... 34,396
.41,160
......... A3,788
... A5.497
.54,172
..••.•.••••..• 64,387
iO
Percent (Col. 9/1)
81.0
............. 81.8
.810
.... 83.1
....................... 83.0
statemontasofDocember31,2013o11he Mid~Atlantic Vision Service Plan, Inc.
U & I Ex.-Pt.2C-Sn A-Paid Claims-Fed Emp Health NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Fed Emp Health NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Fed Emp Health NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Medicare NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Medicare NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Medicare NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Medicaid NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Medicaid NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Medicaid NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Other NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Other NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Other NONE
U & I Ex.-Pt.2D NONE
12.FE, 12.XV, 12.XI, 12.0T, 13
SlatemsntasofOeoomber31,2013of~le Mid-Atlantic Vision Service Plan, Inc.
UNDERWRITING AND INVESTMENT EXHIBIT PART 3 ·ANALYSIS OF EXPENSES
1. Rent ($ .......... 0 for occupancy of own bu!ldlng) .. .
'· Salaries, wages and other benefits ....................................... .
Commissions (less$ ....... 0 ceded plus$ ....... ..()assumed)
4. Legal fees and expenses
5. Certifications and accreditation fws ...
1). Auditing, actuarial and other consulting services ....
7. Traveling expenses ........
8. Marketing and adwrtising ...
9. Postage, express and telephone ...
10. Printing and office supplies ...
11 Occupancy, depreciation and amorlizaHon.
Claim Acl'ustment Ex nses 1 2
Cost Other Claim Containment Mjustment Exoenses EXoenses
........... 45,189
General Administrative
Exoenses
.. ....... :365,617
....... 718,337 ........... 5,801 ,646
.......... 1,745,001
. .............. 18,275 .. 124,880
. ............ 26,641 ............. 215,547
...63,511)
. ......... :W,966
' ................. 9,192
.513,900
......... 16g,632
.. ...... 74,371
.. .... 494,571
lnwstment Exoenses Total
......... .410,806
.......... 10,352 ............ 6,530,337
.... 1,745,001
"' ....... 0
.. ... 0
............... 143,135
...... 242,188
.......... 577,416
........... 100,598
...... 83,56~
.... 555,696
_ 12. _ ~qul]:!fl)en_l
.................. 61,127
.... 52,640 ...... 422,438 "" ............... 3,470 .. 478,548
13. Cost or deprec1ation of EDP equipment and software
14. Outsomced se111ices Including EDP, claims, and other services ....
15. Boards, bureaus and association fees ................................. .
16. Insurance, except on real estate
- - - -1-7;-Collection and bank service charges
18. Group service and admlnlstralion fees
19. Reimbursements by uninsured plans
20. Reimbursements from fiscal intermediaries
21. Real estate expenses ....
22. Real eslate taxes ....
23. Taxes, licenses and fees:
23.1 State and local Insurance taxes ...
23.2 State premium taxes ........ .
23.3 Regulatory authority licenses and fees.
23.4 Payroll taxes
23.5 Other (excluding federallnoome and real estate taxes)
24. ln~estrnent expenses not included elsewhere
25. AgJregalewrlte-lns for expenses. ..
26. Total expenses Incurred {Lines 1\o 25) ......................... .
27. Less expenses unpaid December 31, current year.
28. Add expenses unpaid December 31, prior year.
2[1. Amounts receivable relating to uninsured plans, prior year ...
30. Amounts recei~able relaUng to uninsured plans, current year .. ,
31. Total expenses oald runes 26 minus 27 olus 26 minus 29 Ius 301..
2601. Other .......
2502.
2503
2598. Summary of remaining write-Ins for Line 25 from overflow page ...
2599. TOTALS runes 2501 tl1ru 2603 Ius 259allline 25 above
............. 0
................... 0
.0
DETAILS OF WRITE-INS
... 0
.. 0
(a) Includes management fees of$ .. ,.g,g78,242 to affiliates and$ ......... 0 to non-affiliales.
14
....49,005 ............. 396,494
.... 12,776
............. 4,705
. ......... 103,370
........... 38,065
.. (268,808) ........ (2,909,963)
........... 15 239
......... 808,800
. ......... 56,674
.410,218
.. ...... ..46,345
..123 347
..... 8,135,461
.. 92,992
........ .46,725 ............... 133,623
.......... 2,128,533
... 2233 522
........ 903840 ....... 8,176,092
.......... 15,239 ......... 123,347
.............................
...........................
.0 .......... 0
........... ..15 239 .... 123347
.. ' ... 0
........ 0
............... 445,49g
............ 116,146
............... 42,770
......................... 0
........................... 0
........ (3,198,771)
...... 0
.. ................ 0
. .... 0
. ........... 0
..410,218
.. 46,345
...... 0
.......... 0
..... 0
......... 138 586
.13,822 {a) ....... 8,958,083
.. 14g,666
.. 180,348
.. .......... 2,128,533
............ 2233522
.13,822 ............ 9093,754
....................... ............. .138,566
.. .... 0
........................ ... ..... 0
..... 0 .. ... 0
....... 0 ......... 138586
statemenlasofDecember31,2013oflhe Mid~Atlantic Vision Service Plan1 Inc.
EXHIBIT OF NET INVESTMENT INCOME
1. U.S. govemmenl bonds ... l•l 1.1 Bonds exempl from U.S. tax ..
1 Collected
DurinoYear Earned
DurlnoYear
1.2 Other bonds (unaffilialed) ....... 1.3 Bondsofaffillates.
......... l•l· 1•) ••. 1•) .... (b)
.. ...... 536,256 ................. ..474,453
2.1 Preferred stocks (unaffiliated) 2.11 Preferred stocks of affiliates .. .. 2.2 Common slocks (unEffillated) .. .
2.21 Comm011 stocks of affil1ates .... .. 3. Mortgage loans 4. Real estEte. 5. Contract loans .....
.......•.......•. (b)
(0) (d)
.... 1~87 ......... 1,687
....... 208,212 .. ...... 210,083
6. Cash, cash equivalents and short-term Investments .... (e)... . ........................ 1,751 ............ 1,479 7. Derivative Instruments .... .. 8. Other Invested assets .. . 9. Aggregate wrlte-lns lor investment income ...................... .
10. Total aross Investment Income ...... 11. Investment expenses .... 12. Investment taxes, licenses and fees, excluding federal income faxes ... 13. Interest expense 14. Depreciation on real estate and other Invested assets ............ . 15. Aggregate write-Ins lor deductions from investment Income ... . 16. Total deductions (Lines 11 lhrough 15) .............. .. 17. Net investment Income (Line 10 mimrs Une 16) .. .
0901. 0902. 0903. 0998. Summary of remaining write-Ins lor line 9 from overflow page 0999. Totals ILines 0901thru 0903 Ius 09981 ILine 9 abovel... ....... . 1501. Equity Management Fee .... 1502. 1503.
DETAILS OF WRITE-INS
(Q .. ...... 395,218
.. .... 0 .. ... 1143124
(g) .. . (g) .. . (h).
........ (J).
...... 0
...... 0
........ 395,218 .... 0
..... 1 082 920
.. ........ 13,822
.. .......... 0 ..120 252
. ...... 134 074 .. ............. 948 846
..... 0 .. ... o
................................ 120,252
1598. Summary of remaining write-ins lor Line 15from overflow page... .. .. 0 1599. Totals (Lines 15011hru 1503 Ius 1598\ (Line 15 abovel.............. .120 252
(a} Includes $ ..... 714 accrual of discount less $ ..... 515,804 amortlza~on of premium and less$ .... 978 paid for accrued Interest on purchases. (b) Includes$ ........ 0 accrual of discount less$ ......... 0 amortizallon of premium and less$... .. . .0 poid lor accrued dMdends on purchases. (c) Includes $ .......... 0 accrual of discount less$ ......... 0 amortization of premium and less$ ....... 0 paid for accrued Interest on purchases. (d) Includes$ 0 lor company's ocoupancyofits own buildings; and excludes$ ......... 0 IntErest on encumbrances. (e) lncludes$ .......... 0 accrual of discount les~ $ ........ D amor~zaUon ofprtlmlum ond toes$ ....... 0 paid foraccroed illltllllslon purchases. (Q lncludes$ .......... 0 accrual of discount less $ .......... 0 amortizallon of premium. (g) lndudes$ .......... 0 lnveslment expenses and $ .......... 0 Investment taxes, tlamses and fees, excluding federal income taxes, allributable to SegregEied and Separate Accounts. (h) Includes$ ......... 0 Interest on surplus notes and$ ......... 0 interest on capital nol€s. (i) Includes $ .......... 0 dej.reclation on real estate and$ ......... 0 depreciation on olherinvested assets.
EXHIBIT OF CAPITAL GAINS (LOSSES)
1. U.S. government bonds ......... 1.1 Bonds exempt !Tom U.S. tax ... 1.2 Other bonds (unaffiliatetl) ... 1.3 Bonds of affiliates 2.1 Preferred slocks (unaffiliated).
2.11 Preferred stocks of alflllales 2.2 Common stocks (unaffiliated) ...
2.21 Common stocks of alnliales ... 3. Mor!9age loans ...... 4. Real estate ... 5. Contract loans ....... 6. Cash, cash equivalents and short-term investments 7. Derivative instruments .. .. 8. Other Invested assets ... .. 9. Aggregate wrlte-lns for GBpital gains (losses) ....... .. 10. Tolal GBPit81 Qains {losses) ............................... ..
0901. 0902. 0903. 0998. Summary of remaining write-Ins for Line 9 from overflow page .... . 0999. Totals rltnes 0901 thru 0903 Ius 0998l/Une 9 abovel ............. ..
Realized Gain (Loss)
on Sales orMaturit~
........... 17,613
.. ..... 1,091,091
.. ...... 0 ....... 1108 704
Olher Realized
AdJustments
....... 0 .............. 0
DETAILS OF WRITE-INS
............... 0 ....... 0
15
.. ..... 0 ..................... 0
Total Realized Capital Galn.(Loss)
/Columns 1 t 2) · .................... 0
.. ... 0 . .. 17 ,613
...... 0 .................... 0
...... 0 ..... 1,091,091
.. ..... 0 ...... 0
0 . ..... 0 ...... 0 .. .... 0 ....... 0 ..... 0
..... 1108 704
......... 0 ..0
.. ... 0 ...... 0 ..... 0
Cllange In Unrealized
Capital Gain {Loss)
.. ......... 6,366
1,736,291 ................ (1,258,914) .
..... 0 ...483 743
...... 0
...... 0
Change in Unrealized
Foreign Exchange CapllEI Gain {LoSs)
..... 0 .. 0
..... 0
.. ... 0
statamentasofDooomOOr31,20t3ollhe Mid-Atlantic Vision Service Plan, Inc.
1. Bonds (Schedule D) ........ .
2. Stocks {Schedule D):
2.1 Preferred srocks .. .
2.2 Common stocks .... .
3. Mortgage loans on real estate (Schedule B):
3.1 Flrstlfens.,
3.2 Other than first liens
4. Real estate {Sche<iulll A)·
4.1 Properties occupied by the oompany ...
4.2 Properties held for the producllon of Income
4.3 Properties held for sale .....
EXHIBIT OF NONADMITTED ASSETS Current Year
Total Nonadmltled Assets
5. Cash (Schedule E-Part 1), cash equivalents (Schedule E-Part 2)
PriorY ear Total
Nonadmitted Assets
3 Change In Total
No,l!admilled As_;~ts lCo1.2-Cot11
.. ...... 0
. ..... 0
.. .................. 0
...... 0
... 0
.. ........ 0
........... 0
.. .... 0
and short-term Investments (Schedule DA)..... ............ ........ . ........ ............ . ......... 0
6. Contract loans..... .. ... 0
7. Derivatives (Schedule DB)... . .. ............. 0
8 Other invested assets (SchedUle BA)... ..7,168,000 ....... ~ .. 10,128))26 .... 2,960,526
-----------1~-9.~Receivables-for_securlties. .. .... 0
10. Securitles!endingrelnveste:d:o:,,:,,: •• :,,:,:,:.~(;S,:h:oo~o;.I,~D~l~)'"'.''"'.''"'.''"'.''"'.':::l:..::..::..::..::..::::..::..:~I:..::..:::::::::::::::::::~I~~~~~~~~ .. ~ ... ;.0~~-----------11. Aggregate write-ins for Invested assets.
12. Subrotals, cash and Invested assets (Lines 1 to 11) ...
13. Title plants (for Tme Insurers only) ........
14. Investment Income due and accrued.
15.- Premiums and oonslderaVons:- --
15.1 Uncollected premiums and agents' balances In the oourse of oollection ..
15.2 Deferred premiums, agents' balances and instalknllllls booked but rleferred and not yet due ....
15.3 Accrued retrospective premiums.
16. Reinsurance:
16.1 Am(Junts recoverable from rein~urers ...
16.2 Funds held by or deposited wilh reinsured companies.
16.3 Other amounts receivable under reinsurance contracts ........ ..
17. Amounts receivablll relating to uninsured plans ...
18.1 Current federal and foreign Income tax recoverable and lntarast thereon .....
18.2 Net deferred tax asset
19. Guaranty funds receivable or on deposit.. ....
20. Electronic data processing equipment and software.
21. Furniture and equipment, Including health care delivery assets
22. Net aq'ustmentln assets and liablll~es rlue to foreign exchangll rates ..
23. Receivabllls from parent, subsidiaries and affiliates ....
24. He<llth care and other amounts receivable .....
25. Aggregate write-Ins for other than lnvllsted assets
26. Total assets excluding Separate Acoounts, Segregated llccounts and Proleotlld Cell Accounts (Lines 12through 25) ........
27. From Separate Accounts, Segregated Acwuntsand Protected Cell Accounts ........
28 TOTALS (Lines 26 and 27) ..
... 0
..... 7,168,000
...... 7,229
..... 108,195
.............. 440,620
............................... 0
. 7,724,044
... 7,724,044
DETAILS OF WRITE-INS
1101 ..
1102.
1103.
1198. Summary of remaining write-Ins for line 11 from overflow page ....
119g, Totals !Lines 1101 thru 1103 olus 1198\ !Line 11 above\,, ..
2501.
2502.
2503.
2598. Summary of remaining write-Ins for Line 25from overflow page ...
2599. Totals !Lines 2501 thru 2503 olus 2598\ /Line 25 above\.. ....
16
..... 0
................................. 0
... 0
.0
.......... 0
........... 10,128,526
.................. 1,917
.. .......... 525
................ 0
.. ...... 10,130,968
. .. 10,130,968
...... 0
............ 0
.. ......... 0
................ 0
...0
. ... 2,960,526
. ...... 0
., .. 0
........ (5,312)
.. .... 0
.. ..... 0
.. .. 0
.. ..... 0
.. ... 0
.... (107,670)
. ............... 0
..... (440,620)
. ....... 0
..0
......... 0
...0
.... 0
.. ..... 0
......................... 0
...... 2,406,924
......... 0
..2,406,924
....... 0
.. .............. 0
...0
' ....... 0
...0
.... 0
.0
.. ........ 0
........ 0
.. 0
smtementasafDecember31,2D13ollhe Mid~Atlantic Vision Service Plan, Inc.
~
t Hea~h maintenan~ O~W~nizations .....
2. Provider servi~ organizations ...
3. Preferred provider organizations ...
4. Point of service ............. .
5. Indemnity only ............. ..
6. Aggregate write-ins for other lines of business ...
7. Total. ..
10601. Vision Only.
10602.
10603.
Source of Enrollment
""""'\osgs, Summary of mmaining write-ins for Line 6 from overflow page ....
06S9. Totals (Lines 0601 !hru 0603 plus 0698) (Une 0 above) ....
EXHIBIT 1 • ENROLLMENT BY PRODUCT TYPE FOR HEALTH BUSINESS ONLY
............ . .............. , .................. .
Prior Year
........................
.. ............................ .
2 First
Quarter
. ...
Total Members at End of
Second Quarter
4 Third
Quartar Current Year
Current Year Member Months
··················································I·······-·····························
..... .. ............................ 1,078,317 ............................ 1,124,594 ..................... 1,174646 .............................. 1.162.051 ........................... 1,157,496 ........................... 13,871,246
............ .. .... 1,078.317 ........................... 1,124,594 ..................... 1,174,646 .............................. 1,162,051 ............................... 1,157,496 ........... .. ......... 13,871,246
DETAILS OF WRITE-INS
.. ............................. 1,078,317 1....... .. ........... 1,124,594
.................. 0
. .... 1.078.317 ........ 1,124,594
..... 1,174,646 ... 1,162,051 I"'""'""
··························!··········· . ............................................... , .................. ..
... 0
-1.174,646
............................... 0
1,162,051
1,157,496 ..... 13,871,246
...0
... 1,157.490 13,871246
' "
statementasotDeoember~1.2013ofthe Mid-Atlantic Vision Service Plan, Inc.
A&H Premiums Due and GENESIS HEAL TI-ICARE ...... . SENTARA HEALTHCARE ALLEGIS CONTRACTOR ... PTRADEF MAX!MUS .... K121NC.-CSO-C FULL~ ATD .. _ ................................. .
N BUY-UP f
GA"TE' CHC\fi PRINCE WIWAM COL US INVESTIGATIONS: ENH PPO PLAN-EE + f - ·-·-- ~'""""''r~
CIENAI
FMDI
1;;:~~~
IENH PPQ I ""TI\11:
GATE I LAUREAtk:< ENHPPO PL MCGUIRE CEMENT us f QW AMERICAN CAPITA STD PPO PL ""' ee ARB!TRON I
..LP ...
Y-1
1T,4T ..••• >subtotal d unpaid
IT 2- AI '
1-30Days
u AND HEALTH IIMS DUE AND !UNPAID 5
31-6C Days 61 - eo Days I 1· Over eo Davs
:~i 1:::::::: ..... -1.!!,57S 1 ......... .
............. ....................... . ···-~··· ..... 18,451! .... .,......... . ............. . . .... 2S,OS8 ................. ................ .. .......... 8
................. ............... ...... ...... ...... .
................. 11,971 .............. L .......................... . ........................ . .... _... . ...................................... ..
..... :::~~:~~; 1::=:::::: ................... ····················
,966
·····--··· ...................................... ~574~~ . ........ ~1"02"497
....... .48 543 j§1,040
.................... 8 .................. 5,646
.. .5,554 .. .5,654
1,872,91 I,Bn,S1
.......... l .... 2.61~ ... 2,61! ... 2,61~
6
Nonadmitted I Admllted I
s~atemen!asoroecembor31,2013oflhe Mid~Atlantic Vision Service Plan, Inc.
Ex.3 NONE
Ex.3A NONE
19,20
"' ~
StatementasafDec:emoora1,2013oithe Mid-Atlantic Vision Service Plan, Inc.
EXHIBIT 4- CLAIMS UNPAID AND INCENTIVE POOL, WITHHOLD
I II
(R~ported and Unreported)
I
w z 0 z
22
I II
tl
S!l!tementasofDecembera·,,zo13oflha Mid-Atlantic Vision Service Plan, Inc.
EXHIBIT 7- PART 1 -SUMMARY OF TRANSACTIONS WITH PROVIDERS
Pavmerlf Method
Capitation Payments:
1. Medical groups.. . ..•...
2. Intermediaries ············- ................................................. ···········-···~ ··················~·-···
3. All other providers ................................. ···················-· ·······-···--···
4. Total capt!a!ion payments..... ........... . ................. .
Other Payments:
5. Fee-for·seiVice ........................... .
Direct Medical Expense Pavment
...•..••• 0
••..•••..••••..•• ..••••.••••...• . ... ' ............................................. 0
..•••..••••..••••..••••..••••••••.••••.••• 0
....... 5,088,166
Column 1 as a%
of Total Pavment
... 0.0
Total Members Covered
4
Column3 as a%
ofTotal Members
-~·-······ ................................. . ·······························- .....•. 0.0 [-······························· ·······[····························-··········-
.... 0.0
.... 0.0
..... .XXX. ...................................... .XXX. ........... .
COlumn 1 Column 1 Expsnses Paid Expenses Paid
to Affiliated to Non-Affiliated Providers Providers
.... 5,088,166
B.
7.
Contractual fee payments..... ..... ..................................... • ........... .
Bonus/withhold arrangements ·fee-fur-service ...
Bonus!wtlhhold arrangements -contractual fee payments ...
Non-contingent salaries •••..
..-... ~ ... ··::::I ::::::::::::~:·:::::::::::::~~:~~~:~~~ .... 8.0
.92.0
0.0 __ :::: : :: ····:::::::::1 ~:58:'_""'1··· ............................................ !
8. .... 0.0 . .. .XXX ....................................... .xxx_~·-··
9. .•.•.• 0.0 ...XXX .... ....... .XXX. ........ .
10. Aggregate cost arrangements.......... .. ........... . ............................ 0 ..... ......................... 0.0 . .•. XXX .................. 1 .................... .XXX. ...
11. All other payments ... ···p·· ....... 0 ................................ 0.0 XXX .................. \ ................... .XXX..... . ........ I •.•
12. Total other payments.... ................................. ......•••.•••••.• ••...•••.••••. .................................. . ................................. 63,602.073 ·········--· ............... 100.0 .................. .XXX ................ ·--~· .............. .XXX... . •••........................ 58,513,907 ........................ -5,088,166
1\J' 13 . Total Line 4 Ius Line 12) .. ~... .. ....................................................... ~··· ...................................... ............... . .................................. 63,602,073 .............................. 100.0 ...................... XXX. ..................................... .XXX ........................................... 58,513,907 ............................. 5,088,166 ...
EXHIBIT 7- PART 2 -SUMMARY OF TRANSACTIONS WITH INTERMEDIARIES 2 3 5 6
lntermecfiary's Intermediary's Name of Capitation Total Adjusted Atrthorized Control
Jntermedia Paid Capttal Level RBC
NONE
"' "'
I II
statementasa!DecemberJ1,2013ofthe Mid~Atlantic Vision Service Plan, Inc. 1
EXHIBIT 8 • FURNITURE, EQUIPMENT AND SUPPLIES OWNED
Descriotion "'''
3. Pharmaceulic:als and surgfc:al supplies .......................... .
4. Durable medical equipment...
5. Other property and equipment .................................................... .
6. TotaL .................. -................. .. ................... .. ............................................................... ! .............................................. 0 ! .......... .
2 I I I
I
lmorovements
.. .. 0
Accumulated
Depredation
4
Book Value
"'" Encumbrances
Assels
Not
Admitted
Net Admitted
Assets
... 0
.. .. 0
............................. . ................................................ 0
.. ............................... _,0
.................... 0 ............................................ 0
StalemenlasofOII!:flmber31,2013ottho Mid-Atlantic Vision Service Plan, Inc.
NOTES TO FINANCIAL STATEMENTS
1. Summarv of Significant Accounting Policies
A. The accompanying financial statements of Mld~Atlantic Vision Service Plan, Inc. (Company) have been prepared on the statutory basis of accounting prescribed by the National Association of Insurance Commissioners' (NAIC) Accounting Practices and Procedures Manual.
B. The preparation of financial statements in conformity with the Annual Statement Instructions and Accounting Practices and Procedures manual 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 of revenues and expenses during the reporting period. Actual results could differ from those estimates.
C. Accounting Policies that Materially Affect Assets, Liabilities, Capital and Surplus or Results of Operations
Premiums are recognized over the period of coverage and are generally based on the number of eligible participants. Receivables and related premiums are estimated based on the most recent eligibility received from clients under the program. Net revenue relating to uninsured plans is recorded as an offset to claims adjustment expenses and general administrative expenses. In addition, the Company uses the following accounting policies:
1. Short-term Investments: Short~term investments are stated at amortized cost. 2. Bonds: Bonds are stated at amortized cost using the interest method. 3. Stocks: Stock is stated at market value. 4. Preferred Stock: Preferred stock is stated at market value. 5. Mortgage Loans: The Company has no mortgaged loans. 6. Loan-backed Securities: The Company has no loan-backed securities. 7. On April4, 2013, the Company invested $30,000,000 in VSP Optical Group, an affiliate who provides
independent eye care professionals and their patients with high-quality ophthalmic products and cutting-edge laboratory technology and services. The Company owns 10% of the voting shares and approximately 17% of the non-voting shares of VSP Optical Group. In accordance with SSAP No. 97, Investments in Subsidiary, Controfled and Affiliated Entities, A Replacement of SSAP No. 88, the investment is recorded based on U.S. GAAP equity of the investee.
8. Investments in Joint Ventures, Partnerships and Limited Liability Companies: The Company has no investments in Joint Ventures, Partnerships and Limited Liability Companies.
9. Derivatives: The Company has no derivatives. 10. Premium Deficiency Calculation: The Company does not utilize anticipated investment income as a factor in the
calculation of premium deficiency. 11. Liabilities for Claims Unpaid and Related Expenses: Claims unpaid and related expenses represents the
estimated l!ablllty for claims reported to the Company, claims Incurred but not yet reported and unpaid claims adjustment expenses.
12. The Company has not modified its capitalization policy from the prior period. 13. The Company has no pharmaceutical rebate receivables.
2. Accounting Changes and Corrections of Errors
The Company provides for contracts if It is probable that expected future claims, Including maintenance costs, will exceed anticipated future premiums and investment income. For purposes of determining aggregate health policy reserves, contracts are grouped in a manner consistent with our method of acquiring, servicing and measuring the profitability of such contracts. Over time, the Company has experienced changes in the manner in which it acquires, services and measures the profitability of Insurance contracts. Accordingly, we updated contract groupings during the third quarter of 2013. As a result of this change in estimate, surplus increased by $1 ,860,729 as there was no aggregate health policy reserve at September 30, 2013 or December 31, 2013. The table below shows the impact of the change on total liabilities, net income and surplus at December 31, 2013. There is no impact to prior year balances.
Total Liabilities Net Income Surplus
Balance Before Change $ 10,022,661 $ 7,176,609 $68,844,811
Change $ (2,862,660) $ 1,001,931 $ 1,860,729
Balance After Change $ 7,160,001 $ 8,178,540 $ 70,705,540
3. Business Combinations and Goodwill~ The Company has no business combinations or goodwill.
4. Discontinued Operations- The Company has no discontinued operations.
5. Investments A. Mortgage Loans: The Company has no mortgaged loans. B. Restructured Debt: The Company has no restructured debt. C. Reverse Mortgages: The Company has no reverse mortgages. D. Loan Backed Securities: The Company does not hold any loan-backed or structured securities. E. Repurchase Agreements: The Company has no repurchase agreements. F. Rea! Estate: The Company owns no real estate. G. Investments in low~income housing tax credits (LIHTC): The Company has no LIHTC. H. Restricted Assets: The Company has no restricted assets.
6. Joint Ventures Partnerships and Limited Liabilitv Companies- The Company has no joint ventures, partnerships and limited liability companies.
7. Investment Income- The Company has not excluded any investment income.
8. Derivative Instruments The Company has no derivative instruments.
26
SlatemBIIt as of December 31, 2013 of the Mid-Atlantic Vision Service Plan, Inc.
NOTES TO FINANCIAL STATEMENTS
9. Income Taxes
A. The components of the net deferred tax assetl(liability) at December 31 are as follows:
1. 12/31/2013 Ordinary Capital Total
(a) Gross Deferred Tax Assets $ 354,991 $ 450,032 $ 805,023 (b) Statutory Valuation Allowance $ $ $ (c) Adjusted Gross Deferred Tax Assets (1a ~1 b) $ 354,991 $ 450,032 $ 805,023 (d) Deferred Tax Assets Nonadmitted $ $ 440,620 $ 440,620 (e) Subtotal Net Admitted Deferred Tax Asset (1c -1d) $ 354,991 $ 9,412 $ 364,403 (Q Deferred Tax Liabilities $ $ (1,091,837) $ (1,091,837) (g) Net Admitted Deferred Tax Asset/(Net Deferred
Tax Liability) (1e -1f) $ 354,991 $ (1,082,425) $ (727,434)
2. Admission Calculation Components SSAP No. 101 (a) Federal Income Taxes Paid in Prior Years
Recowrable Through Loss Carrybaciks $ 354,991 $ $ 354,991 (b) Adjusted Gross Deferred Tax Assets Expected To
BeRTaliZecqEXCimlfhg Tfi8 AmriuntOfDElferrect Tax Assets From 2(a) abo\e) After Application of the Threshold Limitation. (The Lesser of 2(b )1 and 2(b)2 Below) $ $ $ 1. Adjusted Gross Deferred Tax Assets Expected
to be Realized Following the Balance Sheet Date $ $ $ ----- 2-'-----Ad.lulit.e.d-.ilios_s_ D.e.ferred_Tax_Asset_s_Ailowed
per Limitation Threshold NIA NIA $ 10,605,831 (c) Adjusted Gross Deferred Tax Assets (Excluding
The Amount of Deferred Tax Assets From 2(a) and 2(b) above) Offset by Gross Deferred Tax Liabilities $ $ 9,412 $ 9,412
(d) Deferred Tax Assets Admitted as the Result of Application of SSAP No. 101 (Total 2(a)-t-2(b)+2(c)) $ 354,991 $ 9,412 $ 364,403
1. 1213112012 Ordinary Capital Total
(a) Gross Deferred Tax Assets $ 1,343,881 $ 396,068 $ 1,739,949 (b) Statutory Valuation Allowance $ $ $ (c) Adjusted Gross Deferred Tax-Assets (1a -1b) $ 1,343,881 $ 396,068 $ 1,739,949 (d) Deferred Tax Assets Nonadmitted $ $ 0 $ (e) Subtotal Net Admitted Deferred Tax Asset (1c -1d) $ 1,343,881 $ 396,068 $ 1,739,949 (Q Deferred Tax Liabilities $ $ (481,907) $ (481,907) (g) Net Admitted Deferred Tax Asset/(Net Deferred
Tax Liability) (1e -1n $ 1,343,881 $ (85,839) $ 1,258,042
2. Admission Calculation Components SSAP No. 101 (a) Federal Income Taxes Paid in Prior Years
Reco\erable Through Loss Carrybacks $ 1,343,881 $ 57,088 $ 1,400,969 (b) Adjusted Gross Deferred Tax Assets Expected To
Be Realized (Excluding The Amount of Deferred Tax Assets From 2(a) abo\e) After Application of the Threshold Limitation. (The Lesser of 2(b)1 and 2(b)2 Below) $ $ 12,600 $ 12,600 1. Adjusted Gross Deferred Tax Assets Expected
to be Realized Following the Balance Sheet Da:e $ $ 12,600 $ 12,600 2. Adjusted Gross Deferred Tax Assets Allowed
per Limitation Threshold NIA NIA $ 10,209,363 (c) Adjusted Gross Deferred Tax Assets (Excluding
The Amount of Deferred Tax Assets From 2(a) and 2(b) above) Offset by Gross Deferred Tax Liabilities $ $ 326,380 $ 326,380
(d) Deferred Tax Assets Admitted as the Result of Application ofSSAP No.101 (Total2(a)+2(b)+2(c)) $ 1,343,881 $ 396,068 $ 1,739,949
26.1
Statement as or December 31, 2013 olltl(l Mid-Atlantic Vision Service Plan, Inc.
NOTES TO FINANCIAL STATEMENTS
9. Income Taxes (continued)
1. Change Ordinary Capital Total
(a) Gross Deferred Tax Assets $ (988,890) $ 53,964 $ (934,926) (b) Statutory Valuation Allowance $ $ $ (c) Adjusted Gross Deferred Tax Assets (1a ~ 1b) $ (988,890) $ 53,964 $ (934,926) (d) Deferred Tax Assets Nonadmitted $ $ 440,620 $ 440,620 (e) Subtotal Net Admitted Deferred Tax Asset (1 c- 1d) $ (988,890) $ (386,656) $ (1 ,375,546) (D Deferred Tax Liabilities $ $ (809,930) $ (609,930) (g) Net Admitted Deferred Tax Asset/(Net Deferred
Tax Liability) (1e ·1D $ (988,890) $ (996,586) $ (1 ,985,476)
2. Admission Calculation Components SSAP No. 101 (a) Federal Income Taxes Paid in Prior Years
Reco\oerable Through Loss Carrybacks $ (988,890) $ (57,088) $ (1 ,045,978) (b) Adjusted Gross Deferred Tax Assets Expected To
Be Realized (Excluding The Amount of Deferred Tax Assets From 2(a) abo\oe) After Application of the Threshold Limitation. (The Lesser of 2(b)1 and 2(b)2 Below) $ $ (12,600) $ (12,600) 1. Adjusted Gross Deferred Tax Assets Expected
to be Realized Following the Balance Sheet Date $ $ (12,600) $ (12,600) 2. Adjusted Gross Deferred Tax Assets Allowed
per Limitation Threshold N/A N/A 396,468 (c) Adjusted Gross Deferred Tax Assets (Excluding
The Amount of Deferred Tax Assets From 2(a) and 2{b) abo\€) Offset by Gross Deferred Tax Liabilities $ $ (316,968) $ (316,968)
(d) Deferred Tax Assets Admitted as the Result of Application of SSAP No. 101 (Total2(a) + 2(b) + 2©) $ (988,890) $ (386,656) $ (1 ,375,546)
3. 2013 2012 (a) Ratio Percentage Used to Detennine Reco\oery
Period and Threshold Limitation Amount 2868% N/A
(b) Amount of Adjusted Capital and Surplus Used to Detennine Reco\€ry Period and Threshold Limitation Amount $ 70,705,540 $ N/A
4. There are no changes to adjusted gross and net admitted DTAs due to tax planning strategies.
B. There are no temporary differences for which a D1L has not been established.
26.2
Stotamenl as of December 31, 2013 of U1a Mid-Atlantic Vision Service Plan, Inc.
NOTES TO FINANCIAL STATEMENTS
9. Income Taxes (continued)
c. Current income taxes incurred consist of the following major components:
(1) (2) (3) (Col1-2)
12/31/2013 12/31/2012 ~~ 1. Current Income Tax
(a) Federal $ 1,805,745 $ 2,708,152 $ (902,407) (b) Foreign (c) Subtotal $ 1,805,745 $ 2,708,152 $ (902,407) (d) Federal income tax on net capital gains/(losses) 388,046 241,205 146,841 (e) Utilization of capital loss oarry~forwards (Q Other (56,623) 80,083 (136,706) (g) Federal and foreign income taxes Incurred $ 2,137,168 $ 3,029,440 $ (892,272)
(1) (2) (3) (Col 1-2)
2. Deferred Tax Assets: 12/31/2013 12/31/2012 Change (a) !Ordinary:
(1) Discounting of unpaid losses $ 208,022 $ 264,264 $ (56,242) (2)-Unearned-premium-reser~..e $-· -· -99;838-$-· -58,344-$-· --41,49 (3) Policyholder reserves $ $ 1,001,931 $ (1,001,931) (4) ln-..estments $ $ $ (5) Deferred acquisition costs $ $ $ (6) Policyholder dividends accrual $ $ $ (7) Fixed assets $ $ $
_@ Compe~ation and benefits accrual $ $ $ -- - -
$ - $- $ (9) Pension accrual (10) Receivables -nonadmitted $ 40,398 $ 855 $ 39,543 (11) Net operating loss carry-forward $ $ $ (12)Tax credit carry-fotward $ $ $ (13)0ther (including items <5% of total ordinary tax
assets) $ 6,733 $ 18,487 $ (11,754) (99) Subtotal $ 354,991 $ 1,343,881 $ (988,890)
(b) Statutory valuation allowance adjustment $ $ $ (c) Nonadmitted $ $ $ (d) Admitted ordinary deferred tax assets $ 354,991 $ 1,343,881 $ (988,890) (e) Capital:
(1) ln-..estments $ 450,032 $1 57,602 $ 392,430 (2) Net capital loss carry~forward $ $ 338,466 $ (338,466)
(99) Subtotal $ 450,032 $ 396,068 $ 53,964 (Q Statutory valuation allowance adjustment $ $ $ (g) Nonadmitted $ (440,620) $ $ (440,620) (h) Admitted capital deferred tax assets (2e99- 2f- 2g) $ 9,412 $ 396,068 $ (386,656) (i) Admitted deferred tax assets (2d + 2h) $ 364,403 $ 1,739,949 $ _(_1 ,315,546)
3. Deferred Tax Liabilities (a) Ordinary:
(1) ln-..estments $ (1 ,091 ,837) $ (481,907) $ (609,930) Fixed assets $ $ $ Deferred and uncollected premium $ $ $ Policyholder reserves $ $ $ Other (including items <5% of total ordinary tax liabilities) $ $ $ (99) Subtotal $ (1 ,091 ,837) $ (481,907) $ (609,930)
(b) Capital: (1) ln~oestments $ $ $ (2) Real estate $ $ $ (3) Other (including items <5% of total capital tax
liabilities) $ $ $ (99) Subtotal
(c) Deferred tax liabilities (3a99 + 3b99) $ (1,091,837) $ (481,907) $ (609,930)
4. Net deferred tax assets/liabilities (2i- 3c) $ (727,434) $ 1,258,042 $ (1 ,985,476)
26.3
statementasofDecember31,2013oflhe Mid-Atlantic Vision Service Plan1 Inc.
NOTES TO FINANCIAL STATEMENTS
9. Income Taxes <continued)
The change in net deferred income taxes is comprised of the following (this analysis is exclusi\.e of non-admitted assets as the Change in Nonadmitted Assets is reported separately from the Change in Net Deferred Income Taxes in the surplus section of the Annual Statement):
2013 2012 Change
Total deferred tax assets $ 805,023 $ 1,739,949 $ (934,926) Total deferred tax liabilities (1,091,837) (481,907) (609,930) Net deferred tax asset $ (286,814) $ 1,258,042 $ (1,544,856) Tax effect of unrealized losses 169,310 Change In net deferred income tax $ (1,375,546)
The provision for federal income taxes is different tram that which v.rou19 be computed ay applying federal income tax rates to income before taxes as foiiOOJS:
Income before fEderal income taxes Tax-exempt income Di-..idends recei\ed deduction Change in non-admitted assets Other Total
Federal income taxes incurred Change in net deferred income taxes Total statutory Income taxes
$
Amount
10,315,708 $ (67,208) (99,192)
(112,982)
10,036,326 $
$
$
2013 Effecti\€!
Tax Effect Tax Rate
3,610,498 35.00/o (23,523) (0.2%) (34,717) (0.3%) (39,544) (0.4%)
0.0% 3,512,714 34.1%
1,749,122 1,375,546 3,512,714
At December 31, 2013, the Company had no net operating loss credit canyfoiWards, AMT credit canyforwards or capital loss carryforwards.
The following is income tax expense for 2011, 2012 and 2013 that is available for recoupment in the e\€!nt offuture net losses.
Year Ordinary Capital Total 2011 $ 2,949,357 $ $ 2,949,357 2012 2,839,880 57,088 2,896,968 2013 2,640,346 2,640,346 Total $ 8,629,583 $ 57,088 $ 8,686,671
There were no deposits admitted under IRC section 6603.
The Company's federal income tax return is filed on a consolidated basis and includes the following entities:
Vision Ser.tce Plan (CA), Altair Eyewear, Inc., Eyefinity, Inc., Vision Service Plan, Inc. (NV), Eastern Vision Service Plan, Inc., Vision Services Plan, inc., Oklahoma, Vision Service Plan of Illinois, NFP, Massachusetts Vision SeNce Plan, Inc., Vision SeNce Plan (OH), Vision Service Plan Insurance Company (Cl), Eastern Vision Service Plan IPA, Inc., Vision Service Plan Insurance Company (MO), VSP Holding Company, Inc., Marchon Eyewear, Inc., March:Jn lntemational Ltd., Marchon BRL Ltd., Alaska Vision Ser.ices, Inc., Indiana Vision Ser-..ices, Inc., Mid-Atlantic Vision Service Plan, Inc. 0/A), Southwest Vision Service Plan, Inc., Vision Service Plan (HI), Vision Service Plan 0NA), Vision Service Plan of Idaho, .,c., Vision Service Plan of Wyoming, Wisconsin Vision Service Plan, Inc., Marchon France SAS, Marchon Hispana S.L., SXHoldings, LLC, VSP Optical Group, Inc., Plexus Optix, Inc., VSP Labs, Inc., VSP Ceres, Inc., Eyeconic, Inc., VSP Global, Inc., Optical Opportunities, Eyefinity Europe, Eyefinity France and Dragon
The method of allocation among companies is subject to a written agreement, appro\.ed by the Board of Directors, whereby allocation is made primarily on a separate retum basis.
26.4
Slalementaso1Dacomber31,2013ofthe Mid~Atlantic Vision Service Plan, Inc.
10.
11.
12.
13.
14.
15.
16.
17.
18.
NOTES TO FINANCIAL STATEMENTS
Information Concerning Parent Subsidiaries and Affiliates A. The Company is a wholly owned subsidiary of Vision Service Plan (a California non-profit corporation). B. No assets have been transferred to or from the Company to a related party. C. The Company incurred expenses during 2013 and 2012 of approximately $9,978,000 and $8,589,000 respectively
-for such services. D. Amounts due to Vision Service Plan as of December 31, 2013 and December 31, 2012 are $1,298,311 and
$1 ,099,884, respectively. E. There are no guarantees or undertakings in place between the Company and any related party. F. Vision Service Plan provides the Company with data processing, employee related services and other administrative
services for an agreed upon fee under the Administrative and Marketing Agreement. G. Not applicable. H. Not applicable. I. Not applicable. J. Not applicable. K. Not applicable. L. Not applicable.
Debt The Company entered into a promissory note on March 29, 2011 with parent, Vision Service Plan. The $15,000,000 note receivable maturing in March 2016 requires Vision Service Plan to pay the Company sixty equal monthly installments of principal and interest commencing in April 2011, The interest rate _is 4.5%.
Retirement Plans Deferred Compensation Postempi~Nm~nt l?_~nefits an_d Compensat(_}d Absences and other Postretirement Benefit Plans The Company has no retirement plans, deferred compensation, postemployment benefits or compensated balances and postretirement benefit plans.
Capital and Surolus Shareholders' Dividend Restrictions and Ouasi-Reoraanizations (1) Not applicable. (2) Not applicable.
-(3) -Notapplicablec-(4) The Company declared an ordinary distlbution in the amount of $10 million to its parent company, Vision Service
Plan (California) on October 1, 2013. The distribution was paid on November 8, 2013. (5) Not applicable. (6) Not applicable. (7) Not applicable. (8) Not applicable. (9) Not applicable. (1 0) The portion of unassigned funds (surplus) represented or reduced for cumulative unrealized gains and losses is
$3,119,533. (11) The Company has no surplus notes at December 31, 2013. (12) Not applicable. (13) Not applicable.
Contingencies The Company has no contingencies to disclose.
Leases -The Company has no leases.
Information about Financial Instruments with Off-Balance Sheet Risk and Financial Instruments with Concentrations of Credit Risk The Company has no financial instruments.
Sale Transfer and Servicing of Financial Assets and Extinguishments of I labilities Including Wash Sales The Company does not sell, transfer or service financial instruments or extinguishments of liabilities. The Company has no wash sales.
Gain or Loss to the Insurer from Uninsured Plans and the Uninsured Portion of Partially Insured Plans
The gain from operations from Administrative Services Only (ASO) uninsured plans was as follows:
a. Net reimbursement for administrative expenses (including administrative fees) in excess of actual expenses
b. Total net other income or expenses (including interest paid to or received from plans)
c. Net gain from operations d. Total claim payment volume
*The Company has no partially insured plans.
$ 3,198,770 $ 3,460,409
$( 2,8t5,350) $ (2,926,457) $ 383,420 $ 533,952 $ 166,556 $ 185,523
19. Djrect Premium Written/Produced by Managing General AgentsiThird Party Administrators The Company has no premiums written by managing general agents or third party administrators.
26.5
statementasofDecember31,20t3ol1ha Mid~Atlantic Vision Service Plan, Inc.
NOTES TO FINANCIAL STATEMENTS
20. F§lr Value Measurements
(1) Fair Value Measurements at Reporting Level 1 Level2 Level3 Total Date Preferred stock
Industrial and Miscellaneous (Unaffiliated) $ 51 38~ $ 51 389 Total preferred stock $ 51 389 $ 51 389
Common stock Industrial and Miscellaneous (Unaffiliated) $12,937,359 Ji. $ $12,937,359 Investment in Affiliate $28,741,086 $28 741 086 Total common stock $ 12 937 o!l9 $28 741 086 $41 678,445
Total assets at fair value ~ j2 937359 $ fij 389 ~21.! Z~J 086 $41,Z·~ 834
Total liabilities at fair value
Not Practicabl
Aggregate Admitted e T~ge of Financial Instrument Fair ValtJe Assets 1Level1\ (Level2l {Level.3) (Carrying
Value) Preferred stock $ 51,389 $ 51,389 $ $ 51,389 $ $ Bonds $23,379,456 $23,076,704 $ $23,076,704 $ $ Common Stock $41,678,445 $41,678,445 $12,937,359 $ $28,741,086 $
21. Other Items A. The Company has had no extraordinary events. B. The Company has no troubled debt restructuring. C. The Company has no other unusual items. D. Not applicable. E. The Company has no business interruption insurance recoveries. F. The Company has no state transferable tax credits. G. The Company has no sub prime mortgage related risk exposure. H. The Company has no retained asset accounts.
22. Events Subsequent~ Type I~ Recognized Subsequent Events: No events have occurred subsequent to the close of the books or accounts for this statement that may have a material effect on the financial condition of the Company.
Type II- Nonrecognized Subsequent Events: On January 1, 2014, the Company will be subject to an annual fee under section 9010 of the Affordable Care Act (ACA). This annual fee will be allocated to individual health insurers as defined in the guidance, based on the ratio of the amount of the entity's net premiums written during the preceding calendar year to the amount of health insurance for any U.S. health risk that is written during the preceding calendar year. A health insurance entity's portion of the annual fee becomes payable once the entity provides health insurance for any U.S. health risk for each calendar year beginning on or after January 1, 2014. As of December 31, 2013, the Company has written health insurance subject to the ACA assessment, expects to conduct health insurance business in 2014, and estimates their portion of the annual health Insurance industry fee to be payable on September 30, 2014 to be $843,750. This assessment is expected to impact risk based capital ratio by (1.2%).
23. Reinsurance The Company does not reinsure its business.
24. Retrospectively Rated Contracts & Contracts Subject to Redetermination The Company has no retrospectively rated contracts
26.6
statsmentasofDecernbsr31,2013ofUle Mid.,Atlantic Vision Service Plan, Inc.
NOTES TO FINANCIAL STATEMENTS
25. Change in Incurred Claims & Claim Adjustment Expenses
Activity In claims unpaid and related expenses Is summarized as follows:
2013 2012
BALANCE-January 1 $ 3 717 058 $ 3101173
Incurred related to: Current year 65,239,665 55,077,885 Prior years (393,947) (263 046)
Total incurred 64,845,718 54,814,839
Paid related to: Current year (61 ,033,036) (51,333,775) Prior years (3 364 682) (2 865 179)
Total paid (64,397718) (54,198 954)
BALANCE-December 31 $ 4 16!; Q58 ~ 3 71.I,058
26. Intercompany Pooling Arrangements The Company has no intercompany pooling arrangements.
27. Structured Settlements The Company has no structured settlements.
28. Health Care Receivables The Company-has h-ealtiT -care receivables.
29. Participating Policies The Company has no participating policies.
30. Premium Deficiency Reserves
1. Liability carried for pmmium deficiency reserves (1)
2. Date of the most recent evaluation of this liability 3. Was anticipated investment income utilized in the calculation?
$0 01/24/2014
Yes[] No[X]
31. Anticipated Salvage and Subrogation Salvage and subrogation are not applicable to the Company.
26.7
statementaso1December31,2013oflhe Mid~Atlantic Vision Service Plan, Inc.
GENERAL INTERROGATORIES PART 1 ·COMMON INTERROGATORIES· GENERAL
1.1 Is the reporting entity a member of an lnsllrance Holding Company System CO/lslsllng of two or more affillafed persoriS, one or more of which Is an lnsurel1 If yes, complete Schedule Y, Parts 1, 1Aand 2.
1.2 If yes, did the reporting entity register and file with Jts domiciliary State Insurance Commissbner, 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 Slli:lject to stalldards and disclosure requirements substanUally similar to those required by such Act and regulations? Yes[X]
1.3 State regulaling? cV~i~m~'''------,-----c----cc-c-----------------2.1 Has any change lleen made during the year of this statement in the charter, by·laws, articles of Incorporation, or deed of setttament of the
reporting entity? 2.2 tfyes, date of change:
3.1 State as of what date the latest financial examination of the reporting entity was made or Is being made. 3.2 State the as of date that the latest financial examination report became a~ailable 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 tile report was completOO or released.
3.3 State as of what dale the latest financial examination report became ava~able lo olher slates or lhe public from ellherlhe state of domicile or the
reporting en1i1y. This Is lhe release date or completion date of !he examination report and not the date of the examination (balance sheet date). 3.4 By what department or departments?
Vi inla Bureau of Insurance
3.5 Ha~e all financial statement adjustments within the latest financial examination report been accounted for In a sullsequent financial statement filed with departments? Yes [
3.6 Ha~e all of the recommendations within the latest financial examination report been complied with? Yes [
4.1 During the period covered by this statemenl, did any agent, broker, sales representatlve, non-affiliated sales/service organization or any combination thereof under common control (other than salaried employees of the reporling entity) receii'B credit or commissions lor or control a substantial
part (more than 2(1 percent of any major line 61 business measurOO on direct premiums) of:
4.11 sales of new business?
4.12 renewals?
4.2 During the period covered by this statement, dkl any sales/servlce organization owned In l'ttlole or In part by the reporting entity or an affiliate, receive credit or commissions foror control a substantial part (more than 20 percent of any major l!ne of business measured on direct premiums) of: 4.21 sales of new business?
4.22 renewals? 5.1 Has the reporting en!lty been a party to a mei'{Jer or consolklation during the period covered by lhis sta1ement7
5.2 If yes, provide the name of the entity, NAIC company code, and slale of domicile (use lwo letter slale abbreviation) for any entity that has ceased to exist as a result of the mer er or consolidation.
Nomo of En til
6.1 Has the reporting entity had any Certificates of Authority, licenses or registrations (including corporate registration, If applicable) suspended
or revoked by any go~ernmer~tal entity during the reporting period? 6.2 If yes, give full Information:
7.1 Does any foreign (non-United States) person or entity directly or lndirecUyconlrol10% or more of the reporting entity? 7.2 lfyes,
7.21 State the percentage of foreign control 7.22 State the nationality(ies) of the foreign person(s) or entity(ies); orlfthe entity Is 11 mutual or reciprocal,
the nationality of its manager or attorney-In-fact and ldentlfy the type of entltyOes) (e.g., lndi~idual,
cor oration, overnment,mana erora!torne ln-facl
1 Natlonali
B.1 Is the company a subsidiary of a bank holding company regulaled by the Federal Reserve Board? B.2 If response to B.11s yes, please klentify the name of the bank holding company.
B.3 Is the company affiliated with one or more banks, thrifls or securities finns?
B.4 If response to B.31s yes, please provide the names and locations (city and state of the main olfice)of any affiliates regulated by a federal
financial regulatory services agency [i.e. the Federal Reserve Board (FREI), the Office of the Comptroller of the Currency (OCC), the Federal Deposit Insurance CorPoration (FDIC) and the Securities ExchanQe Commission (SEC)] anclldentlfv the affiliate's rimarvfederal re ulator
I Afflliat~ Name I Location {~ity, State) I F~B I ~C F~IC I 9. What Is the name and address of the lndepelldent certified publiC accountant or accounlingfirm reta1ned to conduct the annual audit?
Deloille & Touche 555 Mission Street Sen Francisco CA 94105
10.1 Has the Insurer been granted any exemptions to the prohibited noll-audit services provided by the cerlifled ifldependent public accountant requirements as allowed in Section 7H oflhe Annual Financial Reporting Model Regulation {Model Audit Rule), or substantially similar state law or regulation?
10.2 If the response !o 10.1 is yes, provide infonnation related to this exemption:
10.3 Has the Insurer been granted any exemptions related !o the other requirements of the Annual Financial ReporiTng Model Regulation as allowed for In Section 17Aof lhe Model Regulation, or substantially similar state law or regulation?
10.4 If the response to 10.3ls yes, pro~lde lnforma~on related to this exemptlon:
27
SEC I
Yes[X] No[ ]
No[ ] N/A[ ]
Yes [ No[X]
12/31/2012
12/31/2012
(11/09/2014
No I N!A [X] No I NJA lXI
Yes [ No[X]
Yes [ No[XI
Yes [ No[XI Yes [ No[XI Yes [ No[XI
Yes[ I No[X]
Yes[ No[X)
""""'"""""""%
Yes[ I No[X)
Yes[ I No[X]
Yes[ ) No[XI
Yes[ I NoiXI
statamentasorDeoomOOr31,2013ofthe Mid~Atlantic Vision Service Plan, Inc.
GENERAL INTERROGATORIES PART 1 ·COMMON INTERROGATORIES· GENERAL
10.5 Ha$ the reporting entity esl<lblished an Audil Committee In oompliancewlth the domlclliafl' slate Insurance laws? 10.5 If the answer to 10.5 is no or nla, please explain.
11. Whallsthe name, address and affiliation (officer/employee of the repor~ng entity or actuarJ/consultantassociated with an actuarial consulting firm) of the Individual providing the slatement of actuarial oplnlonloorlification? Frederick W. Kilbl)urne 15677-G Avenida Alcacllola. San Diego. CA 9212.8
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 eslate holding company
12.12 Number of parcels involved 12.13 Tolal book/adjl)sled carrying value
12.2 If yes, provide explanatil)n.
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 Slales trustees of tho reporting entity?
13.2 Does lhis statement cqnlaln aiJ bl.,!slness tran~cte<l fur the reporting entity thro~gh Its United States Br[!nch on rlsk.s wherever located? 13.3 Have !here been any changes maMto any of the trust Indentures during tho year? 13.4 If answer to .(13.~) ls y~s, bas !he domiciliary 9! entry_~ta!(l approved the_ ch~nges?
Yos [X)
Yes[ I 14,1 Are the senior officers (principal executive officer, principal financial officer, principal accou~ting officer or controller, or persons performing similar functions)
No[ I NIA[ I
Yes[ ] No(X]
Y~l
Y~l
No{
N!!l I No[ I
N/A[ J.
of the reporting entlty subject to a code of etllk:s, which Includes the following standards? Yes [X] No [ a. Honest and ethical conduct, inducting tile ethical handling of actual or apparent cooHicls of interest between personal and professional relationships; b. Full, lair, aoourate, timely and understandable disclosure In the periodic reports required to be filed by the reporting entity;
o. C<lmpliance with llPPllcable governmental laws, rules and regulations; d. The prompt In lerna I repl)rting of violations to an appropriate person or persons ldentllle<lln !he code; and
e. Accountability for adherence to the code 14.11 11tfie-resPOn50lo-14.11s no~ please-9Xriiiilii: -
14.2 Has the code of ethics for senior managers been amended? 14.2.1 lithe response to 14.2 is yes, provide Jnform;~tion related to amendment(s).
14.3 Have any provlsloos ollhe codu of ethics been waived for any of the specified officers? 14.31 If the response to 14.3 rs yes, provide the nature or anywarver(s).
15.1 Is tile reporting entity !he beneficiary of a Letter of Credit that is unrelated to reinsumnce where the issuing or confirming bank Is not on the SVO Bank List?
15.2 lithe response to 15. lis yes, Indicate the American Bankers Association (ABA) Routing NJmber and the name of the Issuing or confirming bank of the Letter of Credit and describe the circumstances In which the Letter of Credit Is trlooe-ed.
1 2 3 American Bankers Association (ABA) Issuing or Confirming Circumstances That Can Trigger Routino Number Bank Name the leiter of Credit
PART 1 ·COMMON INTERROGATORIES· BOARD OF DIRECTORS 16. Is the purchase 0( sale of all investments of the reporting entity passed upon either by the Board of Directors or a subordinate 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 fordisdosllfe to its Board of Directors or trustees of any material interest or affiliation
on the part of any of its officers, directors, lruslees or responsible employees that Is In co1flicl or Is likely to confilct with the official duties of such person?
PART 1· COMMON INTERROGATORIES· FINANCIAL 19. Has this statement been prepared using a basis of aoommting other than Statutory Accounling Principles (e.g., Generally Aooepted Accounting Principles)? 20.1 Total amount loaned during lhe year (illclusive of Separate Accounts, exclusive of policy loans):
20.11 To directors or other office I"$
20.12 To stockholders not officers 20.13 Trustees, supreme or grand (Fraternal only)
2.0.2 Total amount of loans outstanding at the end of year Oncluslve of Separate Aooounts, ex~lusiv<1 of policy loans): 20.21 To directors or other officers 20.22 To stockholders not officers 20.23 Trustees, supreme or grand (Fraternal only)
21.1 Were any assets reported in this statement subject to a contractual obllgatlot'l to transfer to another party without lhe liability for such obligation being reported In the statement?
21.2 If yes, state the amount thereof 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
27.1
Yes[ I No[X]
Yes[ ] No[X]
Yes[ I No[X]
4
Amount
Yes!X] No! Yes[X] No [
Yes[X] No[ I
Yes! No IX]
$. ....... 0 $ ... . .... 0 $. .. ..... 0
$ .... "'""""""""""0 $ .... "" 0 $. .. ..... 0
Yes [ No[X]
statementasoroer.:embar31,2013orlhe Mid-Atlantic Vision Service Plan, Inc. PART 1 ·COMMON INTERROGATORIES· FINANCIAL
22.1 Does this statement Include payments for assessments as described In the Annual Statement Instructions other than guaranty fund or guaranty assoclalion 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
PART 1 ·COMMON INTERROGATORIES· INVESTMENT 24.01 Were all the 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 refKJrling entity on said dale (other than securities lending programs addressed in 24.03)? 24.02 If no, give lull and complete information relating thereto.
24.03 Fm security tending programs, provide a description of the program induding value for oollaleraland amount of loaned securities, and whether collateral is carlied on or off-balance sheet (an allemative is to reference Note 17 where this lnfamaUon Is also provlded).
24.04 Does the company's SOO.Jrlty lending program meet the requirements for a oonforming program as outlined in the Risk-Basad Capital Instructions?
24.05 If answer to 24.041s yes, report amount of collateral for conforming programs. 24.00 If answer to 24.041s no, report amount of ootlateral for other programs. 24.07 Does your securities !eliding program require 102% (domestic securities) and 105% (foreign sewrities}from the counterparty at the
outset of the GOillract? 24.08 Does tl1e reporting entity non·admll wten the cotlaleralreceived from the counlerparty falls below 100%? 24.09 Does lhe ref'Orling enuty or the reporting enlily's securities lending agent utilize the Master Securities Lending Agreement (MSLA)
to conduct securities landing? 24.10 For the reporting entity's security lending program, slate the amount of the following as of December 31 of the current year:
24.101 Total fair value of reinvested cottateral assets refKlrled on Sclledule DL, Parts 1 and 2. 24.102 Total book adjusted/carrying value of reinvested cotlaleral assets reported on Schedule DL, Parts 1 and 2. 24.103 Total payable for securities lending re~XJrled on the liability page.
25.1 Were any of the stocks, bollds or other assets of the reporting enllly owned at December 31 of lhe current year ootexctuslvely under the oonlrol of the reporting entity or has the reporting entity sold or transferred any assets subject to a put option contract that is wrrently 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 Pledged as collateral 25.26 Place<l under option agreements 25.27 Letter stock or securities res!rtcted as to sale 25.28 On deposit with stale or other regulatory blldy 25.29 Other
26.1 Does the reporting entity l'lave any heclglng transactions reported on Schedule DB?
Descrl tlon
26.2 If yes, has a comprehensive descriplion afthe hedging program boon made ava~1able to !he domiciliary stale? If no, atlach a desCfiptlon with this statement.
27.1 Were sny preferred stocks or bonds owned as of December31 of the current year mandatorilyronvertlble Into equity, or, at the opUonof the Issuer, coovcrtible Into equity?
27.2 If yes, state the amount theree>f at Decomber 31 of the current year; 28. Excluding Items in Schedule E-Pm\3-Special Deposlts, real estate, mortgage loans a lid Investments held physically In the reporting enlily's offices,
vaults or safoty 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 trustoompany in acrordance with Section 1, Ill- General Examination Conslderatlons, F. OUtsourcing of Critical Functions Custodial or Safekeeping Agreoments of the NAIC Financial Condition Examloors Handbook?
26.01 For agree1nenls that comply with the requirements of the NAIC Financial Condition Examiners Handbook, complete the following:
1 ' Name o!Custodianlsl Custodian's Address
CiU roo Global Markets inc Smith Berne 2380 E. Bidwell Sl. Folsom, CA 95630 Wells Far oAdvisors, LLC 62(1 Coolid Drive Suite 300 Folsom, CA 95630 Wells Fa lnslilutio!lEII Securities, LLC 400 Ca ilol Mall Sacramento, CA 65614
26,(12 For all agreements lhal do not comply with the rcQUIIements of \he NAIC Financial Cond1lton Emmmers Halldbook, provide the
name location and a com lela ex Ia nation:
Names Locations
28.03 Have there been any changes, lnduding name changes, In lhecustodian(s) Identified In 28.01 Wring lhe current year?
26.04 If s, iva lull and com lela information relalin thereto:
ad custodian New Custodian
28.05 Identify all Investment advisors, brokBrs/daalers or Individuals acting on belmlf of broker/dealers that have access to the Investment
aocounls, handle securities and have author! to make lnveslmenls on behalf of there ortln enlll :
1 Cenlral Re istralion De osito Numbe s Name
Yes[ I
Yes[ Yes[
Yes [
Yes[ No[XI
Yes[ No[XI
Yes[ I No[X]
No[ N/A[X]
No[ NJA[XI No[ NJA[XJ
No[ NIA[XJ
Yes[ I No[XJ
Yes [ Yes[ I th[
No[XJ NIA[ I
Yes[X] No[ I $....... . ..... 0
Yes[ I No[XI
Com tete Ex lanalion s
Yes[ I No[X]
Address CRD# 7059 Clti roll Global Markets Inc Smtih Barna 2380 E. Bidwell St. Folsom, CA 95630
29.1 Does the reporting entity have any diversified mutual funds re~XJrled In ScheduleD-Part 2 (diversified according to the Securities and
Exclmnge Commission (SEC) In the Investment Company Act of 1940 [SecUon 5 (b) (1)])?
27.2
Yes[ ] No[XI
statementasot0€cembsr31,20t3oflhe MidbAtlantic Vision Service Plan, Inc. PART 1- COMMON INTERROGATORIES -INVESTMENT
29.2 If n yes, complete the following schedu e:
1 2 3 ·-Book/Adjusted
CUSIPII Name of Mutual Fund Ca~ryln[l Value
29.2999. TOTAL 0 29.3 For eactl mutual lund listed in the table above, complete the followi sclledute:
1 2 3
Amount of Mutual Fund's BooWAdjusted
Name of Mutusl Fund Name of Si[lniHcanl Holding Carrying Value !from the above tablel ofthe Mutual Fund AllriOOtable to Holdin
30. Provide the following Information for all short-term and long-term bonds and all orelerred slodffi. Do oo\ subslitute amorlized value or statement value fur lair value. 1 2 3
Statemelll (Admilled) Fair
Value Value
30.1 Bortds ........ 31,206,072 ........... 31,508,823
Exa:ss of Statomelll over Fair Value H. or Fair Value over
Statement(+) .302,761
30.2 Prelerrodstocks. .. ....... 51389 ............. 51,389 .................... 0
'-""~·3'--'T~o-~1·~··~·~· ~ .... ~··~···~···~···~···="""======='==···~ .. ··~···~31~,2~5~7,4~6~1""'="-· .31,560,212 ....... ' ......... 302,761 30.4 Describe the sources or methods ullllzed Ill delennlninglh~ la1r values:
Thlrfalr values wertnlblaineCHroiirMcGr!iwHill : S&P PrlclngiQ;-a)l~clmrs-elVIOO;trfl'OilTotJrntrolilible iil~epeiitlenf Soura:s Wfieri.iioi available frrirri S&P Prlcln IQ.
31.1 Was tho rate used to calculate lair value deltlnninOO by a broker()[ custodian fur any of the =rities In Sch.edule D? 31.2 If the answer to 31.1 Is yas, doos the reporUng entity have a oopy of the broker's or custodians pricing policy (tlard copy or electronic copy) lor all
brokers or custodians used as a prlcil19 source? 31.3 If the answer lo 31.21s no, describe the reporting entity's process fur determinin[l a reliable pricing source for purpDlles of disclosure ol lair value fur Schedule D.
4
Dale of Valuation
Yes[X] No[
Yes{X] No[
_ _32. 1 _j-IJ!IIll <1.Rihe fllioo re.quiremenls of the ~urposes.and Procedures Manual of lhe NAIC Securilies_Valualion Office been followed? -32.2 If no, list exceptions:
------- --- Yes]X]-- No [·-I
PART 1 -COMMON INTERROGATORIES- OTHER 33.1 Amount of payments to trade associaUons, service organizations and statistical (l( rating bureaus, if any? 33.2 List the name of theorganlza11on and the amount paid if any such payment represented 25% or more of Ure total payments to
34.1 34.2
trade associations, service o anlzaUons and staUstl~;al or rati bureaus durin the erlod oo;erecl b this sta\emelll
$ .....
~;;;;;;;;;;;;;=.;;;;;;;;;;;;=.;;;;;;;~N~,m~'~;;;;;;=;;;;;;;;;;;;;;;=;;;;;;;~===±============j 35.1 Amoullt of payments fur expenditures ill connecUon wllh matters before legislative bodies, offiCers(){ departmll:nls of gO'Iernment, ff any? $ ... 35.2 List the rn~me of tile flrm and the amount paid 11 any such paymentrejlfesenled 25% or more ~I the total paymelll expenditures
in connection with matters before Je lslatil'e OOdles officers or de rtments of ernment durin the ~od covered b this statement.
NONE
27.3
..... ,()
........ 0
. ......... 0
statementasorDooomber31,2013oflhe Mid~Atlantic Vision Service Plan, Inc.
GENERAL INTERROGATORIES PART 2 ·HEALTH INTERROGATORIES
1.1 Does the reporting erJtlty have any direct Medicare Supplement Insurance in force?
1.2 If yes, Indicate premium earned on U.S. business only
1.3 What porUon of llem (1.2) is not reported on the Medicare Supplement Insurance ExperienC€ Exhibit? 1.31 Reason for excluding
1.4 Indicate amount of earned premium attributable to Canadian and/or Other Alien not Included In Item {1.2) above. 1.5 Indicate total incurred claims on all Medicare Supplement insurance.
1.6 Individual policies: Most current three years: 1.61 Total premium earned 1.62 T olallncurred claims 1.63 Number of covered lives All years prior to most current three years: 1.64 Total premium earned 1.65 Total incurred claims 1.66 Number of covered lives
1.7 Group policies: Most current three years: 1.71 Total premium earned 1.72 Total incurred claims 1.73 Numberofcoveredlives All years prior to most current three years: 1.74 rotal premium earned 1.75 Total incurred claims 1.76 Number of covered lives
2. Health test:
21 Premium Numerator. 2.2 Premium Denominator. 2.3 Premium Rallo (2.1/2.2) ..... 2.4 Reserve Numerator. 2.5 Reserve Denominator .. . 2.6 Reserve Rallo (2.412.5) ... .
Current Year ......... 78,515 942 . ......... 78 515 942
.. ..... 100.0 ........ .4108 384 ....... .4108,384
.. ..... 100.0
3.1 Has the reporting entity received any endowment or gift from contracting hospitals, physicians, dentists, or others that is agreed will be returned when, and If the earnings of \he reporting entity permits?
3.2 If yes, give partiG~.dars·
4.1 Have copies of all agre€ments slating the period a~d nature of hospitals', physicians', and d€nUsts' care offflred to subsCiibers and dependents been filed with the appropriate regulatory agency?
4.2 If not previously flied, furnish herewith a copy(ies) of such agreement(s). Do these agreements Include additional benefits offflred?
5.1 Does the reporting entity have s!op"loSS relnsuranC€?
5.2 If no, explain: The Company solely provides prepaid vision coverage. The largest aggregate amount insured In any one risk is $200
5.3 Maximum retained risk (see Instructions): 5.31 Comprehensive medical 5.32 Medical only 5.33 Medicare supplement 5.34 Dental and vision 5.35 Other limited benefit plan 5.36 Other
PriorY ear ...... ~.65 B40 939
....... 65 840 939 ........ 100.0
. " ........ 6 532 1l93 ................ 6 532 993
. .. , "'"""""""""'""1~0.0
6. Describe arrangement whiollthe reporting entity may have to protect subscribers and their dependents against the risk of insolvency Including hold harmless provisions, conversion privileges with other carriers, agreements with providers to continua rendering services, and any other agreements:
Yes [
Yes [ ]
Yes [XI Yes [ I Yes[ I
$ ..... $. $ $. $ ...
No[XI
No[XI
No[ I No[X]
No[XI
.. .... 0 .. ........ 0 .......... 0
...... 200 .. .. 0
$. """"""""""""" ....... 0
The Company's agreements wlth Its Member Doctors prohibits them from seekioo payment (except for copayment If any) from or bringing any legal action against the Companys subsCiibers or their dependents for tile Company's covered serviC€s. The Company maintains other arrangements of this type to the extent rooulred by law.
7.1 Does the reporting entity set up l!s claim llaiJi\ityfor provider services on a service date IJasis? Yes [X I No [ I
7.2 If no, give details:
8, Provide the following Information regarding participating providers: 8.1 Number of providers at start of repor~ng year
8.2 NumiJer of providers at end of reporting year
9.1 Does the reporting entity have business subject to premium rate guarantees? 9.2 If yes, direct premium earned:
9.21 Business with rate guarantees IJetween 15-35 months 9.22 Business with rate guarantees over 36 months
10.1 Does the reporting entity have Incentive Pool, Withhold or Bonus arrangements In Its provider contracts? 10.2 lfyes:
10.21 Maximum amount payable bonuses
10.22 Amount actually paid for year bonuses 10.23 Maximum amount payable withholds
10.24 Amount actually paid for year withholds
28
............ 1,041 ..................... 1,106
Yes[ No[XI
Yes [ No[X]
Slatemelltasof[ffl{:ember31,2013oflfle Mid-Atlantic Vision Service Plan, Inc.
GENERAL INTERROGATORIES PART 2 ·HEALTH INTERROGATORIES
11.1. Is the reporting entity organlz.ed as:
11.12 A Medical Group/Staff Model,
11.13 An Individual Practice Association (IPA), or 11.14 A Mixed Model (combination of above)?
11.2. Is the reporU119 entity subject to Minimum Net Worth Requlremenls?
11.3. If yes, show the name of the state requir"1ng such net worth. ~~~' ill;"lli'''------------------------11.4. If yes, show the amount required. 11.5. Is !his amount included as part of a contingency reserve in stockholder's eqully?
11.6. If the amount Is calculated, show the calculation $64,040.124 (claims Incurred\ plus $808 799 (claims adjustment expense) and $8,135.462 (general administrative expenses) divided by 365 davs then multiplied by 45 davs.
12. List service areas In which reportin entil is licensed to opemte:
Vir inla Ma land Washln ton
1 Name of Service Area
13.1. DQyou act as a custodian for health savings account? 13.2. If yes, please provide the amount of custodial funds held as of the reporting date. 13.3. Db you_act as an oclm\nlstratorfor health savings acmunts? 13.4. If yes, please provide the balance oflhe funds administered as of the reporting date.
28.1
Yes[ No[XJ Yes [ No[X) Yes[ No[X] Yes[X] No I I
$ ........ .... 8,998,075
Yes [ I No[X]
Yes[ No[X]
Yes[ No[X)
statementasofDecember31,2tlt3oflhe Mid~Atlantic Vision Service Plan, Inc.
FIVE-YEAR HISTORICAL DATA
Balance Sheet Items (Pages 2 and 3}
1. Total admlllad assets (Page 2, Line 28).
2. Tolaf IIW'diUes {Page 3, Line 24 ) ...
3. Statutorysurplus ........ .
4. Total capital and surplus (Page 3, Line 33)
Income Statement Items (Pa[le 4)
5. Total revenues (Una 8).
5. Total medical and hospital expenses (Line 18) ................................ .
7. Claims adjustment expenses (Line 20).
8. Total administratlll€ expenses (Line 21)
9. Net underwriting gain (loss) (Line 24)
10. Net Investment gain (loss) (Line 27).
11. Total other income (Lines 28 plus 29).
12. Net income or (loss) (Line 32)
Cash Flow (Page 6)
13. Net cash from operations (Line 11).,, ................................................... .
Risk·Based Capital Analysis
14. Total adjusted capital.
15. Authorlzsd control level risk-based capital ........................ ..
Enrollment (Exhibit 1)
16. Total members at end of period (Column 6, Line 7) ............................... ..
17. Total member months (Column 6, Line 7) ..................................... ..
Operating Percentage (Page 4) (Item divided by Page 4, sum of Lines 2, 3, and 5) x 100 .0
18. Premiums earned plus (lsk revenue (Line 2 plus Lines 3 and 5) .....
19. Total hospital and mediGal plus other non-health (Line 18 plus Line 19) ...
20. Cost contaimnentexpenses ........ .
21. Other claims adjustment expenses ......
22. Total underwriting deducUons {Line 23) ......
23. Total uru:Jerwriling gain (loss) (Line 24) ..
Unpaid Claims Analysis (U&I Exhibit, Part 28)
24. Total claims incurred lor prior years (line 13 Col. 5) ............................ ..
25. Eslimated liability of unpaid claims- (prior year (Line 13, Col. 6)]
investments in Parent, Subsidiaries and Afllllates
26. Affiliated bonds (Sch. 0 Summary, Line 12, Col. 1) ...
27. Affiliated preferred stocks (Sch D. Summary, line 18, Col. 1) ...
28. Affiliated common stocks (Sch D. Summary, Line 24, Col. 1).
29. Affiliated short-term Investments (subtotal included In Sch. DA,
Verification, Column 5, Line 10) ...
30. Affiliated mortgage loans on real estate
31. All other affiliated .......
32. Totalolabo¥elines26to31
1 2013
2 2012
3 2011
........ .77,865,541 .............. 80,56£,377 ............... 66,083,331
........... 7,160,001
........... 8,998,075
...... 11,246,915 ............... 14,782,006
......... 7,572,348 ................. 6,340,309
4 2010
..£7,235,912
5 2009
.73,141,934
...13,037,059 ............... 16,761,028
.. .. 6,022,7£0 ... 5,567,526
........ 70,705,540 ............... 69,320,461 .... 51,301,325 ............... 54,198,853 ............ 56,380,906
....... 81,244,914 .......... 68,117,598 ............... 68,126,588 .. ..... 56,107,442 ............... 52,750,737
..... 64,040,124 ............... 54,292,245 ............ .45,804,194 .............. .43,550,604 . .. .41,162,048
..... 808,799
.......... 8,136,463
.......... 8,260,528
........... 1,669,503
"""'"" .... (2,369)
.... 8,178,540
...... 4,978,027
......... 70,705,540
......... 2,465,585
........... 1,167,496
......... 13,871,246
. ................. 100.0
................... .81.5
....... 843,181 .................... 421,983 . ... 397,632 .................... 328,884
........ 5,200,777 ....... ..4,903,036 ................. 3,524,462 .... 6,484,727
.... 4,494,916 ........ 6,575,463 ................. 7,904,139 ............... 6,764,688
................ 1,388,317 ................. 1,863,732 .1,266,042 .. ................... 26,347
.. .. (1,175) ...................... (3,912) ........ (1,729) ...... {2,136)
............... 10,462,316 ............. 5,647,038 ................. 6,916,250 ......... 4,172,287
. ................ 6,401,250 .. .............. 7,056,482 ................. 4,174,722 ................. 7,201,973
.............. 69,320,461 ............... 51,301,325 ..... .54,198,853 ......... .56,360,906
.. .... ' ....... 2,041,663 ................. 1,725,639 .............. 1,637,647 ................ .2,323,632
... 1,078,317 .................. 870,308 ........... 876,927 ......... 857,041
.. ............ '11,768,371 .. ............. 1 0,515,259 ....... 10,534,673 ..... 9,993,836
..... 100.0 ................. 100.0 .................. 100.0 ........................ 100.0
.... .82.5 ................ ' .... .B1.7 . ....... .BO.B ......................... 80.8
.. ........ 1.0 ...... .... . ......... 1.0 ........................ 0.8 ... 0.7 "" .. 0.8
........ 90.2 ..... 92.8 .. ..... 96.7 ........................ 92.0 .......................... 89.2
... 10.5 ............................ 6.8 .. 11.7 .......................... 14.6
......... 3,323,111 ................. 2,838,127 ................. 2,668,599 .. .. 2,340,610
.......... 3,670,333 .... 3,065,318 ............... 2,589,001 ................. 2,498,030
.. ...... 28,741,006
.. ............. ..13.3
.. 1,879,857
' .2,035,674
..... 28 741 086 ......................... ,0 .............................. 0 ... 0 ............................. 0
33. Total investment in oarent Included in Lines 26 to 31 abo¥e .. ................... .... .... ..... .. ........................ .. NOTE. If a party to a merger, have the two most recent years of this exhibit been restated due to a merger In compliance w1th the disclosure
requirements ofSSAP No.3, Accounting Changes and Correcllon of Errors? If no, please explain:
29
Yes( No [ ]
' "
Stltementaso1Decemberst,20t3oflhe Mid-Atlantic Vision Service Plan, Inc.
NAIC Group Code ..... 1189
Total Members at end of:
1. Prior year ······--···.
I 111m 1m 1111111111 ~111111111111 UIIIIIIIIIIIIIIIDIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIW 1111 II ><53031201343059100"
EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) REPORT FOR: 1. CORPORATION ..... Mid-Atlantic Vision Service Plan! Inc. 2. Ric~in. ond, VA
BUSINESS IN THE STATE OF GRAND TOTAL DURING THE YEAR ! I
I Com thensive Host~~al & M~dii':iil 4 r=;;-- I 6 -~:
Vision 1 Dental Total I lncfrvKlual Grou _ Onl . Onl
1,078,317 ···········!···················· 1,078,317
Federal Employees Health
Benefits Plan
(Location)
Ti~eXVIII Medicare
NAIC Company Code ..... 53031 g
T:tle XIX Medicaid
10
Other
2. Rrst quarter ........ . . ... 1,124,594 ... 1,12.4,594 '
l l
......... ·················I ·I···· . ····························I
3. Second quarter .......... .. 1,174,046
4. Third quarter ... ......................................... 1,162,051
5. Currentvear. .. __ ....................... .. ...1,15?:.496
6. Curre~r member months .............. "'"" ............................. ! .. _ .............. 13,871.246
. ... 1,1]4,646
...~.1~,051
.1.157.495 I
........ 13,871.246
1:1·- -1········ Total Member Ambulatory Entt~unters for Year:
WI 7. c:>
P~yslclan ................................................ ..
8. Non-physician ...
9. Totals ...................................... . :;: i=::::::=::l~-=~==:l=:===:l::::i:I::::::_::E!====i == ==!= ===!====! ...0 .... 0 .0
1 10. Hospital patient days incurred... . ............ .
11. Number of inpatient admissions ......
12. Health premiums wn1ten (b) ...
13. Life premiums direct ....
14. Property/casualty premiums written .... ~ ...
15. Health premiums earned ................ ; ............................... .
16. Pro~casualtv premiums earned ............................ .
17. Amount paid for provision of heaHh care services ....... .
18. Amount incurred for provision of health care services ........ .
..0
.. o ............. ............. ................. ... .............................. .............. .......... I
I I
.78~~-~-~~~-~~ :::::::~:::~::: .. :::::::::_::~~ .. :: :::::::::::::::~:~ .. ~::::~:::: .. ::: :~~:: ........... ~.... .. ................. _ ... 78,5j5,942 ................ :::~:::[:: ...
: I I ............. o .......... .......... · ...................................................... 1 ........................... : ......... :.1 ....... L ... ····· ································!·· .......... , ..................... . , I .78,515,942 ................................ ..... .................... - ........ ,_ ................................... 78,5~5,942 ............................ -.... .
... _ ......................... ~............... . .................................................. ~ ......................................... L ... . ......... .. .............. 0
.83,602,073
64,040,124
I .63,6~2.073
.64.040.124
(a) For health business: number ofperso~YS insured under PPO managed care prOOucts .......... O and number of persoi\S insured underindemniiy only products ........ .0. [b) For health premiums written: amount of Medir:are nle XV!II exempt from state taxes or fees $ .......... 0
sta!ementaso!December31.2D13ofthe Mid-Atlantic Vision Service Plan, Inc.
NAIC Group Code ..... 1189
Total Members at end of:
1. Prioryear ............................................................... .
2. Firstquarter ........................................ .
3. Second quarter .. .
4. Third quarter .. .
llllllllllllll~ 1111111111 ~IIIIIIIIDIIIIIIIIIIIIIIIIIIII~IIIIIIIIm IIIII II~ 1111111111111 * 5 3 0 3 1 2 0 1 3 4 3 0 2 1 1 0 0 *
EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) REPORT FOR: 1. CORPORATION ..... Mid-Atlantic Vision Service Plan, Inc. 2. Richmond, VA
BUSINESS IN THE STATE OF MARYLAND DURING THE YEAR
Comprehensive (Hospital & Medical 2 I 3
Total Individual Group
4
Medicars Suppleme1t
Vision oow
Dental Ooly
7 Federal
Employees Health Benefits Plan
[Locatkln)
WJeXVIII Medicare
NAIC Company Code ..... 53031 s I 10
TiUe XIX Medicaid I Other
...395',026 ................................. ..... ....................................... .............................. .. ...................... 395',026 .................................................................................................................. - ........................................... .
____ 415,5'03 ........................ 415',503 .............................................................. - ................................... _,,
..416,170 ..................................... ·- .............. . ..................... .416,1711 ......... ..
...406,713 ....................................... . ... .. .......... .. ...... ..406,713
5. Currentvear .......... . ....................... 402,696 ............................................................................................................................... .402,696 ................................................................................................................... - ............................... ! ..................................... ! 6. Current year member months.. ... .4.926.019 - ............................................................................................................................. 4,926.019
Total Member Ambulatory En~unters for Year:
~I 7. Physician ........................................................ ..
6. Non-physician.......... .. ..................... ..
9. Totals .............................................. .. :::~:::::: I ::::~ .. ::::::::~::: .. - ::::::::~-1 ::::::::~:::_ ::::::::::::::::::~-1 :::::::::::::::::::::::::.:::::::::~-1 :~ :::::::::::::~:::: ~::::~ 1 ...................................... 1 ...................................... 1 ...................................... 1 ...................................... 1 .......... .......................... 1
...0 ... 0 ... 0 ... 0 .... 0
10. Hosoital oatien! davs incurred ... ... 0
11. Number of inoatient admissions ... --'1--- ------1----- ----1- -------1- ...... -----1- -------1---- -----1- ........ ----1 ..................... .. 12. Health premiums written (b) ........................................................ , ....... . .. 25,910,261 ...25.910.261 1 ...................................... 1 ...................................... 1
13. Ufe premiums direct .................................................................. . .. .... 0 -- ·- ··················I ·····································I ····································I ··················I - ·······················I - - I I 14. Property/casualty premiums written ... ...0
::: ::a::~:~:; ::;i:~ ·:~~~~~ .. ·:................... . ........ ~--.. ~~:.1·~~-. ·-~-.-~~-·.·.·.·.·.·.·.-.~~-·-~-~-~.::~: 25,910,261 - ....................... ···-·-· ···················I I
17. Amount paid for provision of health care services ... ... 20.988.6841 ..................... +. . . 1 .. . ...... I ... 20.988.6841 ...................................... 1 ..................................... 1 ...................................... 1 ..................................... 1 ..................................... ! 18. Amount incurred for provision of health care services .. .21.133.241 .. .•. 21.133.241
[a) For hearen business: number of persons insured underPPO managed care produc~ ..... - .. 0 and number of persons insuret:l under indemnity only products ....... (b) For hear.h premiums wrilien: amount of Medicare Tr!le XVII! exempt from state taxes or fees $ .......... 0
' "
s~atementaso!Oecembers1,2013ottfle Mid~Atlantlc Vision Service Plan, Inc.
NAIC Group Code ..... 1189
Total Members at end ot
1. Prior year .......................................... · ········~····---····
2. Firstquarter ...
3. Second quarter ...
4. Third quarter ...
5. Currentvear ...
6. Currentvearmembermonths._ ............. ..
Total Member Ambulatory Encounters for Year:
1111111 ~111111111111111 ~1111111111111 ~IH 111111111111111111111111111111 ~E 1111111111m 11 ,.. s s n s 1 2 o 1 s 4 s o 4 1 1 o o .,
EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION ~a) REPORT FOR: 1. CORPORATION ..... Mid-AtlanticVision Service Plan, Inc. 2. Richmond, VA
BUSINESS IN THE STATE OF VIRGINIA DURING THE YEAR ; I
CiliiiPiiEenswe IFiOso~at & MediCa1 2 I 3
Totru Individual Group
4
Medicare Supplemer!
...................... 083.291 1 ..................................... 1 ..................................... 1 ..................................... 1
.. .. . ........... ~:~::::~: I ::::::::::::::::::::::::::::::::~::::I :::::::::::::::::::::::::::::::::·::::I :·:::::::~::~~--:··:=~: ::~:::I _ ... 755.3381- ..... -- .. ·-·-1 .......... _ ...... ____ 1
..... .754,800
. ... 8,945.227 .........................................
Vision o,,
.683,291
...709,0~1
~-758,4V6
.755,338
.754,800
...... 8,1;)45.227
Dental Onlv
7 Federal
Emp1oyees Health BeneiitsPian
(location)
NAIC Company Code ... 53031 s I 10
Title XVIII I Title XIX Medicare Medicaid I Other
•.••..•••.• ························I ····································I······
w 1 7. Physician ...... . ········I 0
B. Non-physician ...... .
::::~:~~I :::::::::::::::::::::::::::::::::::~t: ... __ ::::::::::::::::::.:~-~·1 .......................... :::::::~·1 :::::::::::::::::.:~:::::::~~I:::::~··:::::::::::~ ... ::::::~·11 ::::.~:::.~~:~ .... :::.~~:~ :::l· •mOmlmomm omml m mm mmmml 9. Totals ........ .. .. ...... 0 ... 0
10. Hospital patient days incurred .................... . ...0
11. Number of in atrentadmisslons ...................................... . ................................... 0 ___ ................................................................................................................... ~ .......................................... 1 .......................................... ___ , ................................................................................... .
12. Health premiums written (b) ... .52,605,681 ........................................................................... , ............... -.52,605,681 ................................... 1 ........... ,_,, .............................................................................................................................. -----1
13. Ufe premiums direct .....
14. Pm,.rty/~,ayprnmrumow""o... .. .................................. 0 1 ...................................... 1 ..................................... 1 ...................................... 1 ...................................... 1 .................................... ! 15. Health premiums earned... .. ................. .52,605,681 ... 52,605.,681
16. Pro mtums earned ......................................................................... 0 ......................................................................................................................................................................................... ! ........................................................................................................................................................ .
17. Amount paid for provision ofheaHh care services ... ... 42.613_,., 1
.................................... 1 .................................
1 ............. - .. .
1 B. Amount im:urred for orovision of health care services ... 42,906.883
{a) For heaHh business: number of persons insured under PPO managed care products ......... 0 and number of persons insured under indemnity only pro duels ........ 0. (b) For heaHh premiums written: amount of Medicare Title XVITI exempt from state taxes or fees S .......... O
" .. .. 42.613.3~9 1......................... ! ........... _................... !.................................. + .................. -...... _ .... _ .. __ .... 42,906,883
Statementasofoecember31,2013of!he Mid-Atlantic Vision Service Plan, Inc.
lllmlllllllllllll ~11111111 Mil IIIII ~11111111110 111111111111111111 HI~ IIIII In 1111 ~ 5 3 0 3 1 2 0 ; 3 4 3 0 4 s 0 0 0 *
EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) REPORT FOR: 1. CORPORATION ..... Mid-Atlantic Vision Service Plan, Inc. 2. Richmond, VA
BUSINESS IN THE STATE OF WASHINGTON DURING THE YEAR NAIC Group Code ..... 1189
Total Members at end of:
1. Prioryear. ... ..
2. First quarter .. .
3. Second quarter .......................................................................... ..
4. Third quarter ......................................... - ................................... .
5". Current vear ................................................................ .
0. CUrre~rmembermonlhs .................................... .
Total Member Ambulatory Encounters for Year:
~I 7. Physician ................. .
Total
...0
. .. 0
..0
.0
.0
.. .................................. 0
Comprehensive IHosoltal & Medical) 2 I 3
lndtvidual Grou1
...0 •·· ................................... .
4
Medicare Supplement
~-·"'~~~-'"' v ·~I;;
Vision Onl·
Dental Onl·
7 Federal
Employees Health Benefits Plan
"""""""I"""""""" m ommm """I""" """""""""" mmmm""'"""
(Location)
TrtleXVIII Medicare
NAIC Company Code ... 53031 s I 10
Title XIX Medicaid I Other
...................... =.
8. Non-physidan .......................................... ..
9. Totals .......................... .
.o I .............................. 1 ................................ I ....... . .0
--... 0 . ....................... ol ::;1 ::~ ;1::· ·:·;1· ·:;1 ::·::~1
10. Hosoltal oatientdavs incurred ...• . ...................... 0
-r---:~~~~=-1--- -1 11. Numberofinpatientadmissions ............ .
12. Health premiums written (b) ...
13. Llie premiums direct .......................... .
14. Property/casualty premiums written ................ .
15. Health premiums earned ...
10. Prooerly/casualtv oremiums earned ... ..0
17. Amount paid for provision of health care services ...
18. Amount incurred ~vision of health care servioos ...
...0
.. 0
I - - + - +-
········· -····---.. ·1·· ··················· -··········I ·····································I
(a) For health business: number of persons insured under PPO managed care products .......... O and number of persons insured underindemnilyonly products._ ..... 0.
(b) For health premiumswritlen: amount of Medicare TiHe XVIII sxamptfrom state taxes or fees $ .......... 0
.. ................................................................................................ 1
statementasofDewmber31,2013oflhe Mid-Atlantic Vision Service Plan, Inc.
5ch. 5-Pt. 1-Sn. 2 NONE
5ch. 5-Pt. 2 NONE
··--sen. g;;pt. 3~5n.-2 NONE
5ch. 5-Pt. 4 NONE
5ch. 5-Pt. 5 NONE
5ch. 5-Pt. 6 NONE
31,32,33,34,35,36
Stalemantasoroecember31,2013ollhe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULES· PART 7 Restatement of Balanoe Sheet to ldentifv Net Credit for Ceded Reinsurance
ASSETS (Page 2, Co!. 3)
1. Cash and invested assets (Line 12)
2. Acciclenl and health premiums clue and unpaid (Line 15) ............................................................. .
3. Amounts recoverable from reinsurers (Line 16.1) .............................. .
4. Net credit for ceded reinsurance.
5. All o!herar.lmilled assets (balance) ....
6. Totals assets (Line 28).
LIABILITIES, CAPITAL AND SURPLUS {Page 3)
7. Claims unpaid (Line 1)
B. Accrued medical incentive pool and bonus payments (line 2).
9. Premiums received In advance (Line 8).
10. Funds held under reinsurance treaties with authorized and unauthorized reinsurers (Line 19,
flrst inset amount plus second Inset amt~unt) .................................... ..
11. Reinsurance In unauthorized companies (Line 20 minus Inset amount)
12. Reinsurance wl!h cerUfied reinsurers (Una 20 Inset amount)
13. Funds held under reinsurance !realles with certified reinsurers (Line 19 third Inset amount) ...
14. All other liabilities (balance)
15. Total liabilities (Line 24) ................................................................................................... ..
16. Totalcapitalandsurplus{Line33) ...................... ..
17. Total liabilities, capital and surplus (Line 34), ................................................................... .
NET CREDIT FOR CEDED REINSURANCE
18. Claims unpaid.
19. Accrued medlcallncentlve pool... ...
20. Premiums received In advance.
21, Reinsurance recoverable on paid losses ............................................................. ..
......... 73,470,932
............ 2,024,995
......... XXX.
.. ............ 2369,614
............. .77,865,541
.............. .4,108,384
.283,616
............................ 2768 001
' .......................... 7,160,001
.................. .70 705 54(1
.......... ' ................ 77 ,865,541
.. ................ 0
. ......... 0
.......... 0
.. ............... 0
22. OUter ceded reinsurance recoverables
23. Total ceded reinsurance rect~verables
................................................... f====·=·····=·····d!..-0 .................................................................... >====="'-·'
24. Premiums receivable.
25. Funds held under reinsurance treaties with authorized and unauthorized reinsurers
26. Unauthorized reinsurance .......................................................... .
27. Reinsurance with certlfier.l reinsurers ...
28. Funds held under reinsurance treaUes wltll certified reinsurers ................................... .
29. Other ceded reinsurance payables/offsets ............................ ..
30. Total ceded reinsurance payablesloffsets ........................................ ..
31 Total net credit for ceded reinsurance ..
37
. ..................... 0
................................. 0
............................... 0
.. ........... 0
.. ............ 0
.. .......................................... 0
. ......................................... 0
. ...................... 0
Restatement Adlustments
Restated rGrossofCecledl
........................... 73,470,932
.. ........................... 2,024,995
...0
... 0
........................... 2 369 614
......... 0 ....... ........ . ........ 77,865,541
........................................... 0
.. ....... .)(XX ........
.... 0
... 4,108,384
...(l
................................ 283,816
.. ............................. 0
................. 0
..................... (1
.. ........... (1
........................ 2 768 001
.. ....................... 7,160,001
...70 705 540
. ..... .77,865,541
statemantasofDeoomber31,2013o1the Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE T ·PREMIUMS AND OTHER CONSIDERATIONS
AG!ive Stale Etc. Slatus
1. Alabama ......................... . ..... .AL .... N .. . 2. Alaska.. . ...•.......•........ AK .... N 3. Arizona ................................... IV. .... N .. . 4. Arkansas ............................... AR .... N ... . 5. California ........................... CA .... N 6. Colorado .......................... CO .... N 7. Connecliwt .. CT ...• N 8. Delaware •. . ............. DE .... N .. . 9. DislrictofColumbia ...... .DC .... N .. .
1Cl. Florida ...... . ... FL ...• N .. . 11. Georgia. .. . .... GA , .• N .. . 12. Hawaii. . ........... HI ...• N .. 13. Idaho ...• . ......... 10 .... N .. 14. Illinois ................... ..IL .... N 15. Indiana ...... . . .......... IN , .. N .. . 16. Iowa ... lA ... N .. . 17. l<ansas ................ KS ... N •... 18. Kentucky .. . ....•.. KY .... N
Accldenl &Heallli
Premiums
Allocated bv States and Territories
Medicare TiUeXVIII
r</edlcald Title XIX
Direct Business Onl
5 ' Federal Employees Life &Annuity
Health Premiums and Benefits Plan Other
Premiums Considerations
Property/ Casualty
Premiums
Total Columns
2 Throuoh 7 ..... 0
............ Cl . .... Cl
. ................... () ...................... ()
. ... Cl ..... Cl . .... Cl
. ................. () . ............ ()
... (l
. .. Cl
. .. Cl .. .,(l
. .. 0 ..0
. .......... Cl ....... 0
19. Louisiana... . ...••.. .LA .... N... . ....... 0
DeposHTypo
Contracts
-----------I-20.-Meine ... - ........ : ..... ME- -,;;;Nb ... =~l==~~h~=~·h=~~l==-~-=1----1·~---1--~ .. -... -...... •0 1~---1---------21. Maryland .................................... MD ... .L... .. •. 25,910,261 ........ 25,91Cl,2B1 ..... . 22. Massachusetts. . .................. MA .... N... . .................. 0 23. Michigan....... . ............. MI ... N 24. Minnesota... . .. MN .. N ... 25. Mississippi. . ...... MS .... N 26. Missou~. ............ MO . ... N 27. Montana ..................................... MT .... N .•...
................ 0 .. ...... 0
.......... 0 ........................ 0
. ........ 0 - - -28.-·Neb"raska;;;;.:::;;;;-;::.::.= .. .-:::::.--.--.NE .-... N:: .. . .. .-::: .. o- ---- - --
29. Nevada.... . .. NV .... N ... 30. New Hampshire... . ......... NH .... N ... . 31. New Jersey...... . ........... NJ ... N ...... . 32. New Mexico... .. .... NM .... N .. . 33. New York ..................................... NY .... N .. . 34. North Carolina ........ NC ... N ... . 35. North Dakota .............................. ND .... N ....... . 36. Ohio.... . ... OH .... N .......... .. 37. Oklahoma... ..OK .... N 38. Oregon.... . ............... OR .... N. 39. Pennsylvania.... . ............... PA .... N. 40. Rhode Island ................. RI .... N .......... . 41. South Carolina ............................ SC .... N .. 42. South Dakola ............................ SO .... N. 43 Tennessee .......... TN .... N .... 44 Texas ................................. TX .... N .. 45. Utah ........................................... UT .... N 46. Vennonl. ...................................... VT .... N 47. VIrginia...... . .......... VA ... .L... 48. Washinglon... . ......... WA ... .L... 49. West Virginia....... .. .... WV .... N .. 5~. Wisconsin... .. .......... WI .... N. 51. Wyoming ......... WY .... N. 52. American Samoa ........................ AS .... N. 53. Guam.. .. ............ GU .... N 54. Puerto Rico........ .. ...... PR .... N .... . 55. U.S. Virgin Islands..... .. .. VI .... N .. . 56. Northern Mariana Islands ......... MP .... N .. . 57. Canada ..................................... CAN .... N 58. Aggregate Other allen ................. OT .... .XXX ..... . 59. Subtolal.. ..... XXX .. . 60. Reporllng entity contributions for
Employee Benefit Plans. .. ... XXX.
.... 52,005,681 ......
.. 0 ........... 0 .... 78,515,942 .................... 0
...0 .... 0
61. Total (Direct Business) ... al ........... 3 .... 78 515 942 ............ .-....... o ........... 0
58001. 58002. 58003.
DETAILS OF WRITE-INS
.... 0 ..................... 0 ................ 0 ..................... 0
............. 0 .... 0
..... Cl ........... 0
. ................. 0 . ............... 0
. ...... 0
. ....... 0 .. ...... 0
. .... 0 .. .... 0 .. .... 0 ...... 0 .. ... 0 ...... 0 .. .... Cl
. ............ () .. .............. 0 .. ............. 0 . ............... 0
..... 0 .... 0
. ........ 52,005,681 .. ......... 0
. .. 0
... 0 ..0
. .. 0 ..... 0
.. ......... 0 .. .......... 0
. ................. 0
.................. 0 ..... 0
...78,515,942
.. ...................... 0 ... 0 ......... 78515942
.......... 0 ......... 0
. ..... 0
............. 0
............. 0
........... 0
58998. Summaryofremainingwril€-lnsforline58.... .. ........... 0 ........ 0 , ................. 0 .......... 0 .. 0 .. 0 ......................... 0 .......... 0 58999. Total !Lines 58001lhru 58003 + 589981....... . ........... 0 ................. 0 .................. 0 ............................ 0 ..................... 0 .................... 0 ..... 0 .... 0 (L)- Licensed or Chartered- Licensed Insurance Carrier or Domic lied RRG; (R)- Reg1s\€r ~Non-domiciled RRGs; (Q) ·Qualified -Qual Hied or Accre<l!ted Reinsurer; (E)- Eligible- Reporting Entilieseliglble or appro~ed lo write Surplus Lines In lhe slale; (N) ·None of the above- Not allowed to wrile business In lhe state. Explanation of basis of allocation by states, pramlums by state, etc.
The Company allocates based on the situs of the contract
(a) Insert the number of L respor~ses except for Canada and Olher Allen.
38
statementaso!Dec6!11ber31,2013oflhe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE T ·PART 2 INTERSTATE COMPACT· EXHIBIT OF PREMIUMS WRITTEN
Allocated by States and Territories
1
States Etc.
Life (Group and lndividu~i)
2 Annuities
(Group and lndlvldu~il
1. Alabama ...... . . ... AL ...................................... .
2. Alaska .............................. . . ...•.........•........ AK
3. Arlzona. . ....................... f\1.
4. Arkansas. . ..................... AR California ... . . ............................................... CA
6. Colorado ....... . ............................ co
Direct Business On I 3 4
Disability Income Long-Tenn C<lre (Group and (Group and Individual lndMdu~i)
7. Conflecticut.. . ............................. CT ............................................................................ .
B Delaware .........
e. District of Columbia.
10. Florida.
11. Gtlorgia ..
12. Hawaii.
13. Idaho ........ .
14. Illinois .. .
15. Indiana ....................... .
16. Iowa
17. Kansas ...................... ..
18. Kentucky ..
19. Louisiana
20. Maine ........................... .
21. Maryland ...
. .............................................. DE
. ............................................... DC .................................. ..
..... JL .. . ........................................................ GA ............................... ..
............... .HI
..................................... . .... ..10. . .......................... .IL
. ............................................... .IN
...................................................... lA ............................. .
. ..... KS
.................................... KY
................. LA .....
. ......................................... ME
. ................ MD .................................................................... ..
22. Massachusetts ................................... .. . .... MA ............................. .
23. Michigan .......................................................... .. . ..... MI ..
......... MN 24. Minnesota ... ..
25. Mississippi..
26. Missourl.
27 Montana ...
·································••••·•························· %~ Ji(~NE 28. Nebraska......... . ........ NE
29. Nevada ............................................. NV
30. New Hampshire ......................... NH
31. New Jersey........................................................ . .....•..........•.. NJ ............................................... .
32. New Mexico. . .......................................................... NM
33. New York. ............................... . ... NY
34. North Carolina ... . . .................. NC
35. North Dakota ...... . . ..... NO
36. Ohio. • ................................. OH
37. Oklahoma.. . .. OK
38. Omgon ......................................................................................... OR ........................................... . 3G. Pennsylvania............................... . ........ PA ................................ ~ ................................ .
40. Rhode Island ....... RI
41. South Carolina .. .
42. South Dakota ... .
43. Tennessee
44. Texas ....
. .. ..................................... .......................... sc .................................... .. . ... SO
...... TN
................................... TX .............................. .............................. .................. . .................. ..
45. Utah .. ., ......................................................................................... UT ....................................................... .
46. Vermont. ......... VT ............................ ..
47. Virginia .. .. ...................... VA 48. Washington ............................. . .. ............... WA
49. West Virginia ............................. ..... ...w-.1
50. Wisconsin... .... . .. .. ... . .. . . ... ....... .. ................. WI
51. Wyoming ......
52. American Samoa
53. Guam
54. Pullrto Rico ..
. ........................................... WY ............................... .
................. AS .............................. ..
.................... GU .......
......................................................... PR ..
Deposit-Type Contracts Totals
. ...................... 0 ............ 0
.......................... 0
.......................... 0
............... 0
...... 0
. ......................... 0
....... 0
. ....... 0
. ...... 0
. ......................... 0
. .....•• 0
. ....•.............•• 0
.......................... 0
....................... 0
. ......................... 0
....... 0
. ......................... 0 . .............. 0
......... 0
. ......................... 0
. ......... 0
.0
. ........ 0
.......... 0
. .. 0
. ......................... 0
................... 0
......................... 0
................. 0
. .. 0
.......................... 0
. 0
... 0
.. 0
.. 0
.... 0
.. .. 0
. ......................... 0
................. 0
. ......................... 0
............. 0
. .,.0
. ... 0
. ........... 0
............ 0
............. 0
..... 0
........... 0
... o . .... 0
............. 0
..... 0
. ..... 0
55. US V!rgln Islands ........ VI •. .....••.....••. ........................ ..... .............................. . ........ 0
56. Northern Mariana Islands ....... MP ........••. ...... .... ....... ....... .............. ............... .............................. •. . ..... 0
57. Canada ... . ....... CAN ................ .............. ..... ................ . ............. 0
58. Aggrega1e Other Anen. .. ....................................... OTf===·~····~···"!··p···~· ··~··--~··==+"====f====j===="!-"··~····~· .. ·~···~····~····~···"'-j··O 59. Totals .................. 0 .......................... 0 ................ 0 ......................... 0 ... 0 .......................... 0
39
a.. =:I 0 0:: (!)
>:z ~ ::;;; 0 (.)
(!) :z Ci .....1 0 ::J:
<
40
a. => 0 0::: (.!)
>z ~ :;;; 0 (.)
(.!) z
9 0 :I: <( LL 0
~ w Ill :;;; w :;;; 0:::1;; W<( 0:::[5 =>~ (J)~ Zo ;;:~ o, (J)~ !!:!oc 1-0 >~ i=h; ~;t (.!) z
~ w (.) z
·o ~(..) - z aio
O::i=
·~ ~ Q) 0 (J)LL
" z 0-'Ci) I
>>" w +=i_. " => .!l!o ::(w -b:z: ::ii~ ~ ~
~-
1 ~
' j 40.1
15 ;S.,• 0
r?"•"• •• 0) ·~····· a.. ...... '. Vl
>
... ~
StatementasotDecember31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
Gro"p Code
Members
2
Group N•~
4
NAIC Comp.any
""'' 39516 ... _. 06-1227g4Q
47029 •••. 22-zm159
32395 .... 36-3560825
48321 ..... !>h1034073
00000 .... 99-0247673
54682 .... 39-1249640
5:l031 ....• ZH0896S8 47317 .... 91-6056925
47783 .... 82-0339119
47201 •.••• 92-0078509 52050 ••.••• 35-6062367 47097 ••.••• 73-1004909
5 6
........ ···I··
47093 ....
1
1J4.2718308
54380 .... 31-<1725743 ~-- ··--------~-···-····--·-' ..
00000 ..... 23-7375685
00000 ..... 75-1759288
OOOOL. .. 83--0212963 1 ---····--·····---1··· 00000._ .. 20-194-9500
12516 ...... 20--0891619 OOOOL .. 94-1632821 00000 .... 27-0621064
00000 ····127-0621064 00000 .... 27-0621054
00000. ···127.{)521064 00000 .... 27-0621004
00000 .... 27-0621064
00000 ..... 27..0S21213
00000 ...... 27-3107295
00000 ...... 27-5016913 ............ jooooo ...... 2H621143
____ , __
7 Name of
Securities Exchange ii Publicly Traded (U.S. or
International
I II
SCHEDULEY ' PART 1A- DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
10 TI 12 Type of Control
TI 14
Names of Parent. Subskliarles
or Al!ilialt!s Domicirrary Location
Relationsllip to Reporting
Ei!_lity_ Directly Controlled liy
(Name of EnliiY/~rsbnl I
(Ownership Board, I JiControl is
Management Ownership Attorney-in-Fact, Provide lr.fluence, Other) Percenta_g!
LIHimate Controlling Enuty(ies)JPerson(s)
Vision Service Plan Insurance Company (Conneclk:ut)
Eastern Vision Service Plan, Inc. ... LISA ---···I lA ...... . LISA .•..... lA ... .
Vision Service Plan Insurance Company (Missoun") USA... lA. .. .
VISion Service Plan, Inc. (Nevada) ........................ USA..... lA .. .
Vision Service Plan (Kawaii) ............................... USA.... lA. •..
Wisconsin Vision Servtce Plan, Inc. (Wisconsin) ..... USA......... lA. ......
Mid-Atlantic Vision Service Plan, Inc. (Virginla) ...... USA........ RE ••..•..• Vision Service Plan (Washington) ......................... USA ..••..••• lA.. ___ _
Vision SeNice Plan of Idaho, Inc. (Idaho) ...••...••.•.•• USA...... lA. ...
I
Vision Service Pltln (California) ... J.... Vr 5•oi~ Ploo (C•Iilbmi•l-"j-"·
VS~ Holding Cumpany, Inc. ...•••...•.......
Vision Se!Vice Plan (Califomia) ... j'······· Vis~on SeiVice Plan (California) ...... .
Vis\on SeiVice Plan (California) ......... .
VisJon SeiV~ce Plan (Cal~forn~a)---·1······ \Iiston Serv~ce Plan (Cahfarn1a) ...... .
Vis~n service Plan rearifarnial---·r······ Alaska Vision Services, Inc. (Alaska)... USA.... lA ........... Visipn Service Plan (California) .••.
Indiana Vision SeNices, Inc. (Indiana)... USA ........ lA ..... - ........ ViSJJPR Service Plan (California) •••. : •..
VISion Services Plan Inc., Oklahoma (Oklahoma] ... USA... lA... Vision Service Plan (Catifomia) •••. l ... Massachus~tts Vision Service Plan i _ I (Massachuselts) LISA... lA... Vision SeMce Pran {California-) .......
VISion Service Plan (Ohio) .......... ····--··-··-··------ LISA... lA ..... -... Vision Service Plan (Califomia) •. J. New Hampshire VISion Services Corporation [New : I Hampshire) USA. ______ lA. ..••...••..•.• Vision Se!Vice Plan (California) ...... .
Southwest Vision Service Plan, Inc. (Texas) ..... - .. USA. ...... lA... Visibn Service Plan (Calilomia) ... J. Vision SeiVice Plan of Wyoming (Wyoming)... USA... lA.. ·--····-··· Visibn SeiVice Plan (Califamia} .... l. Eastern Vision SaiVice Plan IPA, Inc.... USA... lA... Visi
1on Service Plan (Califarnfe) .... l
\ljslon Service Plan of lmnois, NFP ....................... USA.... lA... . .......... Visi~n Service Plan (Califarnia) .... l ...... .
Board .. . Vision Service Plan (Caliiomia) .. .
Board ...... . Vision Service Plan (Califllmia) .......................... ~ ..
Board .. . Vision SeiVice Plan (California) ..... ..
Board .. .
Board .. .
.
1
Board ... .
. Board .. .
.
1
Vision Service Plan (California] ........ .
. VisionServ1ce Plan (California) ..... .
. Vision Service Plan [California) .••.
Vision Service Plan [California) ...
Board .. . Vision Service Plan (Carrfornia) ....... .
Board .... . Vision Service Plan (California) .. .
Board ..... VISion Service Plan (CaiTfamia) .. .
Board ... ViSion Service Plan (California) .... .
Board ....... . ViSion Service Plan (California) ..... _,. ..
. ,Board ... Vision Service Plan (Cillifamia) .......................... ~ ..
Board ... Vision SeMce Plan (California) ...
Board ... Vision Service Plan (California) .......... ..
_,Board ... Vision Service Plan (California) ...
Board .. Vision Service Plan (California)... . ......... ..
Board ... Vision Service Plan (California) .. .
Board ..• . , Vision Service Plan (Caltfomia) .. .
Vision SeiVice Plan (California)... USA... UDP ........... Vision Service Plan (Califomla) .... l ..... . VSP Optical Group, Inc.... USA.... NIA ............. VisiOn Service Plan (Californla) .••• l ................. .
Ownership ....... 1 ... 100.000 I Vision SeMce Plan (Carlfomia) ...
VisiPn Service Plan Insurance Co~pany Ownership ........ 1 .... .50.000 I ViSion Service Plan (CaiTfomia) .. .
VSP Optical Group, Inc .. .
VSP OpUcel Group, Inc ...... .
USA ....... 1 NIA .••. ......................... 1 USA ....... I NlA. .......... :I ;~~k~:c~=n Services, Inc. (lru:tilna) ..
MaSsachusetts Vision Service Plah
Ownership ...
Ownership ••.
VSP Opt~cal Group, Inc .............................. -.... LISA-... NIA..-.... ·- (~~sach~setls! I _ _ I Ownership .. .
VSP Opllcal Group, Inc --·-······-·---·····-···---· LISA... NJA.... . ... Mid-Atlantic Vis1on Service Plan, Inc. [Virg1ma) ... Ownership ........ .
VSP Optical Group, Inc ........... USA. ....... NIA. ............ Visi~n Servires Plan Inc, OklahoL (Oklahoma)! Owners'hip
Plexus Oplix, Inc. ............ ......... ..••...••.. USA ........ NIA... VSP Optical Group Inc l Ownership
Eyeconic, Inc... • .............................................. USA ......... NIA... vs~ Optical Group, Inc L - Ownership
VSP Ceres Inc .................................................... USA ........ NIA ............. vs~ Optical Group, Inc ................ ~ ·--·······--- ···I Ownership.
VSP Labs, Inc.... USA... NlA .............. VS~ Optical Group, Inc. .......... ·r· ................. Ownership.
... 10.000 I Vision Se!Vica Plan (California) ........................ , ..
. ..•• 1Q.OOO Vision Service Plan (California) .. .
... 10.000 I Vision Service Plan (California) ........................ ~--
10.000 Vision Service Plan (California) ...... .
... 10.000 Vision Service Plan (California) .•••.
..• 100.000 Vision SeiVice Plan (California) ...
... 100.000 Vision Service Plan (California) ...
...100.000 Vision Service Plan (California) .. .
...100.000 Vision Servlce Pia~ (Caltforr.ia) .. .
15
... ~
:...
statementasofDecemo~r31,2013of!he Mid-Atlantic Vision Service Plan, Jnc.
Group Code
'
Group Name
NAJC Company
Code
4
Federal ID
Number
00000 .... 127.{1933693
Federal RSSD CIK
7 Name of Se~urities Exchange ifPubliely Traded (U.S. or
lnli!rnatio~
00000... . ................... . ................... . 00000 .. -~···················
~~~~~::· : ;~;·~~;;~~-1··················1-- ·········I··
OOOOL •• I26-1998746
00000 .... 68-0450459
00000 ...... 68-0295156
00000. 20-4044711
00000 .... 26-2448S48
00000 .... 98--1024150
00000~··-- 99-0370707
00000 .. . 00000 ... .
00000 .... 11-26173641··
00000 ..•.. 11-32336fJO
00000 ..... 23-2941185
00000 ···- 11-3180867 00000 ...... 98-0201338
00000 .. .
OOOOL ..
00000 ..... I•• 00000 .. .
00000 .. .
00000 •..
00000 ...... 1 .................. 1 ..
00000 ..... .
00000 ...... , ......
00000 .... ············-···- ' ..
~~~~~ :::: I~~~~~-~-~ ~--00000 •.
00000.
00000 ·--·183--462.7457 00000 .... 11-34356fl5
·········I·········· !············-··· ·····-·······1·············· 1·····················-···
.......................
SCHEDULEY PART 1A- DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
' 9 10 TI 12 Type of Control
13
Names of Parent. Subsidiaries
or Affiliates VSP Global, Inc. ... VSP VISion Care- UK, Ltd ...
VSP Canada Vision Care Insurance ...
(Ownership Board, I If Control is
Management Ownership Domiciliary Directly Conlrolled by Attorney-in-Fact, Provide Location Name-of Enti /Person) Influence, Other Percenta e
USA.... . ............ Vision Service Plan (California) ........................ Ownership... . .. 100.000
~~ ::::::::I ~~-~~-----~~-::~-~-~~~~~::~·:~~~~-t~;;;~-~;~i ~:·.::·_:-_::::·_-_::~----=~~--~I:::~:~::= :::I :::~~~:~~~
14
Ultimate Controlling Entity!les¥Person(s)
VISion Service Plan (California) ••
VISion Service Plan (California) ......................... , ..
VISion Service Plan (California) .. . VSP VISion Care Association [Canada) ................ ,CAN .•.
VSP Holding CDmpany, In~... . ....... USA ..... . Ownership ...
. •• 100.000 I VISion Service Plan (California) ......................... , ..
. .. 55.000 Vision Se!Vlce Plan (California) ...... .
JA. .............. I Vision Service Plan (California) ......................... !Ownership ..•..
NIA .............. I Vision Service Plan [California) ................ .
VSP Holding Company, In~ ... 1
-Vision Service Plan Insurance Company USA ......... I NIA. ............ (Connectict.!l) Ownership ....... 1 ..... 45.000 !Vision Se!Vice Plan (California) .. .
Vision Service Plan Insurance Company
,,
Eyeiinity, Inc ............... .
Altair Eyewear, Inc ...
Perfect Optics LLC ......................... .
. , USA ....... 1 NIA. ............ 1 (Connecticut)
USA...... NIA ............. VSP Holding Company, Inc .. .
USA •.••.•. NIA ............... Vision Service Plan (Californiaij .. .
Ownership... ...100.000 VisionSe!VicePian(Californ1a) .......................
1
..... ..
Ownership... ...100.000 Vision Service Plan (Californ1a) .......... •• . ... .
.
1
Ownership ..... 80.530 Vision Se!Vice Plan (Canfornta)... . .
Perfect VISion LLC .. .
Eyeiinity Europe. •.•.
Eyefinity France ...
USA ....... NIA ............. VSP Labs, Inc .. .
FRA.... .. NIA... Eyefinity Inc ...
FRA. .. NtA. ............ 1 Eyefinity Europe ..
. Ownership. ....... .. .. .51.000 Vision Service Plan (Car£fornia) ...
Ownership...... • .• 100.000 Vision Service Plan (Car£fornia) ......................... , ..
Ownership... . .... 87.000 Vision Service Plan (Caflfomia) ...
Eyeiinity/Officemate ?ty ............ . AUS ........ INIA ........... I Eyefinity Inc ..................................................... Ownership... ... 100.000 VISion Service Plan (Caf£fornla) •• MonKey Software ________________ ......................... AUS ........ NlA.. ............ Eyefinity/Officemale ?ty... Ownership. ...100.000 Vision SeNice Plan (California) ....................... , ..
Marchon Eyewear, Inc. ..................................... USA ........ NIA. ............ VSP Holding Company, Inc ·--···-··· .. -··· Ownership. ••...• • .• 100.000 Vision Service Plan (California) .. . Marchon lntemallonal, Ltd...... ........ ...•••... USA ........ NIA. ............. Marchon Eyewear, Inc.... Ownership ....... • .• 100.000 Vision Service Plan (California) .. .
Eye Designs LLC ........................................... USA... . NIA ............. Marchon. Eyewear, Inc. ...................................... OWnership... . .... 50.000 Vision SeNice Plan (California) .. .
R.B. Mexico, Inc ...
Marchon Europe BV ...
Marchon Japan International Yl<....
Marchan Japan KK. ...
MEX ........ NIA. ............. Marchon Eyewear, Inc. .. .
NLD... . NIA. ............. Marchon Eyewear, Inc ......... ..
:\~:~:::· .::::: ~~- ::::::::::::: ~=~:~~~=~~~-~::: __ ........ . OWnership... . .. 100.000 VISion Service Plan (CaiTfomla) .. .
Ownership... . .. 100.000 VISion Service Plan (California) .. .
Ownership... . .. 100.000 Vision Service Plan (California) .......................... ..
Ownersh"tp... .. 100.000 Vrsion Se!Vice Plan (Cafrfornia) •.. Marchon UK Ltd ...
Marchon HispaniaSL ...
Marchon ltariS. SRL ..•
Marcl1on Ita ITa SRL .•••..••••..
GBR. ..•..•• NIA..... • Marchon Europe BV... Owriership... . .. 100.000 Vision Service Plan (California) .........................
1
....... .
ESP... . • NIA ............ Marchon Eyewear, Inc___ _ _______ .................. Ownership....... . .. 100.000 Vision Se!Vice Plan (California) ............................ _
... , ITA.. .. NIA... Marchon lnlemational... Ownership... . .... 99.500 Vision Service Plan (California) .......................... .
ITA. ......... NIA ............. Marchon Europe BV... Ownership ....... .. ..... O.SOO Vision Service Plan (Califomta) .. .
Marchon MS SRL.. ........ . ITA. ......... 1 NIA ............ I Marchon Europe BV .. . Ownership......... • .• 100.000 Vision Service Plan (Carrfomia) ......................... , ..
March on Eyewear (Hong Kong) Ltd... ___ HKG ........ NlA.. ............ 1 Marchon Europe BV .. .
Marchon Eyewear (Far East) Ltd ...................... _ .. HKG ... ··-· NIA... . ....... Marchon Europe 8V .. .
Marchon Germany GmbH .................................. DEU ........ NIA... • ....... Marchon Europe BV .... .
Marchon France SAS............. ........... .................. FRA.... .. NIA ...
Ownership... . .. 100.000 Vision Service Plan (Carlfornia) ...
Ownership. ·-··· ... 100.000 Vision Service Plan (Caflfomia) ...
Ownership... . .. 100.000 Vision Service Plan (Caflfornia) .........................
1
....... .
Ownership... • •. 100.000 Vision Service Plan (Car£fornta) ............................ .
Ownership ....... .. .•• 49.000 Vision Service Plan (Californta) ............ ·-... -... .. DJO--Marchon Switzerland SA. ...
Marchon Eyewear, Inc ......... .. CHE ........ INIA. .. ___ _ Marchon Europe BV ...
Marchon Portugal, Unipessoal, Lda .............•......... , PRL ..... , NIA ............. , Marchon Europe BV ..... .
Marchon Gulf FZ CDmpany... . ..............• ARE ........ NIA ............. Marchoo Europe BV .. .
Ownership ....... , •.. 100.000 I Vision Service Plan (Californta) ..... .
Ownership... •.• . .•• .50.000 Vision Service Plan (Carlfomta) .. .
Marchon Call!lda, lne ...
Marchon BRL Lid ... ~ ····~···
•.. 100.000 I Vision SeNice Plan (Carrfomia) ...
Ownership ........ 1 ... 100.000 I ViSion Service Plan (CaiTfomla) ......................... , ..
CAN ........ , NIA ............. , Marchon International Ltd
USA ....... NlA.. ............ Marchon Eyewear, Inc .•..•. Ownership ••.•
.... ~
~·-
' "
statementaso!December31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
Group
''"
2
Group Name
0
Company ID Federal NAJC I Federal
Code Number RSSD CIK
ooooo .... 1
......... .
00000 •...... 00000 ••.••. 00000. 00000 .... I ................. 1-······
~~~~~:~:::~~~:~~-~ .... OOOOll ........
00000 ----1·· 00000 ......
00000 """"]"" 00000 ..
~~~~~ ::::1 ;;~~~;~ 00000 ..... Bll-0465774 00000 .... 27-1700596
00000 .... 27-1700596
00000 .... .
00000 .... 21-0229593
00000 ...... 37-1691104' .................. i .. .
00000 .... 26-2691541
00000 .. .
00000 ...... 26-2696876 , ....
00000 ..... 33---054904.9 00000 ____ Applied For.
1
.................
1
........ .
00000 .............................................. .
00000 ........................ ·-·· .............. ..
00000 ...
00000 ... 00000 .....
~~~~~ ::::I:::· --······:::::I::·· 00000 .... 00000.
00000 .. "il .. n ..
00000 ........ .
7 Name of Securities Exchange if Publicly Traded (U.S. or
International)
SCHEDULEY PART 1A- DETAIL OF INSURANCE HOLDING CCDMPANY SYSTEM
Nemes of Pareni, Su!Jsidiaries
or Affiliates
Marchon Brasrl Ltda ...
, I " II 11
Rela~onsh1p 11 to Re)mrting I
Entity
12 Type of control
TI
(Ownership Soard, Ill Cl.lntrol is
Domicniary Loca~on
BRA.. ..•
BRA. ...
Management Ownership Directly Contron!ld by Attorney-in-Fact, Provide
(Name ofEntity/Pl!rstln) I influence, O!ller) Percenta~
14
Ultimate Conlrofiing Enttty_\ies)!Person(s)
NtA. ·········-· Marchon Eyewear, Inc. .. _,_ • .L. ........... ····- ... 1 Owners lip...... • .. 100.000 Vision Se!Vice Plan (California). ......................... , ..
NtA ............. Marchon Brasil L!da ............ 1................. . ... Ownership... • .. 100.000 V~on SeJVice Plan (California) •..
Cllrporalion Oplica lntemacional Srl ................... MEX ......... NlA ............. R.B. Mexico, Inc .................. .l... Ownership ........... 100.000 Vision SeJVice Plan (Califomia) •..
Coordinadora Administratiw de Personal...... . . MEX ........ NtA ............. R.B. Mexico, Inc .................... l... Ownership... . .. 100.000 Vision Service Plan (Caliiomia) •..
FC 18 CDmerico e Represenlacoes Ltda ...... .
Marchon Europe Sari... ..... .. NLD .......... NtA. ...•...•••.. ~archon Eyewear, Inc... k.......... ............. Ownership... • .. 100.000 V~on Service Plan (CaiTiomia) .. .
15
Allure Eyewear LLC... • ......... USA.... NtA ........... Marchon Eyewear, Inc,. .... .l ........ ...... Ownership... • ..•• 51.000 V~on Service Plan (CaiTfomia) .......... .
General ?plical Ply Lld ........... ............ •••.. AUS ........ NIA ............ ) Enterprises (Ply) Ltd ... ·······t··· ....... . ......... Ownersh~p... . .... 51.000 Vis~on Serv~ce Plan (Car~om~a) ............................... . I Enterpnses Pty, Ltd. ........ .............. .............. AUS ........ NIA... . .. Marchon Eyewear, Inc ........... ............. Ownershrp... . .. 100.000 Visron Servrce Plan (CaiT;omra) .. .
Marc:hon Eyewear AllS!mlia ?ty Ltd ..................... AUS... NIA. .............. ~eneral Oplical Pty Ltd ...... J ...... ·-··· Ownership... . .. 100.000 Vision SeNice Plan (Cartiomia) .. .
General Optir:al (NZ) Ltd... NZL .......... NIA ............... peneral Optical Ply Ltd ..... ) .• ····---· Ownership... . .. 100.000 Vision SeNice Plan (Cartiomia) .. .
Vw.a Eyewear Australia .......................................... AUS ... .- ..... NIA .............. General Optical Ply Ltd ...... .l ............... - Ownership ........ .. ... 50.000 VISion Sel\lice Plan [Califomia) ....... .
REM Eyewear Australia Ply lld ........................... AUS........ NIA ........... ~eneral Optir:al Ply Ltd .L .............. Ownership....... .. ... 50.000 Vision Service Plan (Califomia) .... .
SX Solar Express Australia Ply lld ................. AUS .......... NIA .............. px Holdings LLC.... .. ..... )... Ownership. ....... ...100.000 Vision SeNice Plan [Califomia)... .. ..... , ..
~archon Eyeweer, Inc.
Optical Opportunities, LLC .......................... US/\... NIA..... .. ... Marchon Eyewoor, Inc ..... -~ ................. Ownership ...... .
MVO Ucensing, LLC..... USA.... NIA. ............. Marchon Eyewear, Inc... .. .. ....... n ...... Ownership-.. .
MVO Ucensing, LLC .................... ... . USA... NIA... Optical Opporrumties, LLC .... _ ................. OWnership. ...... • .... 68.860 Vision Service Plan (California) ................... ..
Mcleod Optir:al Company, Inc. ............................ USA ........ NIA ............. ~SP Essilor Holding Companf LLC .......... Owoorshlp.... • .... 28.000 Vision Service Plan (California) .. .
VSP Essilor Holding Company LLC... USA... NIA... • ~SP Optical Gmup, Inc.................. Owoorship. ...... • .... 36.000- Vision Service Plan (California) .... ..
DragonAt:quisilion Co., Inc ......... ., .... ......... USA... NIA....... 1
Marcllon Eyewear, Ins .......... +····· ...... Ownership.... ...100.000 Vision Service Plan (California) .. .
USA._ ... ._ I NIA ..... Ownership ....... 1 ... 100.000 I Vision Service Plan (Calffomia) ... MEl 3D, LLC ·····---··· ._100.000 I Vision Service Plan (Calrfornla) .......................... , ...
... 13.050 Vision Service Plan (Calrfomia] .. .
Dragon Alliance. LLC, ......................................... USA... NIA...... Dragon Acquisition Co., Inc............ .. ............ Ownership. ....... . .. 100.000 Vision Service Plan (California) .. .
...
1
Dra;;lonAtliance South Pacific Ply Ltd .................. AUS.... NJA. ............ 'oragon Alliance LLC. ........... L. Ownership... . .. 1011000 Vision Service Plan (California) ........ ..
........................... Dragon Alliance Inc................................. ............. USA ....... NIA. ............. pragon Alliance L~C- ...... :---··· .... Ownership . .-. . . .100.000 Vision Service Plin (California) .. .
~~1~:Eff~§;~~: · :. : ~~······ ~!~·.-. ~ili~g~,~:~ ·r--· ~::::~ .. :=--:== .. :::~:::=:::= .. :::::~::. ~~~::··.:·-· ~~::. :.: ~=~~::~:~ ~::: ...... ::t __ _
FIN___ NIA.... . .. ScandiMVian Eye\tlear .. _____ .l._ Skaga Oy ..................... .
Scandinavian Eyevrear LLC ...
Marchon Sports (Shenzhen) Ltd ...
USA. _____ NIA. ............ ~candiMvian Eyewear ......... ..f-.. CHN ....... NIA.. ........... Man::hon Eyewear (Hong Kong) Ltd ....... ..
. I
Eyer:are Innovation Partners, LLC ....... -----~---~-~----~- -~ ~:~.--·.:·.·.·.·. ~~ ::::::::::::: ~:~;ti:l:~~;~c. :::::::r:--· Entemasyon al Gozluk Sanayi vd TicaretAS .......... TUR........ NJA ___ ...... I'Aarchon Europe. --~ Canada Inc....... ··--··-----·-- ................ CAN .......... NIA ........... rsp Canada Vision Care lns~:ance.~ .. .
Marchon Hallas SA ...
'
Owneffirn.P .......
1
1 ... 100.000 I Vis~on Serv~ce Plan (Cal~rn~a) .......................... 1
.... .
_, Ovmers!ilp ....... ...100.000 Visron Servrce Plan (Califorma) ........................... .
Ownership... ...100,000 Vision Service Plan (California) .. .
Ownershlp.. ..... ...100.000 Vision Service Plan (Califomie) ................... , ..
Ownership.. ..... • .. 100.000 Vision Service Plan (Califomia) ..... .
Ownership......... • .. 100.000 _Vision Service Plan (Califomia) .......................... , ..
Ownership ..... ... 100.000 I Vision Service Plan (Califomia) .......................... , ..
Ownership ........ 1 ... 100.000 I Vision Service Plan (California) .......................... , ..
Ownership ....... 1 ... 100.000 IVrsion Service Plan (Califomia) ..... - .................. , ..
Ownership ... ... SO.OOO I Vision Service Plan (California) ...
Ownership ......... l .... .60.000 IVrsion Service Plan (Califomia) ...... .. Ownership... . ...... 1.000 Vision Service Plan (Califumia) ..... .
Ownership... . .. ...50.000 Vision Service ?ian (California) .. .
StatementasofDecembsr31,Z013ofthe Mid-Atlantic Vision Service Plan, Inc.
2 7 Name of
Securilies Exchange ifPullllcly Traded
GrouiJ Group (U.S. or CDde Name lntemalional
OOOOD__.
00000 ...
00000 ...
.... ~
"'
SCHEDULEY PART 1A- DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
Names of Parent Subsidiaries
or Affiliates
Marchon Maurilius ...
Domiciliary loCBtion ~US ...
10 TI
Relationship to Reporting I Directly Conlrolled by
Entity (Name of Entity/Person) NIA. ............ 1 Marchon Sports (Shenzhen) ltd China •.
sterling Meta-Plant India Private Ltd ····················!IND •• ·······1 NIA. ..•••..••...•• I Marchon Maurilius •..••... GENOP Ply Ltd [ALJStralia)... ············~······· . .!,US •..•.••. NIA ............... I Enterprise ?ly Ltd •..••.
12 Type of CDntrol
13
(Ownership Board, llfControlls
Management Ownership Allomey-in-Fact, Provide Influence, Other) Percentage
14
Ultimate CDntrolling Entity(ies)/Person(s)
15
Ownership .. ~ ···1· 100.000 Vision Smvice Plan (California) ... Ownership.. .... . .. 49.000 Vision SeMce Plan (California)... . ........................ .
_, Dwnreship.. .... . .... 0.534 Vision Service Plan_(Califomia) .. ~ ..................... ! ..
' "
smtamentasofDecember31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULEY PART 2- SUMMARY OF INSURER'S TRANSACTIONS WITH ANY AFFILIATES
NAIC Company
Code Affiliated Transactions
Federal 10
Number
Names of Insurers and Parent. Subsidiaries
~ AliiU""
4
Shareholder Dividends
39616 .................. I 06-1227840 ............ I Vision Service Plan Insurance Company (a Connecticut stock I ................. 43,000,000 4-7029 ...... _ ------~22-2777159 .............. Ea:tem V~n Service Plan, Inc. (New York.).: ......... : .............. I ................................. .. 32395 ................ 36-356082.5 .............. VISton Servtce Plan Insurance Company (a Mtssoun stock corl .................. 7,4(]0,000 48321 ................ 94-3034073 .............. VISion Service Plan, Inc. (Nevada) ............ .
99-0247673 ....... ... VISion Service Plan (Hawaii) ......... 54682 .......... .. 39-1249640 ............ Wisconsin Vision SeJvice Plan, Inc. [Wisconsin)-....... . 53031... 23-7089668 ............ Mid-Atlantic Vision Service Plan, Inc. (Virginia)... .. ................ 10,000,000
Capital Contributions
' Purcheses, Sales or Exchanges of
Loans, Secudties, Real Estate,
Mortgage Loans or Other Investments
47317 ................ .. 91-ll05692.5 .......... Vasion Service Plan (Washington)-..................................................... 5,100,000 ...... ................. .. ............................ . 47783 .. 82-0339119 ............ Vasion Service Plan ofldaho, Inc. (Idaho).... ..... .. ............................... .. 47201 ........ 92-0078509 ............ Alaska VISion Services, Inc. (Alaska) ................ .... ............... ....... ............................ ..... .... ....................... .. ..................... ..
Income/ (Disbursements)
lncurred in Connection wi~ Guarantees o~ Undertakings for the Benefit:
of any Affiliate(s)
Management Agreements
'"' Ser.rlce Contracts
136,005,782 . . .21,503,874 ... .30,742.,425
Income/ [Disbursements) Incurred under Reinsurance
~aments
... 2.,977,000 ·····-----~---. . ........ 3,955,593 ...................... "'"'
.3,561,651 15,393,094 .... - ... ~ ............... ..
... 13,100,403' ............... . 2.,978,685 ............... .
.. 1 ,392.,056 ............................... .. 52050 .................. 35-6062367.... . ... Indiana Vision Services, Inc. (Indiana) ...................................................... 4,4(]0,000 ...... ..... ..................... .............. ...... .......... .. ....................... . ... 8,231,742.' ......... ·-· ..... . 95478... 75-1004-909 .......... Vasion Services Plan Inc., Oklahoma (Oklahoma)... .. ........................... .. ..5,362.,805 ........................... . 47093... 04-2718308 ............ Massachusetts VISion Service Plan (Massactluset!s)... ................................. .. ................. . ...7,243,741 ............... . 54380 ................ 31-0725743.... . .. Vasion Service Plan (Ohio) ..................................................................... 4,200,000 .................................. .. ...16,731,314
. .. 3,598,168 ......... .. ....... .. .. ....... 1,165,597 ....................... .
.... 1..... 75-1769238... ......... Southwest Vision Service Plan, Inc. (T exes)... ---.. -- ...... .. N .. 83-0212963 ............ VISion SeNice Plan of Wyoming (Wyoming) ........ ......... .• .. .......... .... ............... ....................... ........ .. ........................... ..
.... ...................... 20-1949500 .............. Eastern Vision Service Plan IPA, Inc ................. ....... ....... ..... ...................... ................................... .. ..... . ........... 125,815 ............... . 125"16... 20-0891619 ............ Vasion Service Plan of Illinois, NFP... .. ............................... . .. .... 14,022,549 ............. ..
. .... (286,092,094):
-··········- :::: I 94-1632821 ............. Vtsion Service Plan (California) .................................... ....... • ......... (69,700,000) ............................... .. 26-199874ti ............ VSP Holding Ctlmpany, Inc...... ............... ........ ................. .. ................. (7,400,000) . 26-1998746 ............ VSP Holding Company, Inc. .................................................................. 3,000,000
9999999.1 Control Totals .... ............................. 0 ... 0 1-----.. . .......... 0 o 1 ........................... o I· ....... ..
jjj TI
Any Other Material ActMty
Not in the Ordinary
Course of the Insurer's Business
12
Totals
179,005,782 ... 21,503,674 ... 38,142.,42.5
" Reinsurance Recoverable/ (Payable) on
Losses and/or Reser.re Credit
Taken/ ~
2,977,000 1 .............................. .
...... 3,955,593 ... 3,561,651
i .................. 25,393,094
. ................... 2.,978,685
. ................... 1 ,392,056 1
.................. 18,200,4031 :••••••: :: ::••••
. ..... ···- ····················:l•·····::;:r:!:l:;jj .............. :~ -...I .................. 1,165,597
XXX
I:: ................. ::::::~::::I ::::::::::::::::~14:~~:~~ 1 ......... .
. ..... [355,792,094) ..... . ......... .
............ '" ............ 0
. ......... (7,400,000) ........ 3,000,000
. .. 0 ... 0
statementasoroecember31,2013ofthe Mid~Atlantic Vision Service Plan, Inc.
SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES The following sup!)lemental reports are required to be filed as part ofyourstatement filing unless ::peclflcal!y waived by the dom!cllial)' state. However, In the avant that your domlclllal)' state waives the filing requirement, your response of WAIVED to the specific lnterrogaklry will be accepted In lieu of filing a "NONE" report and a bar code will be printed below. lflhe supplement is required of your company but Is not being filed fur whatever reason erter SEE EXPLANATION and provide an explanation following the Interrogatory questions.
MARCH FILING
1. Will the Supplemental COmpensation Exhibit be filed with the state of domicile by March 1?
Responses YES
2. Will an actuarial opinion be filed by March 1? 3. Will the confidential Risk-Based Capital Report be Filed with the NAIC by March 1? 4. Will the confidential Risk-Baserl Capital Report be filed with the state of domicile, If required, by March 1?
APRIL FILING
5. Will the Management's Discussion arKI Analysis be filed by Aprll1? 6. Will the Supplemental Investment Risk lnterrogato~es be flied by Aprll1? 7. Will the Accident and Health Policy Experience Exhibit·be filed by April1?
JUNE FILING
8. Will an audited financial report be filed by June 1? 9. Will Accountants Letter of Qualifica~ons be filed with the state of domicile and electroolcally wllh lhe NAIC by June 1?
AUGUST FILING 10. Will Communication of Internal Control Related Mailers Noted In Audit be filed with the state of domicile by August1?
The following supplemental reports are required to be flle<J as part of your statement filing. Howewr, In the event that your company does not transact the type of business for which the special report must be filed, your response of NO to the specific interrogatory will be accepted in lieu of filing a "NONE" report and a bar code will be printed below. If the supplement is require<J of your oompany but is not baing filed for whatever reason, enter SEE EXPLANATION and provide an explanation following the Interrogatory questions.
MARCH FILING
11. Will the Me-dicare Supplement Insurance Experience Exhibit be filed with the state ofdomiclle and the NAIC by March 1?
12. Will the Supplemental Life data due March 1 be filed with the state of domicile arKI the NAIC? 13. Will the Supplemental Property/Casualty data due Marcl11 be filed with the state of domicile and the NAIC? 14. Will Schedule SIS (Stockholder Jnformafion Supplement) be filed with the state of domicile b~ March 1?
15. Will the actuarial opinion on parllclpatlng and non-participating policies as required In Interrogatories 1 and 2 on ExhibitS to Life Supplement be filed with the state of domicile and electronically with the NAIC by March 1?
16. Will the actuarial opinion on non-guaranteed elements as required In Interrogatory 3 to Exhibit 5 to Supplement be filed with the state of
domicile and electronically with the NAIC by March 1?
11. Will the Medicare Part D Coverage Supplement be filed with the state of domicile and lhe NAIC by March 1? 18. Will an approval frorn U1e reporting entity's slate ofdornlctle for relief related to the five-year rotation requirement for lead audit partners be flied
electronically with the NAIC by March 1? 19. Will an approllal frorn the reporting entity's state ofdornlcile for relief related to the one-year coolillg off p6riod for independent CPA be filed
electronically with the NAIC by March 1? 20. Will an approval from the reporting entity's state of domicile for relief related to the Requirements for Audit Committees be flied electronically
with the NAIC by March 1?
APRIL FILING 21. Will the Long-Term Care Experience Reporting Forms be filed with the state of domicile and the NAIC by April\?
22. Will the Supplemental Life data due Aprll1 be filed with the state of dQmicile and the NAIC? 23. Will the Supplemental Property/Casualty Insurance Expense Exhibit due April1 be filed with any state that requires II, and, If so, the NAIC?
24. Will the Supplemental HEmlth Care Exhibit (Parts 1, 2 and 3) be filed with the slate of domicile and the NAJC by April1? 25. Will the regulator only (non-public) Suppleme11tal Health Care Exhibit's Expense Allocation Report be filed willl tile state ofdorniclle
and the NAIC by Aprll1?
AUGUST FILING 26. Will Managements Report of Internal Control Over Financial Reporting be flied with the state of dornlclle by August 1?
43
YES YES
YES
YES YES YES
YES
YES
YES
NO NO NO NO
NO
NO NO
NO
NO
NO
NO NO NO NO
NO
NO
statemelltasoroewmber31,2013oflhe Mid~Atlantic Vision Service Plan, Inc.
SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES
EXPLANATIONS: BARCODE:
1.
2.
3.
4.
5.
6.
7.
B.
9.
- 10. -
11. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 1 3 3 6 0 0 0 0 0 0 *
----------------------- -- -- ---------
· -~~~~~~~~~oo~~~rn~~~~mt-12. * 5 3 0 3 1 2 0 1 3 2 0 5 0 0 0 0 0 *
13. II!IIIIJIII~IIII [IIIIJIIIIJIIII~III [IIIIJIII~IIII Jllll [1111 !Ill [1111 [1111 [1111 [1111[1111!11
14. IMI~~~~~~OO~~~~~~~~m~ * 5 3 0 3 1 2 0 1 3 4 2 0 0 0 0 0 0 *
15. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 1 3 3 7 1 0 0 0 0 0 *
16. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0· 3 1 2 0 1 3 3 7 0 0 0 0 0 0 *
17. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 1 3 3 6 5 0 0 0 0 0 *
18. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 '1 3 2 2 4 0 0 0 0 0 *
19. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 1 3 2 2 5 0 0 0 0 0 *
20. llllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllmlnllllll * 5 3 0 3 1 2 0 1 3 2 2 6 0 0 0 0 0 *
21. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 1 3 3 0 6 0 0 0 0 0 *
22. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111 m1111 * 5 3 0 3 1 2 0 1 3 2 1 1 0 0 0 0 0 *
"' 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 1 3 2 1 3 0 0 0 0 0 *
24. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 1 3 2 1 6 0 0 0 0 0 *
25 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 5 3 0 3 1 2 0 1 3 2 1 7 0 0 0 0 0 *
26. 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 • 5 3 0 3 1 2 0 1 3 2 3 9 0 0 0 0 0 *
43.1
StatementasorDeCIImbar31,2013oflha MidRAtlantic Vision Service Plan, Inc.
Overflow Page NONE
Overflow Page NONE
44P,44L
statementasoroaoombar31,2013orule MidaAtlantic Vision Service Plan, Inc.
SUMMARY INVESTMENT SCHEDULE
Investment Cateoories
1. Bonds: 1.1 U.S.treaslirysecuri1ies .................... ..
1.2 U.S. govommentagoncy obligations {excluding mortgage-backed securiUes): 1.21 Issued by U.S. g()Vemment agencies ................................................ .
1.22 Issued by U.S. gevemment SfXJnsored agencies. 1.3 Non-U.S. go'rornmenl (including Canada, exoludlng mortgage-
backed securities) ........................................................................................ .
1.4 SecuriUes Issued by states, tenilorlos and possessions and p<Jiitical subdivisions In tho U.S.: 1.41 States, territories and poosesslons general obligations., ... 1.42 Political subdivisions of stales, territories and possessions and
political subdivisions general obllgatl()ns ........................ .
1.43 Revenue and assessment obligations ..... . 1.44 Industrial development and similar obligations .•.•.
1.5 Mortgage-backed securities {Includes residential and commercial MBS): 1.51 Pass-through securiUes:
Gross lnvostment Holdings
1 2
Amount Percentaoe
......... 0.0
. .......••.. 0.0
Amount
. ........... 1,011,097 .1.3 ................ 1,011,097
. ........... 1,532,915
........ 891,003
.....•..... 2,526,843
.0.0
... 1.9 ..•.•. 1,532,915
. .....•.. 1.1 ............... 891,003
.. 3.1 •...........•.•. 2,526,843 ............ 0.0
1.511 Issued or guaranteOO by GNMA. ..0.0
Admitted Assets as Reported in the Annual Statement
Securities Lending Reinvested
Collateral Amount
5 Total
{Col. 3+4) Amount Perwntage
.. ................•..... 0 ............ 0.0
........................... 0 .......... 0.0
............... 1,011,0g7 ......•.... 1.4
..... 0 ............ 0.0
•.. 1,532,915 .......•.. 2.1
..... ,891,003 ............ 1.2 .. ... 2,526,843 ........... 3.4
. ........................ 0 ......•.•.. 0.0
......... 0 .......... 0.0 -----------l-----1:512~1ss-uetl of[luafilnf600WFNMA afltfFHtMC.~ •. ====I=====-1.-.... -... -.... o~o- ==::::::::-.=::::::::::::- ::::::::::::=::::= =:::=.=:::::::::o~ ............ oJJI----------
1.513 All other ..•. 1.52 CMOs and REMICs:
1.521 lssuOO or guaranteed by GNMA, FNMA, FHLMC or VA. .. 1.522 lssuOO by non·U .S. Government Issuers and collateralized
by mortgage-based securities Issued or guaranteOO by agencies shown in Line 1.521 ....•..
---- ----- t523 -All other: .•. ~·:;:::::::::= .. ~::= .. ::-... 2. Other debt and other fixed income securities (excluding short-term):
2.1 Unaffiliated domestic securities {includes credit tenant loans and
hybrid securities) 2.2 Unaffiliated non-U.S. securities {Including Qlnada). 2.3 Affiliated securities.
3. Equity lnl€rosts: 3.1 Investments In muhml funds 3.2 Prelerrod stocks:
3.21 ArtiliatOO ........................... .
3.22 Unaffiliated ............................................... . 3.3 Publicly traded equity securities (exoludlng prelerrOO stocks):
3.31 Affiltatoo ..................................................................... . 3.32 Unaffiliated •..
3.4 Other equity securmes: 3.41 Affiliated ........... . 3.42 Unaffiliated ...................................................... .
3.5 other equity lnterosts including tangible personal property under lease: 3.51 Afnliated ...................................................................... . 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 oe<:upled by company .......................... .. 5.2 Property held for production or Income {including$ ......... 0 of
properly acquired in satisfaction of debt) ...................•. 5.3 Property held for sale (Including$ ........ 0 property acquired In
satlslaclion of debt). 6. Contract loans. 7. Derivatives
8. Receivables for securities ........................................... . g_ Securiltes lending {Line 10, Asset Page reinvested collateral).
10. Cash, cash equivalents and short-term Investments. 11. Other invested assets 12. T alai Invested assets ..•.
. ........... 0.0 . ·········--···••><•••••• ................ 0 .. 0.0
.............. 11,062,B80 . ..... 6,051,967
................. 51,389
.............. 12,937,359
.......•.... 0.0
... 0.0 . ~ :: .... :o.o·
.. 13.7 ............•. 11,062,880 .. .7.5 .............. 6,051,967
. .. 0.0
.... 0.0
..0.0
... 0.1 ..................... 51,369
... 0.0
.16.0 .............. 12,937,359
. ........ 28,741,086 .......... 35.6 ............•. 26,741,086 .... 0.0
. .. 0.0
. .. 0.0
... 0.0 .. 0.0
. .......... 0.0 .......... 0.0
.0.0 .. 0.0
.. 0.0
.0.0
. ........ 0.0 . ........ 0.0
.0.0 ..... 30,447 ........... 0.0
. 0.0 .. ~.633,947 ....... 10.7
................ 7168 000 .......... 8.9
.............. 30,447
. .........• 8,633,947
.............. 8C,638,932 ........ 100.0 ........... 73,470,932
5101
......•.• XXX .
...... 0
................ 0
........ 0
................ :: ..... :.::0
..0.0
.0.0
..0.0
........... 11,062,880 .......... 15.1 ... 6,051,967 .......•.•.. 8.2 ................ 0 ........... 0.0
..... 0 ............ 0.0
............... 0 ........... 0.0
. ....... 61,389 ............ 0.1
. ................ 0 ............ 0.0 . .......... 12,g37,359 .......... 17.6
........•.. 28,741,086 .......... 39.1 . .... 0 ........•. 0.0
..... 0 ............ 0.0
..... 0 ............ 0.0
......................... 0 ............ 0.0 . .... 0 ............ 0.0
................ 0 ............ 0.0 . .............. 0 ............ 0.0
.............................. 0 ............ 0.0 . .. 0 ..... 0.0
..0 ............ 0.0
. ......................... 0 ............ 0.0
...................... 0 ............ 0.0
.............................. 0 ............ 0.0
.............................. 0 ............ 0.0 . .... 30,447 ............ 0.0
. ... XXX.... . ....... J<XX .• ........•.. 8,633,947 .......... 11.8
... 0 .......... 0.0 . ........ 73,470,932 ....... 100.0
statemenlasoroecembsr3t,20t3oflhe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE A· VERIFICATION BETWEEN YEARS Real Estate
1. Book/adjusted carrying value, December 31 of prior year ................................... .
2. Cost of acquired:
2. f Actual cost at time of acquisition (Part 2, Column 6)
2.2 Additional Investment made after acquisition (Part 2, Column 9) ...... .
3. Current year change In encumbrances:
3.1 Totals,Part1,Column13 .............................................................. .
3.2 Totals, Part 3, Column 11 ..... .
4. Total gain (loss) on disposals, Part 3, Column 18
5. Deduct amounts received on disposals, Part 3, Column 15
6. Total foreign exchange change In book/adjusted carr~ng value: ·····NON··e· 6.1 Totals, Par\1, Column 16 .••
6.2 Totals, Part 3, Column 13 ...... .
7. Deduct current year's other-than-temporary impairment recognized:
7.1 Totals, Par11, Column 12... .. ........................ .
7.2 Totals, Part 3, Column 10 .....
8. Deduct current year's depredation:
8.1 Totals,Pari1,Column11..
8.2 Totals, Part 3, Column 9 ...
9. Book/adjusted carrying value at end of current period (Lines 1+2+3+4-6+6-7-8) .•.
10. Deduct total nonadmitted amounls ......
11. Statement value at end of current period (Line 9 minus Line 10) ....
·····························-----
SCHEDULE B ·VERIFICATION BETWEEN YEARS Mortgage Loans
1, Book value/recorded Investment excluding accrued interesl, December 31 of prior jl8ar ...
2, Cost of acquired:
2.1 Actual cost at time of acquisition (Part 2, Column 7)
2.2 Mdlt!onal investment made after acquisition (Part 2, Column B).
3, Capitalized deferred Interest and olher:
3.1
3.2
Tolals, Part 1, Column 12 ...
Tolals, Part 3, Column 11... ....................... ..
Accrual of discount
5. Unrealized valuation Increase (decrease):
5.1 Totals, Part 1, Column 9 .......
a. ~:talg:~:;:::;~~:~~:~~:~s~;~rl3:·~~;~~~·~~---·.···_······························· .·.·.·N.·.·()_·_·N.·.·.E··_·_ 7. Deduct amounts received on disposals, Part3, Column 15 ......................................................................... .
8. Deduct amottlzallon of premium and mortgage Interest points and commitment fees ....
9. Total foreign exchange change In book value/recorded Investment excluding accrued Interest:
9.1 Totals, Part 1, Column 13.
9.2 Totals, Part 3, Column 13.
10. Deduct current year's other-lhan-temporary lmpalnnent recognized:
10.1 Totals, Part 1, Column 11.. ............................. . .................................... ..
10.2 Totals, Part 3, Column 10 ...
11. Book value/recorded investment excluding accrued interest at end of current period (Lines 1+2+3+4+5+6-7-8+9-10)
12. Total valuation allowance
13. Subtotai(Line11plusllne12) ...
14. Deductlotal nonadmltled amounts ..................................................................... .
16. Statement value at end of current period (Line 13 minus Line 14) ......
5102
··················-----
S!alementasofDIICembera1,2013ofthe Mid .. Atlantic Vision Service Plan, Inc.
SCHEDULE BA ·VERIFICATION BETWEEN YEARS Other Long-Term Invested Assets
1. Book/adjusted carrying value, Oecember31 of prior year.
2. Costofacqutred:
2.1 Actual cost at time of acquisition (Part 2, Column 8)
2.2 Additional investment made after acquisition (Part 2, Column 9)
3. Capitalized deferred interest and other:
3.1 Totals, Part 1, Column 16 .. ,
3.2 Totals, Part3, Column 12 ..... .
ACC!ual of discount..
Unrealize<l valuation increase (decre<~se):
5.1 Totals,Part1,Column13 ... .
5.2 Totals, Part 3, Column 9 .. .
Total gain (loss) on disposals, P<~t13, Column 19 ................................................. .
Deduct amounts received on disposals, Part 3, Column 15.
Deduct amortization of premium and depreciation .......................... ..
Total foreign exchange change in book/adjusted carrying value:
9.1 Totals,Part1,Column17 ............................................ ..
9.2 Totals, Part 3, Column 14 .................................. .
------------110.-Deduct.current.year's.other.tllan.temporary.lmpalrmentrecognlzed:---------------~----
10.1 Tot<~ls,Part1,Column15.... . ....................... .
10.2 Totals,Part3,Column11 ....
11. Bookladjustocl carrying value at end of current period (Lines 1+2+3+4+5+6-7-8+9-10)
12. Deduct total nonadmitted amounts ................................ .
13. Statement value at end of current period (Line 11 minus line 12) ..
SCHEDULE D ·VERIFICATION BETWEEN YEARS Bonds and Stocks
Book/adjusted carrying value, DeC€mber 31 of prior year
2. Cost of bonds and stocks acquired, Part 3, Column 7 •....
Accrual of discount
Unrealizocl valuation increase (decrease):
4.1 Part 1, Column 12
4.2 Part 2, Section1, Column 15
4.3 Part 2, Section2, Column 13 ......................... . .................................................................................................. .
4.4 Parl4, Column 11 ......................................................................................... .
5. Total gain (loss) on disposals, Parl4, Column 19 ....................................................................... ..
6. Deduct consideration for bonds and stocks disposed of, Parl4, Column 7
7. Deduct amortization of premium .......................................... .
8. Total foreign exchange change io book/adjusted carr~ng value·.
8.1 Part 1, Column 15
8.2 Part2,Sec!ion1,Column19 ...
8.3 Part2,Sec!ion2,Column16
8.4 Part 4, Column 15 ...
9. Deduct current yea~s other -than-temporary impairment recognized:
9.1 Part 1, Column 14 ..
9.2 Part2,Sec!lon1,Column17
9.3 Parl2, Section 2, Column 14: ................................. .
9.4 Part 4, Column 13 ...
10. Bookfadjusted carrying value at end of current period (Lines 1+2+3·f4+5-6-7+8-9) ..
11. Deduct total nonadmitted amounts... . ......................... ..
12. Statemenl value at end of current period (line 10 minus Line 11)
5103
6 355
1 042878
(565 501)
___ __,10 128 526-
2 960 526
7 168 000
7168000
38,474,424
47 167 831
714
483 744
1108703
21913074
515 804
Q
64 806 538
64 81}{:1 ~8
statementasofDeC€11lber31,2{l13otthe Mid-Atlantic-Vision Service Plan, Inc.
Descrlollon
BONDS
Governments (Including all obligations
guaranteed by governments)
U.S. States, Territories and Possessions
Direct and_Jiuaranteed) U.S. Political Subdivisions of States, Territories and Possessions /Direct and ouarnnteed\
U.S. Special Revenue and Special Assessment Obligations and All Non-Guaranteed Obligations
of Agencies and Authorities of Governments
and Their Political Sllbdlvislons
Industrial and Miscellaneous and Hybri~
Securitles (Unaffiliated)
Parent Subsidiaries and Affiliates
PREFERRED STOCKS
Industrial and Miscellaneous {Unaffiliated)
Parent Subsidiaries and Affiliates
COMMON STOCKS
lndusl~al and Miscellaneous (Unaffiliated)
Parent Subsidiaries and Affiliat9s
SCHEDULED· SUMMARY BY COUNTRY Long-Term Bonds and Stocks OWNED December 31 of Current Year
1. United Stales.
2. ca~ada ......
3. Other Countries ...
4. Totals .......................... ..
5. Totals.
6. Totals ...
7. Totals ....
8 United States
' Canada.
10. Other Countries.
11. Totals ......
12. Totals ..
13. Total Bonds
14. U11lted Stales ...
15. Canada ...
16. Olher Counlries ........
17. Totals ...
18. Totals.
19. Total Preferred Stocks
20. Uniled States.
21. Canada ..........
22. Other Countries
23. Totals.
24, Totals
25. Total Common Stocks
26. Total Stocks ................ ..
27. Total Bonds and Stocks ....
BookJAdjusted Cerrvino Value
....... 0
........... 1 532 (.)15
.......................... 891 003
Fair Value Actual Cost
...................... 0 .. .. ' .......................... 0
............ 1551 606 ....................... 1657 740
...... 897 255 ,,g54376
Par Value
of Bonds
" ' ... 0
......... 1475 000
. ..... 825000
.. .......... 3 537 940 ....................... 3 577147 ....................... 3 734 670 ......... 3 460 000
..................... 11 ,062,880 .............. 11,197,120 ..................... 11,570,534 ..................... 10,850,000
..................... 2,283,177 ...................... 2,330,343 .......... 2,309,733 ....................... 2,250,000
....... 3 768 790 . .. 3 825 986 .................... 3 982 822 ....................... 3 700 000
.17114 847 "17 353 448 ..................... 17 863 088 ..................... 16 800 000
..................... 23 076 705
. ........... 51.389
......................... 51 389
....... 51 389
... 9,719,602
........ 163,919
.................... 3 053 837
,,23 379 458 ..................... 24 209 874
....... 51389 ................ , ..... 52 507
...... 51389 . .. 52 507
.... 51389 ...................... 52507
.,,, .. (.),719,602 ....................... 7,248,896
..................... 163,919
............... 3 053 837
.............. 141,087
. ........ 2426 944
... ' " .......... 12 937 35(.) ............. 12 937 359 .• 9 816 707
... 28 741 086 ...... 28 741 086 .. .......... 30 000 000
........... .41678445 .................... .41 678445 ..................... 39 818 707
............... .41 729 833 .................... .41 729 833 ..................... 39 869 214
' ............. 64,806,538 ................... 65,109,28(-l . ... 64,079,088
5104
................ 22 560 000
1.
2.
I II
StatementasofDecember31.2013ofthe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D ·PART 1A ·SECTION 1 11
Quality and Maturity Distribution of All Bonds Owned December 31, At Book/Adjusted Carrying Val~es By Major Types ?f Issues and NAIC Designations
NAIC Desionalion
1 , I 5 , 1 Year Over 10 Years Over 20 %from CoL 7 or Less Throuqh 20 Years Years PriorYesr
-10 Total
Publiclv Traded
ll s~E:~;~ :······ _ ...... . ······ ·························-· ····· 2~1 "1 • :~ :·····:~········· ··.:· ::: ~ :: •. :~· •·•···•· :_ .....••• 1 ·::=
7571
="j .:-.J:~1•! =··········=:•••·: • :····•••••••·!! I ················'·"
1
•
731
1.5 NAIC5............ ............... .......... ............... ..... .......... .......... . ..................................................... L......... . ...... 0 ..... . . .J .......... 0.0 ............................................................. 0.0 1.6 NAIC6... .............................. ...................................... ........... ................ ............. ....... ...................... ................................... .... ............. .............. ....... . .. ..!. ....................... 0 ............. J:.. ...•• JLO ••..••...•••..•••..• ..••.•..••.•• ..••..•••.••.•. . ..... 0.0 1.7 Totals ..................................................................................................... 7571731 ............................ 0 _ ... 0 .............................. 0 ·····················- ...... 0 ............. 7,571731 .......... J... ..... 24.3 .............................. 0 ........................ 0.0 ... 7.571.731
l"i Total
Privatelv Placed fa)
All Otl\£r Governments I'
ll ::~:································································ ·~ ······························=· .. : •.• ::::: ::_=······ ················=··········· : •.•....•••.•.•.....•. :.-·· : ·····:::_]·····~: -~-·······=················ .• :.:::·····-:: : =--::••• ···::··········:=•······ 2.4 NAIC4 ......................... ............................................. ................... .......... . ......... .................... .. .............. .... ...... . .............. J .......... 0..0 .............................................................. 0.0 ............................................. .
~~ ::g ~::~ ........................ . ............................... ······-···- ....... :::::::::::::::::::::::· :::~::::: ~:::::::~~:::~:::~:::~:::~:: ····:~:::::~::: ....... :::::::~- .......... ····················-·· n ::::::~--.:J ...... --~~ ::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::=~--~ . ::::::: .. ::::::: .............................. . 2.7 TotalS.......................... . ... •••••••••··-··-·· .......... ......... . ...................... - ... 0 .............................. 0 ............................... 0 ............................. 0 •••••••••••• ••••••••• ....... 0 .... .L. ••••••• ............ 0 ____ j ____ .0..0 -··· ....................... 0 ........................ 0.0 .... --··••••••••••ou••••••••O .............................. 0
3. U.S. States, Territories and Possessions, etc., Guaranteed I . I
;~ ::g ~-·:::::::::::.::::::::::::::::::~:::::::: .. ::::::::::::::: .. :::::::::::::::::::::....... ----~~-~-----~~--~~-----~~-~:-~-~-~-- ........ : .. ·.·:.:.·:.~~~-~4,299 ······- ····················::·:: ::::::::·~ __ :::::::::::::: .. ::~: ... :::::=~-~:=-·· ........... ····""j"········· ~ .. -~3~:~~-~ ::::::::::::r:. ::::::~:~ .... :::·:::.-.-~~:~-~-~-'-~-- ::::.--.. :::~::··::::··--~--~ ... 1,532,9151-- ····················-······I
~ :: ::~:.-.......... -_-.······-·· :·::::::: .................... ..... ·····=···· -: :~ ::: :::•: __ .-.--._ .... : ........ :::::: _-.. -.-:.[::~: ····················~············ ..................... :·:~: ............................... ···················::::.· "3.6 NAIC 6.......................................... .............. ........................... ..... . ..... ... ................................... .................. ........... .. ................................... . ................... -.0 ......... J... ....... 0.0 ............... ···-···--·-·· ---· ................... 0.0 ................................. ___ ............. ·····--··· 3.7 Totals......................................................... . ............................................... 508.615 ................. 1.024299 ........................... 0 ............................. 0 ............................ 0 ...... ~ .......... 1.532,915 ......... .L ......... 4.9 .............. 1.401,523 ........................ 2.3 ................ 1532.915 ............................. 0
4. U.S. Political Subdivisions of States, Territories and I I
Possessions, Guaranteed I
:~ ;:~g ~ ··:::: ............... ::.::.::.:.::: .. ::::::: .. :··--~--- ·:::::: .. ::::::::::............... _·_·_:::::::· ... ::·:.:·-~-~--~~-~- .:::::::··.::~_::·.:·.~~~·-~~- ==--=------=------- ::::.-.-.~---- ····-····-··· :::}~·-::::::·~~~-:~~~ ::::::::::::::.r.::::::::.-;.-~ ................. 1,923,266 ....... 3.2
.............. 0.0 ................. 891,003
5,
4.3 NAIC 3 ................................................................... ......... ................................... ....... ............ ............ ................................... ............ ..................... . .............................. 0 ............. L. ...... 0.0 ·······-··- .................. .. 4.4 NAIC 4 ................................................... ......... .......................... ........ ........ .... ........ ........... ............................. .... ....... .......................... ...... 0 . . ....... .J ... _ ..... 0..0 ........................ . 4.5 NAIC 5 ················-·····-··· ............................................................................................................ ····- ............. .............. ____ !___ ...... 0.0 4Jl NAIC 6 ............... ···-·····--···-··- ............... ............................... ............ ...... ............. ................................... .. ......................... .... ....... ......... ................ ........... . .... : ......................... 0 ............... l ......... 0.0 4.7 Totals ......................................................................... .
U.S. Special Revtlmre & Special Assessment Obligations, etc., Non-Guaranteed
230.811 ... 060,192 _o ----' I ---------------0
5.1 NAICL 52 NAIC2 ...................................................... .
..... .2.247,6791 ................. 1,290,261 •I= :1 ::::1· :::I- ······················! ·························I 5.3 NAIC3 ....... . 5.4 NAIC 4 ....................................... .
5.5 NAICS ........ ·········································•··· 5.6 NAICO .. . 5.7 TotalS ........................................ . .. .2.,247,679 ... 1290.201 .................... 0 I--·---·
.... l ..... ...... 891.003 .............. L ........ 2.9 .... 1.923.266
.3,537,940 ...... 0
. ........................... 0 ... !. ............... ~-----0
11'< _
1
.... 3,897.905
.t::H ::: I ...... L ......... o.o . ..!. ......... 0.0
.3,537.940 .J 11.3 ... .3,8_9.(:.905
______ o_o . .. 0.0 ... 0.0
Q,Q_ ... 32
.6.4 ···-··- ............... 0.0
... 0.0 . .... 0.0
........ 0.0 . ....................... 0.0
....... 6.4
891,003
.. 3,537,940
.............. 3.537.940 • .............. 0
6.
statementasofDeeemt>ar31,2013ot!he Mid-Atlantic Vision Service Planj Inc.
SCHEDULED- PART 1A ·SECTION 1 (continued) Quality and Maturity Distribution o! All Bonds Owned December 31, At Book/Adjusted Carrying Values By Major Types o! Issues and NAIC Designations
2 6 10 1 Year I Over 1 Year Total I Column 6 as a I Total from C\::llumn I %from Col. 7
NAICDesigna!ion I orlsss ___ Through5Years CurrentYear %ofline9.7 OPriorYear PriorYear Total
Publicly Traded
Industrial and Miscellaneous (unaffiliated)
6.1 NAIC1 .•••••.•.•••..•.•....•.•. ...:~~~~:I ::::::::::~··::~:~::~!~ 1 .................................. 1 ............... ................. ~ ................................ 1 15,012,504
2,059,979
.... 50.0
6.6 ... .52,074,078
1,149,581 ... 86.1 1"'"''""'""""'15,612,504
.. ...... 1.9 ............. 2,059,979
11 Toml
Privelelv Placed [a)
62 NAIC2... __ ...
6.3 NAIC3 ...
6.4 NAIC 4 ................................................................ . 6.5 NAIC 5 .................................... .,. .. .............................................. ! :::::::::::~:::::::::::::::::~:::1 :: :::::::::::::::::::::::::::I ::::::::::::::::::::::::::::::1''""""'"""'""""""'"""''""""''"'"''
1
.................................. .
... 0 1 .......................... 0.0 I .............................. .. o.o I · I ·I
6.6 NAICS ............ .
0.7 Totals........ .............................................................. ........... .. ............... 5 918 376 ............. 11 754,107 ............................. 0
...0
0
... 17.672.483
....... ~:~ 1~ :::::::::::::::::::::::::::::::1 .. 0.0
.. 0.0
.... 0.0 .. ............................................................ 0.0
.......... 56.6 .......... 53223 659 ..... - ......... 68.1 ..... -.17,672,483 ............... 0 7. Hybrid Securities
............................ 0 I···············
(J'J18.
g
7.1 NAICL ...... -..... ............................................ ..........•... ......... .............................•... I·········· .... ········1-- ························I 12 NAIC2.. ........ .
7.3 NAIC3 .. .
7.4 NAIC4 .... - ....................................... ..
7.5 NAIC 5 ................................... . .... ···················I······ ························I
... 0 1 ............................ 0.0 ..•....•...... ·········· .......................... o.o I I······ .. . .... ··I
... 0
• .. 0 .... 0
.. .. 0.0 ................................... ' ......................... 0.0
0.0 .................... . ............................ 0.0
•....•......... 0.0 ........•..... . ............................ 0.0 ................. ·- ·····I··········· ····················I . ....... 0.0 ............................. . .......................... 0.0 ........................... ..
7.0 NA.ICO .. . ......... .. .......................... 0.0 ...... .. .......................... 0.0 ................................................................... . 1.1 Totals .......................................... .. .... 0 .......... '""""'"'""''"O'Q ........................... 0 ............................ 0.0 ............................... 0 1 ............................. 0
Paren~ Subsidiaries and Affiliates 8.1 NAIC 1 ............. .
82 NAICL ................................................................... ····················I .................... ·········I··············- ·············I ................. ··············I ·---····························1···· ························I 8.3 NAIC 3 ........................... , .......... , -· ........................ _ .. · ....... , .... · ................... , ................................. ! ................ ··············I····· ··················-·····I
8.7 Totals .......... .. ..0 .. .......... o I ............................... o I ............................... o ......................... 0 ... 0.0 .... 0 ........................... 0
' "
statementascfDecember31,2013of!he Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D -PART 1A ·SECTION 1 (pontinued) I· ·
Quality and Maturity Distribution of All Bonds OWned December 31, At Book/Adjusted Carrying Va!ues By Major Types pi Issues and NAIC Designations
1 Year Over 1 Year Over 5 Years Over 10 Years Over 20 Total Column 6 as a 2 I 3 I 4 I 5 I ,~ ~ I I•' NAIC DesiQnation J or Less I Through 5"Years Throll1lh 10 Yemrs Through 20 Years Years , Current Year % ofiLine9:7
9.
9.7 Totals ... ___ _
9.8 Une9.7asa%ofCoLIL 10. Total Bonds Prior Year
10.1 NAIC1 ......................... .. I
Total from Column 6 Prior Year
9 %from Col. 7
Prior Year
10 Total
Publit:lv Traded
.. ......... 59,296,772 ............... 1,149,581
11 Total
Prfvatelv Placed (al
~6:~ ~~~~~o:7-~·;·%·-~r·c~~.·a:::· .. ···· .................... -.... ··----·-··· ::::::::::::::~:~~-=~,_: ___ ·.=:-~:-.:·23 '3 ~~3°s~~ =::··::~:::::::::::··::~o:~ :::::::::::::::··:::~-~:.o~: ···::::::::::~ _·: :::::::o:~ ::~~:·::::::~··.::::~~:: :::::· ::::~:.:··--···-· ~-~! .. ::::: .. ::~-~~~~03;~ .:·_·_::~---~:.·_·;;x::_1 oo.o :::::::::::::::~~ .. -~~~D3o~~ :::::::::::::.:~-::: .. :::o:~ ··--~- I
~ ~:: ::~ ::~ .. :~=:::~::.~~ .. :::=~- ........ .. .. ::::::=·::::: .. :::~::~· ................. .... .. ............ ::::::::::::~: :::::~:.:~:::.................... ............ ..................... ::.:::::::::::::·:= .. ::·::.... .. .. :::··:::~:=: .... .......... :::::::=: :::::::::=:::::::~ ........... :l.:·:::::::::~:~ .......... ::::::~ .. :::::·:::::~ ----:::::··:::::::::::--::::~:~ ............................... 0 ............. :XXX ...
.. ::~ I::::::::::::~::::::::::· 11.6 NAIC6 ................................................................................................................................. _ .............................. - ........ -........ ............ ..... ........................... .. ............................ 0 ............. .1 ............ 0.0 ............................... 0 .................. -....... ,0.0 11.7 Tolllls ................. ............................. . ............ 16,477,213 ........ - .... 14,728,660 .......................... 0 ............................... 0 ............................. 0 ............. 31,206,072 ....... ..1 ........ 100.0 ............... 60,446,353 ....................... 100.0 ... 31,206,.072
... 100.0 ...... 100.0
... .XXX .. .
~~:: ~~: ~~:~:: ~ ~~~~~ ~.r.·c;;r. s:·s-~ct-b;s: ....................... _. :::::~=·~:::::::~::::~:: ..... ::::::::·:::::.::::::;; ..... ::::::::::: .. :::::::~:~ ::::~:::~=::::::·~ .::~:~ ::::::::::::::::::::::::::::~:~ ::::: ·::::::--:::::::~~~:~ :::::::::::::~: ::::: ____ :::::::--:::~::: :::::--:::::~::. ...XXX .. . ... :XXX ...... ..
Q---~ I 12.1 NAIC 1............ ......... ................. ..... ...................................... .... .............. ....... ........ .... .. ......... .. ............. ................. ................. .. ...................... 0 ....................... 0.0 12.2 NAJC 2. ................ ................... ....... • ... . . ..... ............ .. ................... .............. .. .................... ......... ................... ............... .. ........................... 0 ....... ..l .......... 0.0 ............................. 0
~~:! ::~ !--: ....................................................................................... ··:::::::::::::·:::::::::·::: :::·::::::::::::::::::::::::::::::: ::::--::::::::=::: ·:::::::· ::::::::::: .. :::: .. :::: .. ::::: ............... -....... -......... -T::·~==.:::::=::::=~ ::=:::~::=l ::::: .. ::=6:~ ::: .. :--::::::=~~==·::::6 12.5 NAJC 5............ .......... .................... ..... .............................. . .... ................................... ... ............... ......... ............. ............. ..... ....... .......................... .... .............................. • ............................ 0 ............ J ........... 0.0 ............................ 0 12.6 NA!C 6 ..................................................................................................... _ ......................................................................................................................... -........... ....... .. ...... - ......... 0 ... - ...... J -------~0.0 ......................... 0 12.7 Tolll!s .................... .............. ................................................ .. ......................... 0 ............................. 0 ....... .. ............. 0 ............................. 0 ............................. 0 ---~··· __ ................ 0 .........
1
............ 0.0 ........................ 0
~;:: ~~: ~;:;:: ~ ~~~; ~-.:r.--c~La:·sedi~~-g~--~ ......... ......... :::::::::::::::::::·:::::::~:6 ............... :.::.:::.::6:b :::::::::::::~:--:~::--::~:~ ... ~::::·:::::::=:--::~:~ :::::::::::::::::::::::::::~:~ ::~:~=:::::.:::::::::::~:~ .... :~::::::~: ::::----· :::::::::::~:.. .. .... . (a) !ndudes $ ........ 0 freely tradable under SEC Rule 144 or qualified for resale under SEC Rule 144A. 1 I
(b) lndudes $ .......... 0 current year, $ .......... 0 prior ye<Jr of bonds with Z designations and $... ....... 0 current year, $ .......... 0 prior year of bonds with z- designations. The letter "Z" means the NAIC designation was not assigned 'bylhe Securities Valuation Office (SVO) at theda1e of the statement. 'T" means the SVO could not evaluate the obligation because valuation procedures for the security class are under regUlatory review. I
(c) lndudes $ .......... 0 current year, $ .......... 0 prior ye<Jr of bonds with 5" designations and $ .......... 0 current year, $ .......... 0 prior year gfbonds with 6'" designatiollS. "5"' means the NAlC designation was assigned by the SVO in reliance on the insurer's certification that the issuer is current in all principal and interest payments. "6" means the NAIC designation was assigned by the SVO due to inadequate cerlilicetion ofpr~cipal and interest payment{
(d) Includes the following amount of non-rated short-term and cash equivalent bands by NAIC designation: NAIC 1 $._ ....... 0; NAIC 2 $ .......... 0; NA!C 3 $ .......... 0; NA1C4 $ .......... 0; 1 NAIC 5 $ .......... 0; NAIC ~;$ .......... 0.
............. 0.0 ............. .XXX............. .. ..................... 0 .............. 0.0 ............. .XXX............. . ...... _ ................. 0
... 0.0 ............ .XXX... ......... .. ............. _ ..... 0
... 0.0 ............. .XXX............. .. ...................... ,_,0 .... 0.0 .... _ ...... .XXX. ...... .. .......................... 0
........................... 0.0 ............. .XXX. ...... ....... . .......... 0 ..................... 0.0 ............. XXX.... .. ............................. 0 .. .... .XXX. ........................ .XXX. ..... • ........................ 0.0
... .XXX.... . ........... .XXX..... . ............ 0.0
(I) 0
"'
statementasofDecember31,2013of!hs Mid-Atlantic Vision Service Plan, Inc.
Distribution by Type
SCHEDULED· PART 1A ·SECTION 2 Maturity Distnbution of All Bonds Owned December 31, At Book/Adjusted Carrying Values By Major Type and Subtype of Issues
1 Year or Less
2 I 3 .
1
4 I , I , I 7 I , Over 1 Year Over 5 Years Over 10 Years Over 20 Total Column6 as a Total from Column Through 5 Years Through 10 Years Throuqh 20 Years __ Years Current Year %of Une 9.5 6 PriorY ear
%fromCol.7 Prior Year
10 Tote!
PubliclvTrsded
11 Total
Privately Placed 1. u.s Governments
2.
3.
4.
1.1 Issuer Obligations.............................................................................. . .. 7,571,731 .................. ......... ..... ........ ....... ......... . ............................................. .7,571,731 ........................ 24.3 ........................ 0.0 ............... 7,571,731 12 Residential Mortgage-Backed SecuritieS ............. ........... .••• ........ .................. ............................ ........ ......... ............ ................... . ............................. 0 ............................ 0.0 ................ ........ ... . ......................... 0.0 .............. ···--·········---···-··-----· 1.3 Commercial Mortgage-Backed Securities..... ...... ....................... ..................... .............................. ............... ..... ........... ......... . ............................ 0 .......................... 0.0 ................................... 0.0 ...................... . 1.4 Other Loan-Backed and Structured Securities ..................................... .................... ..... ............. .......... .. ........ ...................... .. ........ . ............................. 0 .......................... 0.0 .................... . .................. 0.0 ....................... . 1.5 Totals..................................... . ........................................................... ? 1.731 ............................. .0 ............................ .0 ............................. 0 ........................... .0 ................. 7,571,731 ........................ .24.3 .............................. ] ......................... .0.0 .............. ..7.571.731 ................... - .. .0
All Other Governments 2.1 Issuer Obligations ....................... _,_,..... .... .................... . .................... . 22 Residential Mortgage-Backed SeC'Jrifies .. .
. ..• 0
...• 0 ............. 0.0
...... 0.0 ... 0.0
0.0 ... 0.0
............. 1 ·······························I 2.3 Commei"Clal Mortgage-Backed Securities ... 2.4 Other Loan-Backed and Structured Securities .. 2.5 Totals ................................... ···-··-·-· ............... .
U.S. States, Territories and Possessions, Guaranteed 3.1 Issuer OOUW~tions ........................................ . 3.2 Residential Mortgage-Backed Securities •... 3.3 Commercial Mortgage-Backed Securities ................ . 3.4 Other Loan-Backed and Structured Securflies ................. . 3.5 Totals............................ . ............................. .
U.S. Political Subdivisions of States, Territories and. Possessions, Guaranteed
4.1 lssuerObiTgetions ... 42 Residential Mortgage-Backed Securities ... 4.3 Commercial Mortgage-Backed Securfties ................. .. 4.4 Other Loan"Backed and Structured Securflies .. . 4.5 Totals .. ··········-··-··- ........................................................... ..
..... 0 ... 0
.. 508,615 . .. 1,024,299
.......... .508.615 1 ................. 1.024,_299
230,811 1 .................... 660, 192
... 230,811 ...660,192
......... 0
.. 0
....... 0
........ 0
......... 0 Q
..... 0
...... 1,532,915 0
............................. D ......................... 0
a 1 ...... .............. 0 1 ................. 1,532,915
.... 0 I .............. .
891,003 . .. 0 . .. 0 __ o
... 891,003
. .. 0.0
. .. 0.0
. .. 0.0
. .. . .. 0.0
. ....... 0.0 .. ............ 0.0
......................... 4.9
... 2.9 ···-···- ................ 0.0
0.0 ... 0.0
...... .2.9
............. 0
1,401,523
.. 1.40t523
... 1,923,266
............. 1_,923.266
........................ 0.0
........................ 0.0
... .2.3 .......................... 0.0
............ 0.0 ... 0.0
.. ......... 2.3
... 0 1 ..................... - ..... 0
... 1,532,915
.. 1.532.915 ........... 0
..... 3.2 1 .................. 891,003 ... 0.0 ... 0.0
..... 0.0 .... 3.2 ... 891,003 ... 0
5. U.S. Special Revenue & Special Assessment Obligations, etc.,
6.
7.
Non-Guaranteed 5.1 lssuerObiTgations ... 52 Residential Mortgage-Backed Securities ... 5.3 Commercial Mortgage-Backed SecurilieL .. 5.4 Other Laan-Bacl<ed and Structured Securities ........... . 5.5 Totals ........................... .
Industrial and Miscellaneous (unaffiliated)
... 2,247,679 ....... 1,290,261
.2.247.679 .... 1.290,261 ... 0
...... .3,537,1340 .... 0
..................... 0 .. . .0
3.537.940
..... 11.3 ... 0.0
...... 0.0 ... .0.0
........ 11.3
... 3,897,905
.3.897,905
. ....... 6.4 ...0.0
.. ... 0.0 .. DD . .. 6.4
..... .3,537,94-0
......... 3.537,940 I _ .......................... o
0.1 lssuerDbllgalions ................................................................................................. 5,918,370 ............... 11,754,107 ........................................... 17,672,483 ........................ 56.6 ............... 53,223,558 ........................ 88.1 ............... 17,6n,4S3 62 Residential Mortgage--Backed Securities....... ............... ....... ... ... ............... ........... ........ .. ............................. 0 .......................... 0.0 .......... . ......................................... 0.0 6.3 Commercial Mortgage-Backed Securities ..... ...... .. ............ .................... . . ............................... ............... ..... ...... . ............................. 0 ..•• .. .......... 0.0 ........... .. ........................ 0.0 ............................................ . 6.4 Diher Loan-Backed and Structured Securttres ··--··-···-- ...... ............. ........................... ...... ........................ ......... .......... ...... ............ ............... . ............................ 0 .... .... . ........ 0.0 ................................ . ....................... 0.0 ...... . .......................................... .. 0.5 Totals ............................................... ,.. ................................ · .............................. 5.918.376 ............. 11.754,107 .............. o ........................ 0 ......................... 0 ............... 17,672,483 ......................... .55.6 ............... 53223.658 ............•........... 88.1 ............. 17,672.483 ----·---·--·--·---·-····{)
Hybrid Securities 7.1 Issuer ObiTgations ....................... . ...... . 7 2 Residenfial Mortgage-Ba~ked Securities ........................... .. 7.3 G.lmmercial Mor'.gage-Backed Securffies ..... . 7.4 Other Loan-Backed and Structured Securifies ... 7.5 Totals ........................................... . """"""""""""""""""'""" ....... 0 I .... ..0 .0
..... 0 .............. 0
... 0 0
.. 0
...• 0.0 . .. 0.0
. ........................ 0.0 0.0 0.0
. .. o.o 1 ............ + .. 0.0 .0.0
................ 0.0 _____ o_o ....... ., ••. 0 8. Parent, Subsidiaries and Affiliates
:~ ~~;;r:!;?Ei;::~:};;:::~~:_::::: ......................... ~.:::_:_:_:::_:_:_::1~:::=:::::: ·········- :::::::1 Q
..... 0 ~~ ~~~ L~~-~~~~~~~-~~~-~~~~~-~-~-~e~::: ...... ·:::::::::::::::::::::::::::: 1·::::::::::::::::: ............. 0 ........ 0 ........ 0 ... 0
:: I I ... 0.0
.0.0 ...... 0.0 _____ o
......... 0.0 ........ 0.0
0.0 ... 0.0
...... 0.0 ···-··--·--····--·--·------0
Cl>l 0
"'
9.
' "
Stltement as of December 31, 2013 of lhe Mid-Atlantic Vision Service Plan, Inc. I
SCHEDULED- PART 1A- SECTION 2 ;(continued) . Maturity Distribution of All Bonds Owned December 31, At Book/Adjusted Carrying \(alues By Major Typel~nd Subtype of Issues
Distribufion bvTvoe Total Bonds Current Year
9.1 Issuer Obffgalions ............. . 92 Residential Mortgage-Backed Securities ...... .. 9.3 Commercial Mortggge--Backed Securftfes .. ..
9.4 Other Loan-Backed and Structured Securllies ..... - .............. . 9.5 Totals ............................. .
1 1 Year or Less
16,477,213 ...0
2 Over 1 Year
Throuqh 5 Years
... 14,728,860 _ .............. 0
........................ o I ......... - ................... o
3 OverS Years
Throuqh 10 Years
_o .. 0
..... 0
4 Over10Years
Throuqh 20 Years
.0
.0 ... 0
.0
5 Over20 Years
...0
... 0
. .. 0 .. .. 0
. 0 1 ........................... 0" 9.15 Une 9.5 as a% of Col. 6.... ... .................. .......... • ......................... 0.0
6 Total
Current Year
I' q"olumn 6·as a %ofUne9.5
8 Total from Column
6 PriorY ear
9 %from Col. 7
Prior Year
10 I " Total Toial PubliclvTraded Private!v Placed
II
.... ::~::~::: 11 ~:'0.11 : s·······~ l.~:•s.•~•~-1······ .. : 312:
6
:
0
:1; ;- .. :::;;
.. )()C
, .
.31~~~~0:.~ .·~.·.]~~·~.·~~~.~~-~~~. ...::::::: .. :~... • ........ :::::::::~::: ::::::::·.::::::~~.~~~~0:.~ :::::::::::~ .. :::::::::::~:~ 10. Total Bonds Prior Year
~:: ::~:~E~:~~===;::: .. ::: .. :~ .. · ·::::::: :::.: : :~·-· . -- ··~· ·1~§:::: •. --60.4;'-:,r; ::~'0.11--::04~6.:53 _:~:::: 10.1 Issuer Obligations ................ .. 36,803,418 1 .............. 23,317,097 ........... , .................. 525,839 ; ....................... ·'I
~~:: ~~~~0~·~~·;:~ 0~·~~;:·~ .. ::::::::~ .. :::::~ .. :::::::: .. ::~~::::::::::::::::::::::: .. :::::: :· .. :: . .-.. ::·.·.:~.~:~.~~~~: ........... ~.:~~.~::.~ ::::~_:·::::::::~:.:::::~:~ ... ::~ .. :=::: .. ::~~:~0~: ·-·::.::::::::~: .. :: .. ::~:~I~~=: ... :=:::. ...::J::::::~:::... ::::::·.:::::=:~.~:~~;:~ .. ::~~· .·~~.·.·~:~oo.o ::::::::::·.::::~~ ... ~~~~~ :::::::::::::::::::~:~::~~~
11.ii~ ~~f{f~~~~JI~~~:~:::.;~ -~:=:·-~:;: ::1~4~·':': ;:;~1~:~860 :::-:~ : :::_::•:: .. : :~31,':"_0:1 :1::::~:10!! - : .. 60,~6~3~~ ·: .. :::: .. ::::·::.::I:' ::••••••••= : 1:::=~··········· ... 100.0 ... 0.0
... .XXX .. ..
... .XXX .. .. ... 31,206,072
... 0
:::~::~~~-:=:~::~,:~~~:~16,Se~oo9 ::: .. _ -16
·~~~~ ·~-~~7::~ : :::: ..... :::.::::::: ::~······· ::1 : ~1
~~~:::: :J ~:10
~0
:.:~~~:~~~•··· 1UO.O
.. XXX. ... XXX ...
...... 31,206,072
100.0 1DO.O
.... .XXX .. .
.... .XXX ..... .. . .. .XXX ... ..
2---~ I i1i~:::~~::~:::~':::.:E:.::=: .. :: ·:: :~::::::::· :::: -················ ·::·- ::_I::=::: ::~.::1 :~~: ::·:f2: :=:.:=.:: 12.4 Other loan-Backed and Structured Securities.... ............................. ....... ........ ...... ... ................ .. ........................................... -..... -... ...... .. ........ 0 ...... L. ..... ...0.0 .............................. 0 ............. 0.0 ............ .XXX...... ..... .. ...................... 0
~:: ~::~:i:::~=~:~~;~;,;~;=~·~· .. ············ .... ................. :::··:::::·•:: . •. :: ·:::::···~:: ······:: :: ::····:::••••••::: 1.::::.•• : :: .. i •.•• ~···:::o ::. :: 0
• : ~:0
:~. : ... ·········2::·······~·······:::.······· .. ::
en :;: 0
Statem~ntasofDecember31,Z013oftfle Mid~Atlantic Vision Service Plan, Inc.
SCHEDULE DA ·VERIFICATION BETWEEN YEARS Short-Term Investments
Total Bonds Mortgage
Loans
4 Other Short-term
Investment Assels_(a]_
Investments in Paren~ Subsidiaries
and Affiliates
1. Book/adjusted carrying value, De~ember31 of priOr year ... ...................... .-................................•.......................................... .32.,322,883 i ... .32,322,8831·····- ..................................................... 1 .. ,,,,,,,..,,,..,,,,,,..,,,,,,,,..,,,,,,,,, '''''''"'"''
2. Cost of short-term investments acquired ................................................................................... . . ...•...•...•......................... 462.,883,375 • .. 462,883,375 I································ ·I·····............................................ 1
3. Accrual ofdiscounl... .... o ;· ........................................ ············I························· I
4. Unrealized valuation in~ase (decrease) ....................................................................................................................... 1 ........................................................... 0 , ................ , . . ............................ ,............................................................. I
5. Total gain (loss) on disposals .......................................................................................................................................... j ........................................................ 0 1 .......................................................... , ................................................................. 1 .......................... , ......................... ,.......................................................... I
6. Deduct consideration received on disposals ... . .............................................................. ' ......................................... 487,076,890 ............. 4fl7,076,890 ....................................................... .
7. Deduct amortization of premium ........................................................................... . •••••••••••••••••••••••••••• ... •- I ... •••••••••••••••••• .. ••••••••••••••••••••••• ... •• •••••• 0 I•-•••
B. ToOl fureigo ,_,,, oh.ogo io '""'''"'"' omyiog .,,,,, ................................................................................ 1 ............................................................ 0 1 .......................... ······
9. Deduct current year's other·lhan-temporary impairment recognized .............................................................................. ! .......................................................... 0 1 .......................................................... ! ............................................................... 1--... -- ..................................................... 1············-.. --.. --....................................... ~
10. Book/adjusted carrying value at end of current period (Lines 1+2+3+4+5-6-7+8-9) .......... . ......................................................... 8,129,367 ] .............................................. 8,129,367 . .. 0 .. 0
11. Deduct total nonadmltted amounts ... ..0 ........ ..
12. Statement value at end of current period (Line 10 minus Line 11 ... 8.129.367 ... 8.129.367 ... 0 ..................... 0
(a) lndicata the category of such assets, for example,jotnt ventures, transportation equipment: ••
-------~·-------- ---- ------ - ---· -------.
S!alamentasofDIIGffillber31,2013orlhe MidRAtlantic Vision Service Plan, Inc.
Sch. DB-Pt. A-Verification NONE
Sch. DB-Pt. B-Verification NONE
Sch. DB-Pt. C-Sn. 1 NONE
Sch. DB-Pt. C-Sn. 2 NONE
Sch. DB-Verification NONE
Sch. E-Verification NONE
Sch. A-Pt. 1 NONE
Sch. A-Pt. 2 NONE
Sch. A-Pt. 3 NONE
Sch. B-Pt. 1 NONE
Sch. B-Pt. 2 NONE
Sch. B-Pt. 3 NONE
5111,5112,5113,5114,5115, E01, E02, E03, E04, E05, E06
m 0 ....
Sti!tementasofDe~ember31,20t3of!he Mid ..Atlantic Vision Service Plan, Inc.
'
CLISIP entffir::atior
14599999.
' '
I Oo
' I s
Cilv I Sta
SCHEDULE BA ·PART 1 Showing Other Long-Term Invested Assels OWNED December 31 of Current Year
6 I T I B I 9 I 10 11 12
I "'" I "" I 'w· Desig· Originally arui nation Acquired Strale!
Name ofVeruior """" Oo ~-
Book/Adjusted Carrying Valoe
I L•o
'"
13 14 15 CUrrentYear's ClllleTJ!Yea~s
Unrealtled (Daflreoiation) Olher·Tllan-Valua!ion or Temporary lr.crease (Amortization) Impairment
fDecreasel /Ac:re!ion Re<:or:mized
'" '" '" " " Total Capi!a~d Foreign
I Deferred
-~· Interest Cilallflein Investment lrldoth(!f BJA.C.V. lnwme Ownersi11
··-·····390,218 ····-·--··· ··-··100.0 .-395,218 ··-·-····-·-·0 ....XXX. ....
. ... ..395.218 ··-·-· -··- •. 0 •. ..XXX •••
----· --- -·-
m 0
"'
' "
statementasofDecember31,2013oflhe Mid-Atlantic Vision Service Plan, Inc.
Name or Description
SCHEDULE BA ·PART 2 ' ,,
Showing Other Long-Term Invested Assets ACQUIRED AND ADDITIONS MAD~ December 31 of Current Year Location o --
3 I 4 Date I TYI)e I ActtJatCQst Nam~ of Vendor
or Gmeral Partner
NONE
Additional Investment Made After Acquisition
'" Amount of
Encumbrances
g
statementasofDecember31,2013ofllls Mid-Atlantic Vision Service Plan, Inc.
ClJSIP ldB!llffi""tian
4599988.
4699999.
N~meor
DescrtDlion
SCHEDULE BA • PART 3 Showin the Current Year
LDca!ion 6 8 Change in Baok/AdiLISted CarTVinQValue 3 I 4 I I 9 10 I 11 I 12 13
BookiAdjusted CurrerrtYeaL's Cul11lrrtYear's Carrying Value llnrealized ,,., ... ,00, ,.,_Th~ I c.,, ... , I ,,,
,. I I ~ Val,.,~on or Temporary Deferred Change in Name of Purchaser or I Originally Disposal Encurnbranr;:es, Increase (AmortiZ!ltion)l Impairment Interest BJAC.V.
Ci!v ~~- Nature of Disposal Aoquired Date PrbrYear (Dacrease) Accretion Recognlzed and Other (9~10-11~12·
" " " 1B I 1B I ~
" Total Baok/fo4111Sled Foreign Carrying Value
E:<cha~e "" Total Change in Encumbrances Gain (Lass) I Investment BJA.C.V on Disposal COTJSideration on Dis ()Sal income
~·.:~:: \ .:::::~:=~= \ .. := .. ::~-:=~ \ ·~:~~::::::::~ \ ~::~:~:~=· ...... 2.960.520
.. ~1 ~·"·""•"""--=' I .............. u I ................ '
' "
statementasofDecember31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
CUSIP ldentiftcation
130638 AB 1$067J LB
452151 ZK I 641461 HU
349460 R4 9
002409 FR S0374Y XN
1899999. 2499999.
13066Y PQ
13066Y QS
m 207737 FY
0 303867 ES 2133XV NU
""''" ~"'"~ 3199999.
00206R AV 020050 S(
025rn> AT
"""' HJ 0258MO D~
0556BP 3G 06739F FZ 06740K ~
0731l5T AJ
073902 KF
12189T AW
"'"' "' 252445 AC 36159S ZT 36160)( UA 36962G 4G
361426 7C 46625H HR $4918 AB
ILSTSERA..
INvST-CAPI
I Ban::layS Bank I
""
~~~~~-~
,
Descriplion
LLC.
SCHEDULED· PART 1 Showing all Long-Term BONDS Owned December 31 t Year
fuM
I ' 1!1 ' I '
"'" D<lsig natior
.. 1FE
. ............. 1FE
-·-·····-· .. 1FE
-~······1··1········'1-'" -·····-····· .. ~- .. ··-·····-· .. 1 FE .• ............ ..1 FE
--·- ...... 1FE .............. 1FE
Act!JaiCosl
B
, .. Used
fu Obtain
"" Value
---------260.845 1 .... .108251 _ ... 530,915
"-"'
. .. .XXX ..
9
Fair
"~
........ .239,695 ...... 103.052 ____ , ...... 237,020
...... 1.024,505 ...... 100.620 .............. 1,006,200
to I 11
Par Value Book/Adjus-ted Carrying_Value
- .237,713 508,615
..... 51,506 ...... 73:
··1-·1·············"' ··-·- .. -- ... 1FE
··-·- .................. 1 ....... :~::~::~: ::~~~:~ ::~~~~=~:: I::::==~~~~::~~ .... .233.002 .. 1,002.368
127,013
·-----107,201 .......... 1,011.097
.. 1FE
............ 1 .. 1FE
$ .... ------------1 •.... . ...... ······' I
····-·· ~::~ .. ·- ::::::: ::~~~ $..... R ------- ...... 1
R ..... ..1FE
$ .....
..................... .. ...... 1 .2FE
""'
.. 1,379,840 ... -102.690 __ .250,000 __ 10!l.900
·:::~~:: :::::~~~:1 :::::::: .. ::::~~·~~ ..... .251l,58S ...... 100.584
25tl.OOO ........ 99.770 .2,0"83,102 ...... 102.350
..... .250.00!)
............ 572, 130 1 ...... 104.516 _____ .... 791,005 ...... 107.848
... - .... 1,105,670 ...... 104.443 $ ....... ------ __ , -----------250,000 ...... 101.893 ............... 254.733 ..... R ............ 1FE .............. .566,755 ...... 108.377 .............. .S41,885 s..... . ................. 1 .......... _ .250,000 ..... .100.22.7 ................. 250.568
........................... S--· 1 ............ 250,0!l0 ...... 100.918 ................. 252,295 ......... --····- .• 1FE ... - ........ 267.418 ...... 108.0!l3 ................. 257,508 $ ___ .................... 1 ........ 50,000 ...... 101.929 ................. ..50,965
-·-·· :::~::1~ :::::: ::: :::~::::: .. :~~~~;: :::::~~~~ ::: .. ::~::~;~~~:::
1,361,027 .• .250,000
....... 20. o.ooo I .......... .200.000 50,000 ................ 50,000
.... .250,000
.... 250,000 1,900,000
____ 250JIQO
....... 500,000 ...... 700,000
250,000 ................ 524,093
_______ zso.ooo
'""' .......... -50,000 .............. .20~,913 .......... 1,006.556
, I " cu+-nt
, Ye~r's Unrealiz~d Curren! OlherJThan-ValuatiO)l Year's Tempprary
(~~:S~~l (~=~n)l =~~~
--- .(1". ..... (35,49E ..... (85",291
. ....... (65,291
" " " " " 20 " 22
Total Foreign Admitted Amount
_, Exchange Efle!:tlve Am~unt Received Conlfactual Change in ,,. Rate When Due and During Maturity BJA.C.V. of of ~aid Accrued Y~; Acquired Date
·: I• ...... ..6.000 '"r· ............ ..2,813 .......... -11,250 0910712010 1010112015 ........ 3.500 ...... 0.053 JJ ....... . .......... .8,750 .......... 17,5fl0 0710112010 07/01120~
........ s.ooo ..... .2.613 JD ....... ............... _.208 - ............. 2,500 07113/2010 06/0ll2015 .•••• S.OQ_Q_ " ..... .1.4D91Jo _____ ............ .2.917 .............. 35,000 1110312010 06/0112015
I
........ 5.000 ~------0.8511 FA .... -~---·· __ . __ ... 5.500 ......... 1.699 AO ..... .
0410412012 0211512017 1210812010 1010112015 11/1at2010 12/ll112014 .... 4.000
........ 2.500 ........ 1.506 .... 2.000 ... 1.261
.5.000 ....... 1.007
.......... 5.000- ..... 1.0821""- .... I
........ 2.750 ...... 1.562 JD ..... . .............. 1,451 .... 5.000 ...... 1.335 FA .................. 20.833
. ... .XXX ......... XXX ..•
1110312010 05ill11:2015 11/0112010 05!0112014 12/0IS/2010 061011201~
1210612010 0711612014
0210112011 1211212014 t210612010 081011201!
.XXX...... .. . ..XXX ·-
.. .2.6n0 ......... 1.986 FA.. . ............. 12,750 ............. .33,750 0612.912011 OS/1012010
-- .... 1.4ll0 , ..... 1AOO FA.. ................... 1,247 ................ 3,500 Oa/1612011 081241201! ....................... . ......... 1.450 ......... 1.449 JD ..................... 238 ............... .2,900 0512612011 061021201~
......... 2.050 ........ 2.050 MN ............ 110 ................ 1,DZ5 11115/2011 11123/2016
············-··· .......... 1.300 ......... 1.220 JJ ..... 1,3n .... _ ................ 0712512013 0712912016 ··--- ............. ------;0.750 ------0.750 JD ........................ 98 ................... 940 0611012013 06!1312016
... .5.200 . 1.091 JJ .............. 46,93!1 ·········- .98,800 0612912011 0711012014 ...... • .. 4,77B 1112612011 1ZI0712016
........ .28,Sll0 11/DS/:2010 11115m14 ........ - ... 37,100 11/0312010 10/SD/2015 ............. .48,750 Ofi/2912011 0111512015 .............. 5,000 11/0212011 11104/2016
. ..26,5fl0 07120/2010 1om/:2015
..... 3,625 06/0112011 OS/031201~
..... 3,625 0811612011 08!191:201~
............... 9.375 06/1612011 1111412014
I 1
·- --------~· --------~------ - ~-- .......... 1,000 1010512011 1011212010 .......... JAoo ...... .2.391 Jo .................... _.132~-- .......... s.aoo 1111512010 081:241201: .......... 2.950 ....... 1.359 JO .................. 2,456 ........... .29,500 0210112011 06/0112014
~
statementaso!Decernber31,2013oithe Mid-Atlantic Vision Service Plan, Inc.
CUSIP ldenttlirn~fion
78008T L8 BIROYAL 797«0 BG 8 SAN l 822582 AH 5 SHEL
86311M AA
8911~ AB
BS114Q AE 811\.JI'\\.JNIU·I 89233P 4R 4 TOYOTA
B2344G AW 6 VERIZON 9l1142 DF 94980V AA SIWEllS .... ______ _ 95B802. AJ B WESTERN UNION C0J
1:19119 46 B WORLDS
I El912.1 86 0 WORLD
'
_Q_~scnption
r • 1~1 • I ' 7
SCHEDULE D ·PART 1 Sho~ng all Long-Term BONDS Owned December 31 of Current Year
8
R,_ Used
• Obtain Fair
Value
'" "
~' Value P>lrV<
11
" 13
c~• Year's
Unrealized I ,_ I Other-Than-Valuation Yeara Tempora<y
Book/Adjusted I Increase/ (Amortization)/ Impairment r:om~;nav~r,.., (Decrease] Aflcll'!tinn R"""rmm.t
-·-·-·-·····.9ff6,62.2 •··· ·····-----405,348
.501,120
...• 1,017,483 , .....
• 1,013,229 __ ,.,_,,,_.408,701
- ......... 726.543 ,_,, _____ .494,314 , ..
---·---...... (4.1S5) ... {1~1111
-------------- ·------ ·.:~.:~--1 s:~~ I:: I ::::::::.:1~~~~ I ::~~ :::~~:~~:~~~ ::~~~~~-~I~~:=·--------· ... 1,024,550
--- .... .301,797
·----·- .. ..200,000 .... .200,000 •. .100.029 17,863,068 ,,..)00(.., __
15 -,-,-1 ,r- 1 1a 1 1s ~ 21 22
_: __ ::I :~::~l 1 ?'ill
I me.
m ~
~
I II
StatementasafDacember31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D ·PART 2- SECTION 1 Showing all PREFERRED STOCKS Owned December 31 of CurrentYea1
' i'" ; ; ; • Fair Value " ' Dividends
• ' I w
I I " I I 13
I I" I 13 F
" Rata Per
·~~--I I I
Am .. m I ,..~dmi .. d I "·~~~~d • "' •oo• Used to OooloJd I
I Code ~ Number Value - A!ljusted Obtain Recerved Declaretl Valuation
CUSIP I Desai])t!On
of '" '" Carl)llng Fair Fair Actual llut' During l:but lncre:osel Identification Shares 9hw 9h>re Value Value Value "" Un aid Yaar Unpaid (0~1
Preferred stocks - Industrial and Miscellaneo!IS Unalliliate I I' l204418 40 ~~~!A PARANAENSE ENER-SP ADR P~---·--·-- ·-·-····j ::······ R. - ...... 1,411.000 ·····-·- .......... --.13.140 ·····- _______ .18,541 ..... 13.140 I···-··
926062 40 2 VOlKSWAGEN AG-SPONS ADR PFD _______ ..•.. ·····-·····- ..•.. R .. ,_ .... , .. .562.000 .•..•......•..•..... ...... _ -·-· ,_ .. 32,&48 .•. ..56.440 8499999. Total- Preferre~ Stocks -Industrial and Miscemaneous v .. f!il. ····-·····-·-··-·--···-... ·--··· ·-··· ····-···· 51,389
-·-··
16 I cu;~nt Year's
'"'"~ ''~"'d n.o~ Year's Temporary
I IAm~;'a'tion)l lm~irment ~n RecogniZed
" T""'
Cllange
'" B.IA.C.V. 115+16-171
19
Total Foraisn
Exchange Change
'"
20 I 21
BJA.C.V. uT.W
~ 1.~.;.~.~~
stat~m~ntasiJfDecember31,2013oithe Mid-Atlantic Vision Service Plan, Inc.
CLISIP lc!enlifica~on Descri]llion
Common Slocks·lndustrial and MisceHan2ous [Unaffiliatel
001055 10 21ARAC INC-····-------------------·-- ....... . 00130H 10 6 AESCORP-·-····~~ ......
~:;; ~ : ~~~~No~~-~~~~~~~::~~= .................... ____ _
002535 30 0 AARON'S INC ..... -·--·--.. --.. · .. --.... --.. ·~-·~·--.. -·~ ........ ~ ... ~ ... 00287Y 10 g ABBVIE INC .......... ·--·--·- ···-··-····-·- ............. _. 0050SY 10 2 ACLirTY BRANDS INC .... - .... -.--.............. - ....... - .... --·-·---...... .. 00687A 10 7 ADIDASAG-S~ONSOREDADR_. __ ---·· -----... - ................................ .
008252 10 8 AFFlLIATED MIINAGERS GROUP ..... - .. -·---·-·-.. ---···-·----.. 008916 10 B AGRIUM INC .......... _ .... ____________ ·-----------.. ·----···-·--.......... - .. .
009363 10 2 AIRGAS INC .... - .... ---·--·---·---·-·--.... - .............. . 015351 10 g ALEXlON ~HARMACE"lJTICALS INC _________ .... - .... - .............. _, __ ............ .
02209$ 10 3 ALTRJA GROUP INC .. - ......... _ ..... - .................................. .
SCHEDULE D ·PART 2 ·SECTION 2 Showing all COMMON STOCKS Owned December 31 of Current Year
1 codrs
4 Fair Value
Code
Number
• Shares
Boo' Adjusted Carrying
Value
Rate Per Shar!!
Used to Obtain
Fair
Value
FBir
Value
.. ....... _ .. 1,091.000 ~·- .. -~· ....... 72,B7S ......... 66.800 ........................ 72,879 .. ........ 1.623.000 .................... .23,550 ......... 14.510 ........................ 23,$0
R.l ~ .......... 1,BS2.000 ...... .. .......... 39,333 ........ .20.150 ........................ 3B,333 ......... 2.021.000 ...... .. .......... 71,058 ____ 35..160 _,_ .. ___ .. _ .. 71,C68
.. ........ 240.000 ............................ 7,056 ....... ..29.400 - .... _,_ .. ____ 7,(60
__ ,1,302..000 .... - ......... ,_ .... 68,759 ...... ...52..810 ...................... 08,7'59 183.000 .......................... 17,819 --- 109.820 ----·-·- ... _,_.17,819
...37,9>0 " 1 ................. 591.000 .... - ...... - ........ .37,960 ...... -64.23tl
;~: -~-~~~--~-~::.~~~:~~~- -~--~~-=---~--~=:::~:.~ ~~-~~~:~: ·--------·-.26,409
. ..... ..74.000 8;177 ____ 111.650
..... .253.000 ·---.... --.. --. ..33,664 -133.000
. .. 1,477.000 ---·--------··--·-.. .56,702 ........ .38.390
_, ""
-.. - .. .55,575 .... 23,855
.30,14S
10
'"""' "' ~
.. 0
.ss,393 1 -····-·-······-
_4,669 .... s
-·-··-·-··"·"' I====:--=: ... 7,056 .............. 21,850 ............... 6.832
"
Dil'idends 11
Amo.m
Reoeived Duling ,~,
.................. 1.318
.... .319 - __ 3,177
- .......... 12
--·-·-.......... 1 $94 ......... 85
_ .. ________ .. 374
12
Nonadmitted
Declareli
"' Unpaid
ml 02253T 10 4 AMAO::USJTHOLOING-lJNSPADR ......... --.. ··- ..................... ·---·-·- " _ ... 425.000 ·---·---... 18,109 ..... -42.750
......... 8,'l17
...... 33,664 .. .S6,7ll2
...... 18,16!l _95,710
27,373
•.•.• 6,525 1·······--·····-··"' -=::=~ ..................... 709 ::~~ :::::~:::::~: 1·- ............ . ~
"' 023135 10 0 IAMAZON.COM INC ............... , .. ,_, ______ , ............ ..
02503X 10 5 AMERICAN CA~ITALAGENCY COR~ .................... - .. ·-·---·-·--.. . 025816 10 B AMERICAN EXPRESS CO .......................... .
03027X 10 0 AMERICAN TOWER CORP ... _ ......... - .............. - ... - ....... - ...... - .... --.. 031100 10 0 AMErEK INC. .... - .................. _ ................................................... .
~~: ~~ ~ :~:~~~~~~~-;~~~~-~~-:;~·~:=:==:~-~-~~ .. ~-: .. ~~-~---=~ ~:I=~~~ I; 036520. 10 5 ANSYS INC ....... - .... ·-·-·-·-------.. ----·-·-·----·--·-- ....... 037411 10 5 APACHE CORP .......................................................................... . 0374aR 10 1 APARTMENT INVT & MGMT CO -A._ ......................... - .................. .
.............. 240.000
·~--1,419.000
1,015.000
.421.000 . .. 174.000
.. ------429.000 .... 236.000
.. ............. 171.000 .. .... .569.000
.1,698.000
____ J35,T1D ·-·-·398.790
_ ....... _.27,373 ......... 19290 ....... .92,091 .... _..90.730
.33,604 ......... 79.820 ........ - ... 9,165 .... _ . .52.670
_ ........... .48,975 ....... 114.160
...... 25,125 .... -106.460
....... 14,911 ......... 87 .200 48.900
... -43,!)95 ....... 8S.9MJ
... 25.910
.... ..92,0!11 - .33,6J4
...... 9,165' ................... .48,Si'5
_ .. .25,125
..... 14,911 ..... 48,9JO
.43,995
_.45,522
~=::~~ :~:=~:~:=~:~~ I:~:==:~~~~ ~ ........................ . 24,836 .... _ ......... .
.... .3,m .. _ ............... .
__ 40,569 - --- --- --·-·-·· ....... 23,879 ·-- .............. .
- ___ ..7,6"14 ..... _ ................ .
.......... 40,656 ........ 53,220
... 411
~: 1- :::::: ::==~~ .. ..... 341
....... 1.223 037833 10 0 APPLE INC...-... ------.... ··--·---·---·-·-.......... .. ........ 744.000 . -·---- __ 417,466 ___ _561.110 038222 10 5 APPLI!:'O MATERIALS INC ___ ................ - ......... - .... ·-·- ·--·---·-.. ·-· ....... • ..... 1,328,000 .................. -23,492 ....... 17.0'90 ~~~~:::I:::::~:==::=:~~:: 1-----------
... 6,125 1-------···--__ 133
038336 10 3 APTARGROUP INC.--~·--···-·-·-·-·--·-- ....... ........................... .. ............... 172.00D .. __ ·- ____ 11,663 ______ $7.a10 042068 10 6 ARMHOLDINGSPLC-SPONSAOR_ ___ .. _ ..... - .... - ........ - .......... - .................... R. ................. 957.000 .................. _.52,386 ..... -54.740 045387 10 7 ASSAABLOY AB- UNS? ACIR. ........... - ... -.~ .................... - ........ -........ ....... R. .............. 1,032.000 ......................... 27,296 ___ 25.450
046353 10 8 ASTFIAZENECA PLC.SPONS ADR_ __ ·-···-···-.............. --·-·-·--·-- .. _ ... R. ........... 647.000 ........... _ ·--·38,412 ~---Sll.370
052528 30 4 ALIST&NZBNKGGRP--8PONAOR. .............................................................. R. ........... _.870_000 __ ---------.25,100 _ ... .28.850 05523R 10 7 BAE SYSTEMS PLC .SPONADR ............ - .............................. _ ........... _ .•. _ .. R. ......... _ .. 1,048.000 ·-·- .. ~-~--- . .30,725 ........ .29.290
056752 10 8 BAIDU INC-SPONADR ............. .. .... - ....... --.... - ...... - .......................... R. ................. 315.000 ..................... 56,032 ...... 177.880 059460 30 3 BANCO BRAOESCQ-ADR., .............. _ ...... - .... ~ ..... ~.~ ............. ~ ..................... R. ............ 1,481.000 ........................ 18,557 ......... 12.530
05946K 10 1 BANCO BILBAO VIZCAYA-SP ADR. ... - .................... - .... --.. --.............. --·- R. __ ......... 1,614.000 ........... ~ ........ 19,997 ......... 12.390 064058 10 0 BANKOFNEWYORKMEU.ONCORP ........................................ __ _ _ ____ _ _______ 1,852.000 ··-·---........ _, ___ $4,709 .... .34.94D
06738E ZO 4 SARClAYSPLC.SPONSADR__ .. _ ·--·-·- ··--·-·- ........................ _, .. R. .......... -.9B7.0VD ...... - .... - ...... 17,894 ..... 18.130 071813 10 9 BAXTER INTERNATIONAL INC .... --................ .............. ................ .. ............... 285.000 .......................... 19,822_ ......... 69.550
... 11,653 - ........... 52,3lS
_ .. 27,236
:>8,412 .... 25,1)0
30,725 . 55,002 18,557
19,Bl7 ... - ................. 64,7)9
........... 17,8l4 _.19)!'..2
084670 70 21 BERKSHIRE HATKAWAY INC-CLB _________ .................. - ... - ........... . . ....... 1,18s.ooo 1 ...... - ...... - ... 140,494 1 ___ 118.560 1--·-----140.4l4
~--- -------- -------
...... 0,876
.... .30,2a6 ........... .. _ .. 13,930 ....... ·-- .. _ .....
.29,170 -· -------
..... _ .... ,19,662 -·---·-·-·-19,65B - - ---- --·-·-··· .45,001 .............. . 19,598 "' 12,747
..... 1n ____ ... 113
----........ .257 --·-···-·-·--1.812 ··---1.268 -·---·--·1,255
.S13
_,82 ........... - ... ·--··
......... _ ·-.. .224 ..... ··-·- ····-···
..... __ -· - -· .328 - - - ·--·-·---··· -·- ·--~::~: I =: :~ =:: .~=:::=:!:~: ................... 140 I~~:~~:==:~::~~~- --~ .. ::::= .. ::~::::·
13
Unrealtze.J
Valualfon
'""""" Decrease·
I& in Book/Adiusled Carrvlno Valt!9 14
-· Year's Other-Than
Temporary Impairment
Recogn~d
15
Tollll Changa
;; BJA.C.V. (13-14)
............... 17,191 -·- .......... _____ ---·-·-·-·-17,191 ............... (305) ..... .................... • ................... (305)
"""""""8,182 ..... ................. .._, __ ........... 8,182
............. 2,644 --·-·-- ,.___ -··--·-·----2..844 ... - ........... 2li9 -·----.. -·- ----·· .................... .269
......... _ .. ,..25,034 --·--·~ ----·.. .. ............... 2S,034
.................. 6,779 - -··· ·-··---·-.. - ---·------... ~.779 ... - ........... 11,72.9 --·-·-·-.......... .. ................. 11,72Il
.... 10,581 -·-·----- ··---- ....... 10,561
-·-·--.. ·- ·--···--·---·-.. .. .. __ ·-- ...... 0 .. , __ -·-·-·1,262 -----·-·-··--·· ........... 1,262 ---.. --.6,443 -~-~..................... .. ............ .8,443 ............ _ . .4,292 ·-·-···- ........ . ................ 4,292
.... - ......... .4,194 .... ~...... ........... . .............. 4,194 ·-·--·-------33.500 ·-- ..................... - .... -.33.500 --·--.... ~18,638) . .................... ·-·--------{18,638)
................ .27,212 .. -- ..... ---·-·-......... - .... -.27,2.12 .... --.~·--·929 ·-- ........ .. ...................... 929
------... 2.627 ·-·-·- ........ - ..................... -.2,627
16
To~
Fmeign Exchange
Chan~
;, BJA.C.V.
17
NAJC
Mari>et
"
Indicator I Data (a) Acqu1reli
L ......... _ 0411612013
L--··---·- 1111212013 u ........ - ... 0713012013 L_ DBJ2612013
L-.... - 1111&2010 [} _________ 0111512013
L-......... 0610512012 _
1
u _______ .. o91o412012
-·-· L.-........ 0610512012 L_........ 07/1212012
1010312013 1111212013 0411612013 0713112013 1210612013
___
1
L............. 0712312013 _: ___ L._ ....... _. 0711012013
-·- L---·--· 1111S/2010 ............ -ll,405 ·--·---·-···-·· -·-·-·-·-.. 8.405 ·- .................... L........... 11/1412013
____ 1,245 .. --··--···-·--· ................... 1,2.45 .... _ .. -- ·-·- L--·-·- 1012412013 • .. - ........... 3,3B6 .. ---·-- ........... .. .............. 3,396 .......... ____ _ L_ ·-·-· 1111012010
.............. 8,234 ......... -·-·-·-·---· ................ 8,234 ....... ---·-·-·-- L ...... -.... 04/15J2013 ....... ~9,225) .......................... • ................ ~9,225) ...................... L ........... 04/1612013
.............. .45,749 ··- - -·-··· ........ 45,749 ..................... L ...... -... D710BI2013 .......... _, __ .(1:15) --·-·-·--.. --·- _ .................... (135) ..................... L............. 09!.1712013
......... 3,455 - - -··· ·-·-- ..... _.3,455 L-... - ... 1111S/2010
........ -14,356 -·-·---·--·-... .. ............... 14,356 -·, L............ 1111812013 ...... 8,030 -- - ---... ··-- .. _ ... 8,030 Ll ...... ___ 0711412011
.. _ ..... _7,829 ............ - ............... ~ ............... 7,829 L_____ 0711212012
........... - ... 2,474 _____________ ................... ...2,474 u ___ 0711212012
............ _ ... 7,747 ·--·-·-·-·-·· --·-·-·-·-... 7,747 u_ .. ______ 0711212012
----·-·--·.13,130 ..... ........ ........ .. ................ 13,130 L- .. ~·- 1112912013 ................ (4.1140) ..... ........... .. .................. (4,840) . L .......... _ 0711212012
..... 2,129 ·-- ........................ _ ......... .2,129 ... . L .... 1112612013 ................ ~ _ .......... ----------··~ ________
1
L ________
1
,_,
---~~~~~~~:~: :~~=~:~·==::· ~~-~~:~~~~E: ~:~~ ::=~:= ~:~~:=: ~;~:~~
' "
statementesofDecernber31,2D1Joflhe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D ·PART 2 ·SECTION 2 Showing all COMMON STOCKS OWned December 31 of GurrentYear
~ I s I 4
Fair Value Dividends Ch~noe in BooldAdiusted GarrvinQ Value 17 18
ClJSIP
ldentificaflon Des · lion Code
090572 20 7 BIO.RAD lABORATORIES-A ...... - ...
090S2X 10 3 BIOGEN IDEC INC .................... .
09227Q 10 0 BLACKBAUD INC ..... .
092.47X 10 1 BLACKROCKINC ...... ··-··-· 086813 20 g BOC HONG KONG HLDS.SPONSADR .... . R
OB9724 10 6 BORGWARNER INC ........... ·······-·····-·- ................................................. . 110122 10 s I BRlSTOL-MVERS SQUIBB co ______________ _
12.002W 20 4 BURBERRY GROUP PLC-BPON ADR. .•...
124857 20 2. CBS CORP-CLASS B NON VOTING ...... .
~
1250SM 10 a 1 caoE HOLDINGS INc ____________________ ..
125269 10 0 CFINDUS7RIES HOLDINGS INC ........ _, ____ , ......... . I 126650 10 0 CVS CAAEMARK COR!' ....... ~ .. ---- ....................... ------·--------· 154429 10 9 CAMPBELLSOUPCO .................................. _ ------------.. ·---·
ml136375 10 z CANADIAN ~n RAI~LWA: co .............. _ ............... --·--·----·-·- --~ ... ---11 .. . - 139096 10 7 CAPGDI011NISA-UNSPON.,ORADR ............................... ______ ....... R.
!'J 142.339 tO 0 CARUSLE COS INC ..... - .......... - .... --.. -·-·-.. -----.. .
N~mber
• ~
..... 113.000
... 196.000 ........ .326.000
........... 296.000
.. .. .36S.OOO ... 620.000
"""" ,~.
Boold Used to Adjusted Obtain
Canyl~ Fair
Value Value
.. ...... 13,!!68 ....... 123.610
........ .54,B31 1 ..... ..279.r.'O , ........ t2,349 ...... ...37.650
.93,615 ....... 316.470 ........ .23,743 ......... 64,520 _____ .34,584
"'' Value 13,.968
.. ... 54,831 12,349
..... 93,675
... ..23,743
"""" ~ -----10,197
i'" i Dedared ,' bt!l
I unpaid
21.29o IJ ......... . 7,624
..... 58,124 ... 24,718
------------------· _ .... !.... ......... 150 .. .... 55.910 ...... 53.150 .. ..... 5tl.S50
.. 63.740 584.000 :::~~~ I~=::~:~~==:~::
........ 27.224 =J:::::~~=~~~ ----~:~:=~~ ~~~ .. ~=::~~:::=::::~;~ :~~:~:~ ~==:~.~-~~~:~~~ :::::~~~:::::::~:~~::: -~~:J----.. SSB
...... 34,664~ .... - .................. 18,SB1
~:~::~:~~~ :::~:::::~~:~::~:~::~:~~ ... 1.644.000 ______________ 117,661 ______ 71.570 ...................... 117,661 ............... ____ .. .67,618 _____ ) _____________ _
... 980.000 -----------------..42.414 ......... 43.280 ........ ---- ....... ..42,414 ..... 45,432 .. ~ ................. . .. ......... 08<1-.000 ........................ 33,300 ......... 57.020 ....................... .33,300 ........................ 16,717 ·- .. ! ......... 402.000
----------187.000 ·----------.13,616 1""'"'.33.!l70
14,848 ......... 7S.400 ................. 13,010
....... 14,848 SN21:::: ~-: ..... 7,o30
~:: ~~ ~I ~~~~E~~~~-~~-~~--~~~:::.::~:.:=~:::::=: ..... R. 1--.------1,234.000 I .............. .27.271 1'"'""'.22.100 ............. 223.000 .. _ .... ___ .. 10,485 ......... 47.020
~ .... 27,271
...... 10,485
...... 25,468
...... 20,oa4 ...... .43,135
- 80,783
21,005 ....... 4,76e
~:=~ ~~ ~~~~~~0~~- ............................................................... - ............ .
149123 10 1ICATERPillAR INC .............. ,, .. ,_., .................................. .
;:~:; ;~ ~ J ~=~ cP~~~-;~~:~~::::::~_ ............................................................ .
____ ------634.000
1
____________ .,.25,468
1
....... 40.170
........ ..423.000 .... -------------------.20,0M ....... 47.480 ________ 475.000 ........................ ..43, 135 ...... .90.810
___________ 478.000 80,763 ....... 168.960 R.J ............ : ... 370.000 . ------8.577 ........ .23.180
- 20,STS I: :::: .21,253
•. .40"" ..... 40,400
....... 6,398
"
Amount
Received
During y~,
.......... 157
"
Nonadmitted
Declared bo>
UnDaid
........ -.1,818' 11:::::::: .••• ....... 155
__ 242 II"· ................ . .... 280
m __ 35a II·········· _ .
------ ----1,393 ________ .. 590
............. 410 - ___________ 15S ,, ___ _
.. .. 15711-······················
.... 163
607
7831 ................. -------
"
llnreaUzed
Valua~on
Increase/
(Decrease)
...... 2.097
24,661
....... 4,8~ .. . .31,742
.. (975) , ...
12,452 .... 158
.3;621 .. ...... 15,003
'"" . __ ... 11,275
..... .36,753
14
,_, Yeats
Olhar•ihan
Tem~orary
lmp~trment
Reeognized
.. ...... (3,018) 1-·-· ... .6,725 .. .. 4,908
3,860 ,3,111
.... 2,114
.... 2,5;26
_ .. .1,013
..... 35,337
....... 179
156782 10 4 CERNERCOR!' ............... - .... .. 166764 10 0 CHEVRON CORP ................... .
168919 10 8 CHINACONSTRUCHINSPONADR. ....... . 16941M 10 9 CHINAMOBILELTD-SPONAOR. .............. . ·-·-·----·- I --- I R. 16941R 10 6 CHINAPETROLBJM&CHEM-ADR. ............................. __ -·------------ ... , .... . R.
....... 526.000 ........ B02.000
___ ... 1,586.000
917.000 ... 287.000
........ .32.000 156.000
- .. 187.000 .... .205.000
29,319 ..... ....55.740 ......... 112,669 ....... 124.910
..... ___ .... 24,075 _ .. _ts.tao ........ ..47,950 ~-----...52.290
__________ .23,583 ....... ..Jl2.170
'"' .29,319 112,569
--24,ll75" ....... 4-7,950
... 2.3,58.1
.... 17,t\49
.... 10,l40
.20,12.3 ... ,94,386
.... .23,596 .49,040 ....... 19,935
1: ~ : ~ :•····~:: I""""' ------· .... . .......... . .......... 7,f!fl ...................... . .. ............ 3,518 ·- -----~ ............. "'""'""'""15,127
·-·- ................ - ...... - - -----.. .. ....... -A.SD ........................... . ------------..271 ..... _..... ....... .. ............... (1,090) -...................... ..
.937 ~ ................. _ .. __ ................. (1,788) --- ------------· 169656 10 5 CHIPDnE MEXICAN GRILL INC.-............................. . 171340 10 2 CHURCH&DWIGHTCOINC ........ ..
17!l5SS 10 5 CITYWITIONALCORP ...
179895 10 1 CLARCOR INC ...... .
189754 10 4 COACH INC ........................... .
191211i 10 0 COCA-COLACOfTHE. ................................................... .
192.446 tO 2. COGNIZANTTECHSOLtmONS-A. ....... .
194162 10 3 COLGATE-PAlMOUVE CO .... - .......................... .
19a516 10 6 COLUMBIASPORTSWEARCO ............ --·-·---· 2D441A 10 2 CIASAt,JEAMENTO BAS1CO DE-AIJR. __________ _
20449X 20 3 COMPASS GROUP PLC-ADR. ............................. - ............... - .. .
212015 10 1 CONTINENTAl. RESOURCES INC/OK. .................. - ......... .
----------l tnl.OOO .. 1,620.000 1,789.000
...... .17.049 ....... 532.780 _____ 10~0 ____ 65280
___ 14,814 ... 79.220
____ 13,192 ..... 64.350
.. .... 122,251 , ... .56.130 ______ 66,ll22 ... ..41:!10
.. ..... 1!10,653 ....... 1-00.980
.... .552.0(tl) 1-- ......... - - 35,!!961_ 65.210 ......... 88.000 .. - -- - 6 930 ---78150
...... 101-,832 1 _ ........... 5,332 ................... 175
....... 14,8141 .. ------------- ...... 10,181
...... 13,192 -·-------- ----9.194 " ___ 135
140
m I ............. 122,251
....... 1>6,9:22 .................. 180,653
------------......... 35,900 _____________ 6,9ll
..... 113,935 ....... 58,449
110,441 ........................ .
... 33,165 ......... --- .......... . 4,471 ""'"" ....... , .. , __ __
__ 1,881
...... 1,814
. .... .313
R 1-----.2.556.000 I .................... 28,985 R. .............. 1.729.000 .......... 27,887 .. :~:~~~: I :::~:~::~-~--.. ~---~~:s: 31,856 ......... .. ......... .
............... 20,886 I·······!··················· - "' II· := =:=•···•·• .. .... 646
...•..•. 370 .. 462.ooo 1 ........ ------.51,964 I ____ 112.520 51,984 . ........... 43,704 1 . '·······-··
I'
.. .. .3,217 ... 1,983
___ ,5,554
... .3.397 _______ .5,175
... 8,197
........ 57,713 ................ 2,831
.•. ······"" ·~·-··········· ·.-----~--(6,016) ............. . ............. 1,027 ............. .
.............. 8,281 --------·
13 " Total
Change
Total Forelgn
Ex!:hange Cha119e
NAto Market
Indicator '" eJAC.V.
13--14' I '" 6JA.C.V. J!L L .
Date
Acguir.ed
0610512012 .. 2,0!l7
--24,661 L ... 0512312013
. :::~~:~!~ ·:·::::::: .. :::::·:::::·:: 1~::::... :~:~~! --------(975) ---- ·-·--------- u.. ......... 11127/2013
12,452 L -041t812011 ..... 158 ........ .......... L... 10/3012013
.. .. .3.621 ...................... u________ 1213112013
.... 15,003 .................... L .......... 0612S12012 ..... 20,262 ,_ ......... ._ ...... L............ 041161201:1
11,275 ....... ---·- ....... L...... 0411612013 .... 36,753 L....... 01122/2013
.. --·-------(3,018) ................ ·-- L----~--· 04116/2013 ... 8,725 ll... Ofi/10/2010
........ .4,908 ........................ u... 0711212012 .3,860 ............... -... L... 08115/2011 .3.111 ........ ~ .. ---...... u ............ 0811612012
.. ~114 L... 06/TE/2012
....... 2,520 ...................... L.- . ..... 04/1SI2013 .. (1,169) u .............. 10/3112013
....... 1,013 ........................ L. .......... 0710812013 ......... 35,337
- .17S ......... 7,62.7
L.. ... [) __ _
L. ..
1112012.013 1213112013
1112712013 ... 15,127 ....................... L... 1113012!.112
...ABO .......... - ........... U ......... 0713012.013 (1,091l) ............. L. .. -... 11!2612013
,(1,788) • '"'" ............. L ..... - .... 0810i'121l12 .... 3,217 ..... .. ........... L.._ ...... 1011412013 - 1,983 L.__ 03101/2011
S,554 ...................... L.... 0&0512012 3,397 ........................ L ..... -... 0510112012
.. 5,175 ........................ L ............ 0411612013 .... 8,1!l7 ...... """"" ..... L. ........... 1111212012
... .57,713 ........................ L... 07/1112013 __ 2,831 L 08112/2013
2,2.34 .......................... L ------· 0610512012 (6,616) .......................... L... 0711212012
..7,0tr u... 07/tl512013 , ..... 8,261 ...... _ ............... L.... 0910312013
statementasafDecember31,2013oilhe Mid-At~antic Vision Service Plan, Inc. SCHEDULE D -PART 2- SECTION 2
Showing a!! COMMON STOCKS Owned December 31 of Current Year
CUSI? ldentificaffan Des~on
217204 10 6 COPART INC_____ ·······-·····---------·····-·-·-··-... 2216DK 10 5 COSiCOWHOLESALECORP_, ___________________ _
228!!89 10 9 CULLEN/FRDSTBANKERSINC. .... __ ._ ______ _
231021 10 6 CUMMINS INC ___________ ···········-·-·····-·········- ·---·-·-····'"·"·-··· 235851 10 2 DANAHER CORP .. _____ .. ___ ..................... __ -·····-·-.. ··-.. . 237545" 10 6 DASSAUL T SYSTEMES SA-ADR. ... - ............ ___ .. _______________ .. .
2<:7361 70 2 DELTA AIR LINES INC--·-·-·-·---------------........ - ... ··-·-- .. 24903V 10 7 DENTSPLY INTERNA7l0NAL INC .. ___ --- .. _ ..... -----.. --------.. -·-· 251542 1 0 6 DEUTSCHE BOERSEAG-UNSPN ADR..-.... - ...... _ ................ .
I Codi 4
Code
R.
Number
• Shares ___ .. 247.000
Rate Per ,~,
Book/ Used to
Adjl!Sted
Carrying
Value 9,053
Obtain Fair
Value
... -.21o.ooo I -----------.. - ... 24,992
...30.650 ... 119.010
... 802.000 ____ 729.000
____ 929.000
-140.000 • ... .580.000
_ .... 59,693 ...... -74.430
....... 102,767 ... _ .. 140.970 ______ 71,71Q __ .... _772J:IJ
___ ... 17,402 ---124.300 _____ 15,933 ........ 27.47(]
R. 1 .. -......... ,-~~~~ I:::~~== ::~~~::~~:~: I = .. ~~~~~ =8~ ~ :I ~~~TE~I;~~~~c:_~:~-~~~::~=:~:~==~:::::~::::~:=~=-~=:~~:== I~=:::: I~-: I :::::=-~=;::::~ -==:~:=~::;~:: I ::~:~~~::~ 254709 10 81 DISCOVER FINANCIAL St:RVICES _______ ............. ____ .. _______ ,_ ..... - ... ..
256677 10 5 DOI.LARGENERAL.CORP ... - ........... . .......... 11o.ooo ................ 42,827 .. _ao.a2o
Fair Value Dividsr.ds
10 11 12
Nonadmitted
Declared
""; I '"""' Value COst
Declared
bm
~
Amount
Received During
'~; '"' ~d
-2!;: I :::::.~:-=~-~~:~;::~~ ____ ............. ---- -.... ___ .. _ .. __ 253 ....... 59,093 ....................... 44,629 .................. , ___ ,, •.•. 1.568 ...................... . __ 102,767 ................. _ . .64,340 ·-·- ..... _... .. ......... 1,540 __ ... .. ............ .,
-----.. --.71,719 ...... - ................ 37,273 ____ .. ___ .... 2~ ...... ______ 70 - .......... .
•. 17,402 ......... .9.963 --------·-·-·-"""' ................ 102 -- - - -- ____ .. . ... 15,>33 -----·-·-·------.9,614 ............. _ ..... _ ......... 70 ........ ___ _
-------.. 20.~ ............... __ 13,938 _____ .......... _:a ............ ____ _gs ....... .. ...... ____ _ -------... 14,C50 -----.. -----8.685 .. __ ................ - ..... ____ 306 ........ - .... ___ __ ·--- ____ 12,E77 ............. - 8,906 .. __ ... _ ........... ,_, ______ 294 ............ -----------
30,102 ................ - .. 22.216 .................. 339
------.......... 666 I·······- --·······
m I 251ss1 10 sl ooNALDsoN co INc ................... _ .. -. 252037 10 4 DRIL-O.UIP INC ......•. ---- .. 71.000
.. .. 1,110.000 I ____ .. _____ .. 62.105
1
.... _.55.950
.., ______ 206.000 ....................... 8,953 - ..... 43.460
...... 7,aos I ----109.930
_____ .. 62,105
... 42,1!27 ________ .8,953
7,805
.. 48,670 _ .. .35,405
...... 7,552
_:;;:: ~---- ···-·- ····]
... _.70
_,.9791 : .. ~ .. _: : .••• "' ;.., ~~~~ ~~ ~~ :~%ov~~~;:~:::::~ ::::::::~~-~=-=-=::~: .. :·---.. ------.. · .. ----- 1
--...
--------.. 5,450.000 ................... 137,0M ____ ..25.150
...... - .... 1,219.000 -------· ---.52.161 ........ 42.790 --------... 714.000 .......... _______ _39,191 ...... .54.890 ----- ....... .266.000 .. ___ --------27,73$ _____ 104.271)
R. I ----·---633.000 ----- ............... 20,370 _.32.160 § l! liE~~~~~~:~~~~~~--~~~~~-~---:~--~- -- ,-·-·· - 253.000 ___ .. 17,067 1 ........ 67.460
............. 137 ,t;Ba .52,'1S1
......... _, ______ ,39,191
27,736
--20,370 17,1ll7
___ .. ___ ... 47 ,932 ................. _ .. .. 32,646 ______ .. ___ ... .. ..
-.13,831 ____ 12,293
____ .... 8,765
--~9
... 62
_ _756
... -1741:=::: .. ~::: .. _____ ..
----223
::.~ ~~ ~I :;:N;>~~;o;-;[)~=-~-=-~::~-~=::~-~ ::==... :::~=-=~ :.~~ ~~~:::: I~ I:::~ :::==:~::~~~ ____ 16,167
_ .... 1S,BS3 ---=~~:~ I~:=~::~:.=::~=:~~;~ ___ ,7,712 ___ ..206
.16,4171 .. _ .... ________ ..92 --------·-·---· ~:~~~ ~~ :I ::s~;~~~~~~-~~-~-~-~~- ........................................... . 3<l2445 10 11FLIRSYSTEMSINC .. , .. ___ ..... - ...
30303M 10 2 FACEBOOK INC-A. .... -----~-- _____ .... ___ ..... ---.. ----------.. ·-·· 303075 10 5 FACTSET RESEARCH SYSTEMS INC ..... . 303250 1 0 4 FAIR ISAAC CORP----- ......... - ....... __ ....... ____ ....................... - .. .
307305 10 2 FANUCCORP-UNSPADR-..... _ ......... ·-·--·--- _ -------..... - .......... - .. . 31620M 10 6 FIDELITY NATIONAL INFORMI\110 ... _ .... - ............. -------.... - .. . 345550 10 7 FDRBlTCITYENTERPRISES-CLA..-.. . 358029 10 6 FREBENilJS MEDICAL CARE-ACIR. .. _ .. _____ .. __ ,., ......... - ... ·--.. ----·
366651 10 71 GARTNER INC .......
~=~ ~~ ~I ~=s~~ER:~~-~;~--~_:::=:~.:=:=:~~·.:==::~.:==:=~·-.:~= ... 380787 20 0 GOLDBI!AGRI-RESOlJRCES-UNADR ........ _ .. ___ ...... .
~:~: ~~ !1~:~~~~~~:~:~ .. , .. __ .. _________________ __ 404132 10 2[HCC INSlJRANCEHOLDINGS INC ......... .
_ .......... 1,550.000
•. 540,000 ............... 283.000
835.000 _____ .. ______ 68.000
.. ............. .2M.OOO
R. 1--·-·-----1.04<1.000 __________ 1,028.000
---- ......... 487.000 R.j ......... .836.000
131.000 _____ .. 362.000
--·----1,555.000 R.l ... - ..... _ .. _444.000
........... - ... 206.000 _________ 141.000
... - ....... .453.000
_ ... 108,872 ......... 70240
..... 54,648 ....... 101200 8,518 ..30.100
- _____ .. .45,641 .... _ . .54.1360
.7,383 ....... 108.580 ____ 17,847 ........ .62.840
32,184 -.30.710 ___ .. 55,183 -----53.060
----·-·--------. .ll.302 ......... 1a.1oo ... 29,745 ...... -.SM80
. .. ___ ........ .9,306 ......... 71.050
..... 11,942 .... .32.990 ..... 116,858
- .. -------19,Z16
_75.150
... 43280 ........... 230,8861 __ 1,120.710
___ ,,11,015 , ___ 78.120
... .20,901 _A6.140
108,872 ... 54,848
. .88,012 .... , ____ .. ___ .. 43,530 ............ _ ... 1,279
=:~~fj I~ ~~~:.~~:~~~~:: I:== ::~= .. :::~~:~ I
- _____ ..... - .. 1 02
______ _92
_______ .23 17,647 ___ .. 6,721
__ .. ___ ..32,1~4 ......... ____ .. ____ 16,877 .......... __ .... _ .. ______ 199
.. _ ...... 55,133 ...... ________ .:J5,813 ..... _ ... - ..... _..... .. .... ---·---90S ..... ___ ... ______ ...9,3:)2 ....................... .6,361 ·-·- ---- ..... _ ................ _. .. _______ .. .
__ 29,745 ................ ·····- 18,929 .. ___ ........... .. ..... _ ....... ..279 ....... - .. _ ..... .
_ .. .S,3J8 .................. ,.,_7,407 .,._ ____ .. , .. ___ ---.. - .. ----------. .. 11,m2 .................... ___ .o,72o .......... .......... • ............... 199
-------116,858 ------------.48,172 .... ........ --- ___ .. _ .. ___ .. ..... 19,216 - - _____ .. ____ .22,643 ........... __ ·-----· ___ , _______ .. 376
_..230,006
11,015" _ ........ 20,901
--·1""'1···-··········-·-·t·--··-·· ····-··· ------·- .... :~:;·:::~ -~:=:::~:=~:~~-; :~:::::~=:: ~-~:~
Ch:an[Je in Book/Adjusted Garrvina Value " 1B
13 14 15 16
um.,.lized
Valuation
lncreasel (OecreaSf!)
...... 1,699
Cur!l!nt
Yea~s
Other-Than
Temporary Impairment
Rec(l!ln~d
··-- ···-·-·"~ 1=::=::=:: _ ... 16,1&1
...... .23,780 - _ .. 19,788
.. ....... 1,77B 6,319 - - _______ ...
- --.. --.. 3.~ .. -----·---.. ............ _ .. 3,675 .......... __________ _
--.. ---.. --.. 1,552 -------·---· .... _ .......... 7,884 --------- - ___ .. .
-----.. - ...... 13,434 -------9,624
.... , ___ 1,371 !··········-·-············ .. 2,618 .5,055
___ ,, 1·-·- ···- ... ·-·· ___ .2,296
... ______ .8,163
----.. ·--:;: I::: :====•••• ...... 3,503 !--···-······-· -
-- ______ ... 447
........ _,_,25,172
.... 7,906 ______ .. __ .2,203
___ 18,113
.... --.. --.. 1,395 _____ .. ____ 5,910
_______ .. ___ .... 799
--- _____ 19,370
--.. 1.437 .. .... 1,070
·---1,901 _____ $,119
~=:~_!:I :=::=::= _ .. .3,7!)5"
--------.. A.D4-5
Torel
Change
'" BJA.C.V.
~ 1,699
_A,259
16,168 23,180
__ .. 19,788 ___ 1,77B
___ .. _______ ,.6,319
.... 3,1!70
......... 3,675 .... 1,552
-...7.864 ..... 13,434 _____ 9,624
__ 1,371
_..2,618 _ .. ___ , __ ,.5,055
- ______ .. .4,229
2,296 - __ 8,183 ___ 2,323
____ 8,303
__ _3.503
--------.......... 447
Total Foreign
Exchan!]!! NAIC Change Market
'" BJAC.V. Indicator I D"' ____@) Acquired
,. 1 L... ... --- 10/01/2013 L.... 11/1512010
L--·--- 11/1212012 L........ 0711312012
L. ..... --- 0912012011
-----.. -- u .... - ... 0112912013 -· L __ --· 07/29/2013
___ .. _____ L. .. _____ 05121/2013
- lJ ........ ---- 07/1212012 ... ___ .. ____ L.______ 07/1212012
L________ 08/2.912013
L. ...... -- 04116/2013 L ..... --- 12/0912013 L. ___ ...... 10/0412013
L........... 0610512012 L._ .... _.. 10/2412013
----·- L ..... -- 04/16/2013 --- L_... 07/0912013
----.. -- L------ 12116/2013 - L________ 07126/2012
_ ........... L._______ 04/16/2013
---- L_ ___ .... 0811212011 ___ u_ ..... --- 1211312013
__ 20,172 --------.. -- L..... 0711312012 ............... 7.906 ..... _______ .. ____ L.. ----.. 0411612013
_ .. _____ ..... .2.203 ... - .............. _ L..... 06/05/2012 ____ , .. _, __ 18,113 ............. ··-- ll _________ 07/2SI2Q13
__________ .. 1,395 ... - .... --·-·-·- L_ ..... ---· 11115/2010 5,910 .......... ___________ L_ .... _.... Otmi~012
.. ___ .. ,_ .. ____ .799 ··-·----------- lJ........... 0712912013 ,. ......... --19,370 ...... - ................ L .... --- 11/1212012 _____________ 1,437 ... ----------- L .... -- 11/1~010
__ ........... ___ t,07n ----- ......... , ...... L. ..... - IJ6/10/2010 , ____ 1,901 ..... _ .............. L.- ...... 0510212013
.............. , • .5,119 ...................... L...... 0811312012 ____ .. 58_328 ---- ___ .. ______ L .... -.. 0310512013
........... - .... (4,166) ...... ··-·-· u ..... _... 02126/2013 ______ .. 83,491 ......... ___ .. __ L------· 0410912013
_ .. 3.755 L_ .. ___ .. I 0610512012
................. 4.045 1 .. -....... --------IL-.... --- I OB/1512011
smtamentasctDecember31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D- PART 2- SECTION 2 Showing all COMMON STOCKS Owned December 31 of ¢urrentYear
CIJSIP Tclentificafion I D~n
404280 40 6 HSBCHOlDINGSPLC·SPONSAOR.. ......... ,,_ ......... . 425883 10 5 HENNES & MI\URITZAB-IJNSP ADR_ __ _
426281 10 1 JACK HENRY &ASSOCIATES INC, ........... .
43300A 10 4 HILTON WORLDWIDE KDLDINGS IN ........... .
433578 50 7 HITACHI LTD--ADR., .................. .
436106 10 B IHOLLYFROMllER CORP ............ - .... .. 438516 10 6 HONEYWELL INTERNATIONAL INC ................... . 43858F 10 S HONG KONG EXCHANGES.UNSP ADR._ ... _.
44S658 10 7 HUNT(JB) TRANSPRT SVCS INC .....
45167R 10 411DEX CORP .............. -
451680 10 4 IDEXX lABORATORIES INC .......................... .. 453142 10 1 IMPERIAL TOBACCO GROUP-AOR_ .................. - ..... - .. ,
455M7 10 7 IND&COMMBKOF-UNSPONADR.._ ...... . ml 4561l37 10 3 lNG GROEP N.V.-SPONSORED ADR. .................. . - 459200 10 1 INTLBUSINESSMACHIIIIESCDRP-·--.. -- ... - .. . !'J 46115H tO 7 IIIITESASAIIIPAOLO·SPONADR ...
'"' 465254 20 9 ISUZU MOTORS Lm.UNSPON AOR._ _ _ - ........ -·-·-...
~ I ' I'
F
Number
" Code I n I Shares
~ I ::~:=::~~~~::~: _ .. 213.000
. ...... 923.000
R. I .............. 337.oao
- ....... 1,062.000
,,_ .......... 578.000
,00, Rate Per
s~.
Used to
AdJusted I Obtam Carrylng Fair Value Value
4M14~--- _.55.130 ......... _ .. 28,112 ........ .9.160
Fair Value
Fair Value
.48,514 28.112
....... ~~::~~:~~~ ::::::: I :::~ .. ::::::~ .. ::::::~~::~ __ .25,75"0 ___ 76.410 l ..... -........... --25,751l
::=--·=:~:~~ :::::~~~ :::=~ .. ::~:::~~::~~:~~ .. _.:~=~~:~~~~~ I ::::~::~::::::::=::~~:~~ I ::~:~::~:~~~ -17,141
_, ... 10,513
_.16,S'!2. __ .. a).5'/
R. R R
- .... 229.000
..... _,_,,78.000
.... .342.000
1,131.000 ... 2,557.000
_ ............ 1ti.912 .,,_.J3.850
.. ........ .8,297 ..... 1 06.370 .. ... _ .. .26,601 ......... 77.780
..... 15,359 --~---13.580
_ ..... .35,824 ,_, .. ,14.010 .31~.000 .......... _,,., __ .,.59,085 ....... 187.57B
26,601
15,3:9
35,B:i4 .... .50,0!5
·--·-... 20,302 .. ..... 7,367
...23,070
_, Cost
.. , ... 40,570
10
Declared
I b" I Unpaid
. ...... 16,5631 :;::::: .. .. 5,204
.. ______ ,20,259 ....................... .
____ ::::: 1 ~: r~::-~•·: .... 45,323
..... 10,594
... 0,300 ,_ .......... 7 ,397 ....... 2 •• - ........... ..
............ 7,230 ...... --.----
........... .23,-4051~] ::····~: -·····-···"·~' .............. 27,:1!!0
--· .. ·-·~·= .... 18,923 ....... ·--·-·-·
.... _ .... - • .!l.sot ...... L ....... ..2s
~"'
465685 10 5 rTCHOLDINGSCORP ... - ........ - .... --.... - ........... .
465036 20 0 I ISRAEL CHEMJCALS-UNSPON ADR..... ,._ - - ..
465562. 10 6 ITAU UNIBANCO KLONG-PREF ADR _ _ .. ~I ~-=:§~~ =~::::~-~g -~~~E __ .,430.000 ..... - .... - ...... _..41,203 _, ... .95..820 ~::~~~~ I ::::~:~::::::::::::;~: I ~:::c:~:::::~:sa
46625H 10 0 JPMORGAN CHASE & CO ........ - ................... ------469814 10 7 JACOBS ENGINEERING GROUP INC ......... , .. ,_ ......
481165 10 B JOYGLOBALINC. ............................ - ..
48137C 10 8 JULIUSBAERGROUPLTD-UNAOR.~ ..... .
485170 30 2 KANSAS CITY SOUTHERN ............... .
48667L 10 S KDOICORP.UIIISPONSOREOADR ..
487835 10 8 KELLOGG CO ................... _ ....... .
494S6B 10 1 KINDER MORGAN INC ...... -
4957:24 40 3 KlNGFISHER PL.C-SPONS ADR-..... 497266 10 S KIRBYCORP ....................... _, ____ _. ___ ...................... - ....... - ..... - .......... ,.-.. .
49e89A 10 9 KOCHOLDINGAS-UNSPONADR..,. • .,_,,_, .......... .
500458 40 1 KOMI\TSU Lm.SPONSADR. ....................... - .......................... _ .. ,_ .. .
5004BH 10 1 KONEOYJ-B.UNSPONSOREDAOR. .•
501173 20 7 KUBOTACORP.SPONSADR ..... ..
501889 20 8 LKQCORP ...................................... .
502441 30 6 LVMH MOE!" HEIIIIIIESSY.UNSP ADR. ..... _ ....... .
515098 10 1 LAND STAR SYSTEM INC ........ - ........................ . 517834 10 7 lASVEG\SSANDSCORP ........ - _____ .............................. - .... .
518439 10 4 ESTEEL.AUOERCOMPANIES-CLA .... ,_., ........ - .. .
530555 10 1 UBERTY GLOBAL PLC-A. ....... -- ........................................ --·-·-""" ,_ .. .
1.m.ooo ___ ................ 103,860 ...... ..58.480
--108.000 .. _ .................... .B,803 .. 62.990 - 1,080.000 ........................ 63,169 _ .... ..58.490
R 1,661.000 .......................... 16,1)29 .... 9.65fl
... 104.000 ........................ 12.,878 ....... 1Z3.1l30
R .. .554.000 ............................ 8,554 ......... 15.440 .._.744.000
·-----.--1,623.000
R. 1 ...... --• .3.323.000
___ 45.4361 ...... .Ot:Ol'il ..... .58,428 ....... 36.000
.42,667 - ...... 12.840 ___ .. 187.000 ......................... 18,560 ........ .99.250
R.l ......... 516.000 ........ , ......... 10,635 .... ..20.610 R_ ........ 1,232.000 ........... - ... - .. ..25,355 ... .20.580
~ :::::::::::::~:::~: ...... ::~::~_::~:~:::~: :::::::: ...... 848.000 ...... 27.833 .32.900
... 103,860
6,803 ....... 63,1~9
16,029 12,578
____ 8,554
..... -45,436 ........... .58.42B
... -42,607 ___ 18,560
... 10,635 - 25,355"
..... 15,684
23,910
..... 27,B33
R_ 1.. .. ..... 1,213.000
....... 808.000
.403.000
......... -.364.000
_ ...... 44,396 ......... 36.600 .................... -- 44,396
.......... .46.420 ......... 57.45tl .... ~ ...... - ..... _46,420 _ .. .31,785 ...... _7B.S70 ................... .31,7115
..... 27,416 ........ 75.320 ..................... .27 ,416
R. I ........... ---3f.i4.000 ...... _ ... 32,3S6 ....... ..89.000 .................... _.32,3~6
.79,090. _, _____ 4,357 1 ., ................ .
55,835 ,_15,953
11,949
.4,571
.• 22
........... .45.581 I:~:-~··•~•~-· I .......... 54,395
........ ............. ~~:~ ..... .S,561 ......... .
_, ___ .25,056 - .. _ .. "'"""'
15,063 .............. - .. .
...... , ........ 21,492 ·\·-·-· ... 13,576 1 -·'·······-·- _ 1
........ 24,m ............... 44.240
.......... 17,336 ... 16,810
.29,537
~3
Dividends
11 t2
Amount Reoe;,.,d
Durtng
Nonadmitted
DeClare~ but
Year II Unpaid
·-··· ... 2,11211········ .............. 5 64 ...... .. ....... 155 ~ ..... .
...... ~~ .. .. ---...290 ~ .......
2,549 ............. .
-.497 .. -·-·- ......... .. .... 392 ................. ---- .. 61 ......... _ .. , ... ..
- .. 204 ........... _ .......... .
:~::.~ 1:::::::::::::::1 ......... n3 I' -· .. .... --······
-.467 1'··- ... ·····-··········1 .. 183 , ......... --.. -..463 ....... · .................. .
- .690 ....... ·-·""""' _, ... 1J122 1 ........... ..
.. .490 /'········ ...•..•••
.._ ........... .. .. 109 ........ -.. ---.---. .. 342 ............ ,_ ....... .
2,024 ............... -.•
. .... 893
• ......... .212
.. 515 .. •. 244
...... 86
• ........ 579 1 -··· .......... .
..5~ 1·········-·········· - .. 248
ChanQe in 8ook!Atlru5ted Ca!Tl'in~ Value
" 14 I 15
Unmalized
Valuation lnmeasal DecreBSe)
... _ ... , ...... 1,813
Current
Yea~s
Other-Thar~
Temporary
lmpailment Rec[)!lniz:ed
..... 6,930 ·--... .4,249
. ......... 278 .. ................ 6,107
.. ......... 2,105
.... 7,488 (336), ..
2,392.
.5,256 ..... . ......... . ,, __ ........ 1,067 ......... .
.. 1,Q56 .......... .
..... - ...... (697] .... _ ................ .
.... 8,533
... (1,676) ·-·- .......... .
.... 1.40S ........ . •. (3,126) ... _ ..................... .
....... 520 - ............. - .. ..
... (1,526) ....... .
... 8,131
• ...... 20,1)1)8
. .2,205
.. .. 7,334
.......... 76 ... .S30
... 3,670
Total
Change ,, SJAC.V.
1S.t4: .... 1,813
.6,930 4,249
....278 ........ 6,107
.2,106
.... 7,488
(33~ ... 2,392
... .0,256 • .. 1,067
1,056
(697J·-· .8,533 (1,1l7R)
_,,"(,409
(3,126), .. ... ,520
.(1,526), ..
.. 8,131
... .20,068
''" ·-·~ .. -7,334 ....... 76
.... 930
..... .3,676
16
Total
Foreign E:ccllange
Change
" BJA.C.V.
H
'"' Market
18
Indicator I Dele Ia\ Ao:rUired
L... ...... 12114/2012
u ........... 0611012010 L. .......... 1111512010
L... 1211312013
. 'u........ 07/1212012 L....... 0411612013
L............. 06/1412013
u... 06/10/2010
L. ...... _. 1210612010
L ........... 0610512012
..... ll..- ........ 1010212013
u ........... 0711612013
u............. 01127/2011
L ....... 1112612013 1111912013
u .... - .. ~ 1112612D13 u ____ ... 0711212012
u... 0910412013
L-.......... 0412612012 L.. ... .
L .... .
11112121tl2
1210412013
06Ill5/2012
07/0612013
u... 11/01/2013
L ........ 10/2212013
u... 071121:2012
:~~~: 1·-·- ......... ----- ........ (145), ____ ,, L ........... 10128/2013
11,970
6,986
:is:~~: I:: ............. -.......... 522
........ .2,418
............ ::~~;~I:::.:: .. :: .. ::: 2.180
... 13,182
• ...... 5,349 2,859
...1>58 ... 11,976
...... 6,986
(2,ru) 1 ..
(5,730) ..
... 622 .... 2,418
.... 8,876
..... 5fl8
... 2,180
13,182
5)40
......... 2,859
L..... 09/2712013
u...... 1012212010 L. .. - 06/05"12012
U........... 09J26/2013
U... 1211BI2013
L.. ........ 1DI1612013 u_ 04/1812013
L....... 10/tl7/2013
L....... 07/2412012
L...... ..... 09/D312Dt3 _, L .. .. ..... 1110712013
SlatememasofDecember31,2D13oflhe Mid ..Atlantic Vision Service Plan, Inc.
SCHEDULE D ·PART 2 ·SECTION 2 Showing all COMMON STOCKS OWned December 31 of Current Year
CUSIP
ldentfficalion S057llA 10 8 LINKEDINCOF!I'-A
Descrlplion
539830 10 9 LOCKHEED MARTIN COF!P ......... .
548561 10 T LOWE'S COS INC ......... ·····---··-·- ··-··--·--.... - .............. .
~ I ' I 4
Cod•
550021 10 2 LULULEMONATrlLETICAINC ............. - .................... _ ......................... 1 ........ 11... 55261 F 10 4 M & T BANK COF!P ................. --·-·-'"'"-'"'--·----·--··-·---· 55616P 10 4 MACY'S INC ... _____ ............... _______ .. --..................................... - ....... .
::: ~ ~ =~~~~~;~~~~:;=.:~~=-~=·:::=:=:-~:=.=~:~~<_:.:~~ -J ~:-I: 5705:!5 10 4 MARKEL CORP _____ .... _ ............. - ......................................... - .......... ..
570912 10 S MARKS & SPENCER PLC-ADR. ....................... - ... .. " 57636Q 10 4 MASTERCARD INC-ClASS A ..... - .... - ..... , __ ,_,
579780 20 B MCCORMICK & CO-NONVTG SHRS ............. .
Number
of
Shai1!S _ .... _ .. 80.000
.._ ............ 450.000
...1,703.000
........ 404.000 - _____ 971.0rrD
. ....... 970.000 ....... 151.000
1,366.000
·---·--·SDO.OOO 5fi.OOO
...... 991>.000 ____ 53_000 I __ _
650.000
Boo" Mjusted
Rate Per
Shore Used to
Obtain
Canylna I F~ir VaJue Value
.... 18,647 ..... 216.830
·--.. 66,897 ...... 148.660 ....... 64,384 ....... ..48.550
23,848 ........ 5!!.030 ............... 113,044 ....... 116.420
51,798 __ 53.4DO
·---12,391 ........ 82.000 .2B,951 ........ 19.730
...... 73,334 ..... 91.730 - ____ .:)2,500 ....... 580.350
..14,277 ..... 14.334 .. 44,279 ....... a3S.480
_ ............ 44,793 ...... ..58.920
ml 580645" 10 9 MCGRAWHILLFIW.NCW..INC ............................... ..
- 58155Q 10 3 MCKESSON CORP .............. - ............... ..
...668.000 ·------ ......... .52,238 ........ 78200
...110.000 ......... _.,_, .. 17,754 -.161.400
"' ... 58733R 10
59261>2 10
SS410T 10
'I MERCADOUBRE INC ....... - .... - ............ .. S M=nlER-TOl.EDO INTERNATIONAL ... -
6 MICHRIN (CGDE)-UNSPON ADR............... ---·-·----·---·---· :~I~==::~;~:~ ::~-~::::~:~~~=:~~: :~~E: 594918 10 4 MICROSOFTCORP-·----·-·"·-·- ......... . 601>822 10 .t; MITSLIBISHI UFJ FINLGRP-ADL ...
600827 20 2 MITSUI & CO LTD-SPONSADR. ... ·----~1:1~ .3,258.000 ------------ ..... 121,947 .... ,_.37.430
............ 4,775.000 ·----·-·----·-.. 31,897 ......... .6.680 83.000 .......... - ............ .23,245 ...... 280.060
60687Y 10 B MIZUHO FIIIIANCIALGROUP-ADR ................ .
607409 10 9 MOBILETELESYSTEMS-SPAD1L._ .... _--- ---.. ------·-·--...
6;11~: ~~ ~ I ~~~~~:;~~~~;~::~~==:~:~~~~ ::~ .. -.. ::~~-~::~::~~~=:~ ... 617446 44 81 MORGAN STANLEY ........................................................ _ . 017700 10 91 MORNINGSTAR INC ..... - ................ __ ......... , .... _,, .. ,_, .. ,_ ....... _ .. ..
li20076 30 71 MOTOROlA SOLUTIONS INC.............. - - ....... --............ - ........... --·--· 026717 10 2 MURPHYOILCORP ...... - ... -·- ................... _ .................. ,_,, __ ,, __ 0285:!0 10 7 MYl..AN INC ....... __ , .. , ...................... ..
037071 10 1 NATIONAL OIL WELL VARCO INC_ .............................. ·--·----·-·
', ............ .6,102.000 R. ·----·-·-·370.000
. 672.000
................. 780.000 .. .... - ..... 1,190.000
32fi.DOO
................. 820,000
......... 731.000 .............. 1,306.000 .-............. 655.000
____ 26,605 ____ ._ ....... 8,003
• ..... .4.360
21.830
_,78,322 ...... 116.550 02,851 ..... 67.770
........ 37,318 _ ... ..31.3130
-.25,457 ......... 78.090 ____ .. .55,350 ......... 67 .500
..... 47,427 _ .. _..54.880
...... ..$,787 ....... ..43.400
.... .52,092 ..... _79.530
6410(>9 40 6 NESnESA-SPONS ADR... .............................. - .... .
651587 10 7 N8NMARKETCORP ..... ----------------·------·---
R. I 489 000 , .................... - . .34,0141 ....... 73.590 - ...... 145000 ..... - ................ ..48,452 .... .334.150
::: ~~ ;[~=~~~~~~~-~:::~~:::::- ................................... . ....... .565.000
.......... _ .. 484.000 654802 20 6 NriTODENKOCORP-UNSPONSADR. ...... _._, __ , __ .... ,. _____ --·- R. ................. 757DrnJ
654902 20 4 NOKJA CORP-3PON ADR-........... .. .................. - ..... _ .. _ ........ R. ... - ........... 997.000
1>55044 10 5 NOBLE ENERGY INC ............... - ....................................... -·----·-.. --. --·- ............... 440.0M 6S98TV 10 9 NOV ARTIS AG-ADR ......... - ... - ..... _............................ ........................... ...... R. .......... _,_,412.000
670100 20 5 NOVO-NORDISKAIS.S?ONSADR. .... _. __ , .. __ ......... - ................................. R. ................. 541.000
___ ..48,375
..... 38,062
.. ... a5.1l20
.... 78.640 ____ 16,147 ...... _21.330
........ 8,086 _ ....... .8.110 .2B,958 ... _.68.110
... - .......... 33,117 ___ 80.380
......... 99,955 __ 184.760
FsirValue
Fair
Value
........... 18.~7
-·-·----.. 56.857 ............ 84,3!4
.................... 23,848
-·-·-·-·113,044 .... 51,118 - 12;3£1
_,,26,.9!:1
...... n.ae4 ......... 32,5W
- .... 14277
·--.44.279
"'"" ,~,
............. 20,688 ...... 43,165
10
Declared
b"' Unpaid
... 64,488 I····················· ..... 27.279 - 112,2S8
...... 49,427
.. .S,S79
..... 14,370 ............ - .. 62,633
-·---·20,751 ............ 11,595
.... 243
-.182 .............. 22,1!371- -- ·-··
:::~~j I :·::~-~~~~-~~-;.:~: I ::~::: .. :::::~:~~~-~-1 ..... 15,169
S,OCS .27,584
-·-·--.121,947
...... 10,8<13 3,898
. ......20,165
... £1
.. Jl2,S54 1--·······-·-···· ------........ 31,8971 ....... - .... - .... -.23,947
=:::~~:~~~: .. :::~~::=~::~:~::~:::~ - _____ ,8,0CG ............... -7,87!1
49,917 .......... .
Diviclencts
11
Amount
""'"' During y~,
"
Nonadrrulled
Declared
b"' Unpaid
................. 1,0341-·-- --····· ................ 783
..... _,_, ... 1,000 -·-··················
164 .... .584 ..... 952
4M .... 111
... M41·-···
.... 561
... ..55
... _,_.426 1-·--······-····· .............. 3,004
... .511
-·-·- .. --635 - __ .. 670
''" ..... 78,322
................ 52,861 .... .37,143 ....... ......... .. ........................ ..
~::~:: I:::: :::.::: .. ~~ .. ~;:~~ :::::::: .. :--·---·-...... _.55,Wl
__ ,47,427
...... 56,767 __ .... ...52,092.
. .... .34,514 _48,452
48,315
38,06~
________ .43.861 ...... 254
.......... 44,B50
....... 42,4441-- ·-······-······
-·-··-·-·44-"' 1----::::: ...... 23,981 1 ........... .. ..... .37,952
...... 37,822
... .32,844
·---·-------100
.............. 116
......... _ .. 119
105
..... 894
1'"
~· .. .... 075
... ::~:: I::~ :::~:~ .:=::.
-··'"·"' --- ·- -- ,.,~ I ·····-····-·-····!······· ...... s.osa _ .. 8 o63 -----------·-· ·---.... - ........ 29.flBB .. .. .. .26,624 , ___ , .. , ..... .
.............. 33,117 --- ---20011 .................. ..
.... 71 .... .309
..... 104 e;o
..... .1,171 _ ................. S9,955 ........................ 55,496
Changa in Book/Adjusted Call'{in~ ValiJe 1T '" " 14 15 '"
Unrear!Zed Valuation
Increase/ (Decrease)
--·---...... (2,040) ..... 23,732
Cummt
Yea~s
O!her-Than·
Temporary
Impairment
Rseo;nized
... 1e.ms 1 .................. - .. .
....... (3,431) ____ 745
....... - ...... 2,371 .................. 4,638
,._ ............. 8,3871::: .. =.: ... :.=: ................. 10,5S1
... 7,773 1···········-·-··········· .................. 1,898 ... - ........... 18,2421·-·- ................ .
- .. 4,387 ..... 17,540 ........ 240 -----................. .
.......... _ .. 3,345 .... -·--·-·-·---· .............. 1,1i27 - -- -·-·-·-·
........ - ....... 2,645 __ ,_, ____ , __
........... _ .. .33,700 ...... _,_.
................ 4,740
,._,_ .. ___ (1,141) 1-·""""- ............. . --.4.271
... - ..... 125 14,348
................. 11,645
"'~ ..... 4,447
....... .!1,692 ...... 2,57!1
·--·-·--·.14,3231 .................... . - _______ 7,323
... _ ........... 3,680 ... 10,500
................. 10,554
_ ......... ~~~~) I ~:=~~~:~::~:~:::: .3,344
......... __ .7,037
-----........ 11,169
'"" Changa
'" BJAC.V. '13-14:
Tool Foreign
"""'"" ""~' ' BJAC.V.
NAIC , ... Indicator ,,,
...... _ 1 L ...... - ....
''" I Acquil1!d
........... (2,040) _ ......... .23,732 -------- I L._ •
12/1612013 1)4/1SJ2013
... 19,896 ,,_,,
...... (3,431)
·----745 -----... 2,371
...... 4,838 ___ 8,387
.... 10,551
..... 7,m
--·-·----1.898 - ..... :.18.242
------·---4.3B7 17J;40
__ ,240
L...... 11m12o1s L... ....... 12/1712013 L. .. _.__ 12/1612013 L______ 1112012013
u .............. 07/1212012
07/1212012
0411612013' 1011SJ2013 04127/2011
0811012012 ....... _. 11/12/2012 . .,._, 0411612013
........... 1211812013 .... 3,345 _______ ......... u ....... -... 1112012013
.... 1,627 ,._, ............. - .. L ...... -... 11115/:2010 2,048 ,._,_ - - -----·- u............. 11121/2013
.............. ...33,700 .................... _ L .... -... 1)411612013 ,._ .......... - ... 4,740 ...................... __ L ...... -... 0411212013
................... (1,141) ·-·--·-........... -.4.271
......... _, .. , .. ,_ .. 125
""" .. .............. 11,645
----- ....... .5,824
u ......... -... 0411112013 L ....... __ 0711212012
L ........ ~.. 1213012013
L._ .... , 0812612013
L............. 10/25/2012
L............. 0712612013
--·--··-·--.... 441
1
.................... _
1
L .. __
110,.~,
......... - ....... .Jl,692 ----------·-·- L.... ...... 11112/2012 ___ ., ___ .2,57S .......................... L..... ...... 11/1812013
__ .14,323
....... - ........... 7,323 .... 3,a8o
................ -1C,SOO
................ -10,554
..................... 5,218 ,.. __ ,,., .. , ... ~2,326} I ..
___ 23
·--·-·-·-·-·3,344 ,7,037
.... _. ___ 11,169
l-~·-·-·-· 0811212013
-·-I L.............. 0711312012 .. U .............. OB10612013
... _ ......... L ....... _. ~11612013
L._ ....... 1111212012
L ........... 1010112013 u ....... _ .. .__ 0711212012
L ............. 1112512013
L-·-·-·- 1211012013 L............ 12/0812010 L ... 1mtl/2013
' "
Sllltementa~ofDecernbsr31,2013oflhe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D ·PART 2- SECTIO~ 2 Showing an COMMON STOCKS Owned December 31 of CjurrentYear
I Codi '
CUSIP lden!illca~on Descri ·on Code
S7103H 10 7 O'REILLY AUTOMOTIVE INC .. 674215 10 B OASIS PETROLEUM INC. 675232 10 2 OCEANEERING INTL INC.·--····
677862 10 41 LI.IKOIL OAO.SPON ADR...·-··-··· 682580 10 3 ONEOK INC ................ .
684060 10 6 ORANGE-SPO~ADR ....... ··-·-··- ······---.. -·-··-·····-·-··-··-""" 593483 10 9 POSCO-ADR. ........ - .... --........... -- ··--·-··-··· 693671.1 10 5 BANK MANDIRl TBK-UNSPONAOR ..... ________________ ................ .
694BOU 20 6 PACIFIC RUB tALES ENERGY COR? ....... -····-·····-·-··-·-·····-.. . 695155 10 9 PACKAGING CORP OF AMERICA ........... -·-···--··-·--···--·-· .. 695429 30 7 PAll COR? ..... - .............. - ............ ----·--···-·- .......... . 7(13481 10 1 PATTERSON-tm ENERGY INC ................. ·············--··--····- .............. , .. .
705015 10 5 PEARSONPl.C.SPONSOREDADR ... ·····················-.. -·-.-----···-----.. .
Number of
~ --------------.56.000
--------.. 520.000 ---·-·····-··-143.000
R. I --·-·----.402.000
Rate Per
'h~
Book/ Used1o Adjusted
Carrying Oblain Fair
Value Value ______ 7,208 ----128.710
24.424 _41t970
........ 11,280 ... 78.880
~"'' 63.120
....... ..85S.OOO ····-····-·····-·-··53.226 ...... _62.180
~t--~:ill~ :~=~:~~ill~ :::~:r~ ····- ......... 654.000 ···-·····- .......... A0,120 ------63.280
·-··-·····-----S5.000 --------------..... 7,255 ......... 85.350 ······----2.275.000 57,603 ----.25.320
R.l. ________ 1,029.000 ... .23,050 ... -22.400
Fair Value
Fair Value
7,208 .... 24,424
11,280 .25,374
~"' 14,203 6,630 .5,769
"'"'' Cost ..4.038
...... 23,7ll2 ....... 3,601 .. .24,659
______ 37,903
..... _____ 12,122.
........ 6,61!2 -· 7.870
---------25,379 ________ .. 32,273
I" I !
Declared
1 ou1 Vnoaid
- ---'···-·····254 _____ j __ ,. ________ _
Dividends 11
Amount Received
Durlna Year
............. 120
·----1.267 ---.. ---190
... m --------..92
--385 ---254
" ---341
~I ~:~~~ :~ : :::~~~;~~~~~~;~;~~~-~--- ----- _____________________ ...... . 2,S70.000 ... 1.350.000
.78,7"19 ......... 30.630 ... 117,626 ----6-7.130
.... 21,713 , ..... 40,1ZC
..... 7,255 ..... .57,60:!
.. .23,05C
·--78,71> ..... 117,52e
.... 55,30~ .46,851
:~:I ::::::1 .... 61,8341::::~
....... 11B,7!l3 "" .. .. 739
... 2,467 ..... .3,~00
"' "" 718546 10 41PHIU.IPS66 _________________ _
7401S9 10 5 PRECISION CASTPARTS CORP. ____ _
741503 40 3IPRICELINE.COMINC •...
74463M 10 S ~UBLIC!S GROU~E-ADR. ......... -·····-·-·····-··· .. ·• .................... . 747525 10 3 QUALCOMMINC._ ......... --..... ---··--·- ······-·····--·-··-·- ..... ·-·- , __ .. .
749660 10 6 RPC INC .............. ······-·····-·-······-- .. --·····-·-··-·-··----7-51212 10 1 RALPH LAUREN CORP ........ ------- . -··-·····- ···-·-·····-·-··· 75281A 10 9 RANGE RESOURCES CORP.·--·-·-.. ----······-·····-·--= ~ :!~~~:~~~~-:~~-~-~ .:~-=-~-----·--··-·····-·-·····-...
···- .......... 717.000 ----------114.000
--~-----·-···--138.000 R. .1,289.000
.3,367.000 3,224.000
________ 55,302 ......... 77.130 ___ 46,858 ____ 269.300
.1611,411 ..... 1,1&2.400
52,578 ....... .22.970 .250,000 ____ 74.250
·-----.. --... 57,548 ......... 17.650
• R
151.000 ~-----------·-··------26,8621 ... ___ 176".570 ....... .322000 ···-----------."ll, 148 ... 64.310 . .. 2,104.000 -----·····-········---.33,853 ........ 16.090
.... 25,506 ........ .05.430
771195 10 4 ROCHE HOLDIN~ LTO..SPONSADR ........... ·······-··-·--·--·-.. ···--··----1---··· I R.
. 452.000 . .473.000 .296.000 673.000
S34.000 325.000
.33,205 ......... 70.200
774341 10 1 ROCKWELl COLUNS INC ..... -····-··-·-··· 778296 10 3 ROSS STORES INC___ .. ---··· 780259 20 6 ROYALOUTCHSHEU.PLC-ADR. ............................................ --............ 1 ...... IR. 78388J 10 S SBA COMMUNICA110NS CORP.CLA_
784117 10 3 SEIINVESTMENTS COMPANY ......... _ ··-·-··----·--·····-·-··-··· 76442P 10 6 SLM CORP ......................... - ..... --- ____ ·-····-·- ..... ·······-·····-·
78454L 10 0 SM ENERGY CO ......... ······-·····-·- ................................. ·--·-··-·-··· 78672M 10 S SABMIL!.ERPLC-SPONSADR..----·- ......... . 786635 20 1 SAGEGROI.IPPLC--UNSPONADR. .. ____ _
80105N 10 5 SANOFI-ADR.. - -- .... -
" " •
79466L 30 21 SALESFORCE COM INC _ --- .... 79546E 10 4 SALLY BEAI!lY HOLDIN~ INC
803054 20 4 SAP AG--SPONSORED ADR - - - - - - ---- - -- -- - ..1 -- I R.
......... 403.000 ..... 1,018.000 ....... 272.000
21,880 ......... 73.920 .50,428 ......... 74.S30 ..38,058 ......... 71270 .29,198 _______ .89.840
-.13,996 .. ___ .34.730
- --- ....... .26,7~ ........ .26.280 _______ .22,606 ---..83.110
.m ... .502.DDD ......................... .25,743 ........ .51280 .. .522ooo ........................ 13.943 .. .2a110 1,237.000 _____________ ... &a,27ll - .•.. ..55.190
..... 671.000 .. ···············------20,264 ........ .30.230 .531.000 .................... _....28,478 ........ .53.6:30
. .219.000 ···-·-···- .......... 19,084 _____ 67.140
____ 160,411
"57! -··-·----.2SO,ODC
""" ·---...... 26,662 ...... 27,140
.. ... 33,850
.25,506 .... .33,205
.. ..21,88~
---.952
------.21 .:~~::~~:: :~:~:-_::~:::::::~~:::I: _______ -········--· ..... .30,393 ······-···
_______ 198.515 .......... _. __
________ 46,3941~,~: ~; ... 24,089
___ 25,283 ..... • ...... ____ _
•.. 20-.356 .............. ·····-··
~-"' _____ ,_ .. 2a,9S3 --···
..... ...343 .. .4,083
·---llH -----------158
.. 26 ... 865 .... 797
·---------21.456 ······- ..... .89
.... ...50,42-B ~--·············-------.46_835 ·············---309
::=~:~: ::::~-~~:=~:~~:~~~ ................. :~·-:~;I .. ::::::::~~:::·1,544 ........... _70
···----.. -----45'8 ...... 26,753 22,606
... 25,743 .... 13,943 - 68,Z70
20,28<;
.. .. 28,473 19,084
......... 21,445 1
.... 24,053
·--17,311
9,64-21= : ··= .. 43,143 .... 9.322
----17,976 __________ 10,738
"' ou ... 83Q
···-···---·672 ···--------175'
12
Nonadmitted Oet:lared
"' Unpaid
Chanoe in Soo!:!Adiusted Carrv[nq Value
1J 14 15
Unrealtzed
Valtnrlon
Increase! (Decrease
......... .2.200
'''
Curren! Yea~s
Olher-Tha!l
Temporary Impairment Recoonize!!
... .3.588(·········--·········--·--........... 715
····-·····=~~~)I::: ::::~:=:::==:::: I
~2,101) -- ................ ..
... (3,666) ···-- ········-·-··· ........ ____ 7,846 --- ···- ···-···
- 2.133 ··················-·-··· ............... 5,560 ······-···
..... 2,943
....... 14,21>5
..... 810 -------···---12. 162 ________ .. __ _
________ 1.3,899 .......... ..
.... 74,797 ············- ...... ··------·-·····-15,849 ············- .... ..
- .. 39,326 .. _ .......
.. .11,1541-••~•-:.: ... ~:. ....... 3,056
-1.865 ·················-··· ............... 6,880 ..... .
, .. [7SO) ... ..
......... 4,221 ····- ·············--· ..
.424 ----- ·····-··· -------------6,884 ·············- ·-·-···
... 1,51)3 ,. _______ .. 6,130
... .4.157 ----... ·-·-·· ________ .. .5,308 ..... ······-·-···-···
Total C.'lange
io BJA.C.V.
~ ... 2,200
-·~ 3,588 .... 715
...... 15,323 2.679
''~II .. ..(2,101) ..
(3,006) .... 7,846
.... 1, 133
.... .0,560
.... ...2,S43
..... 14,265 - .~10
.. .-...... 12,162: . .. 13,899
.74,797 .15,Wl
. •. .39,326
. ..... 11,154 .. 3.056
···-·· 1,565 s.s8o {750), ...
. .. 4,221
..... 424 ... 6,884
....... 1,503
···- ......... 6,130
····-------.4.167
16
Total Mlreign
Ex~ha:nge
ChMge
"
N•c Ma~t
'"
in llndir:alor I Do> BJA.C.V.
----ILL..
~ 0911.812012 1210212013
L ........... I 0610512012
. 1u ............ 11212612013
L ·····-···· 1111212012 L .....
L.
0212112015 0711212012
lL ........ 1l7130J:2013
u....... 1"212012013 L 0812312013
L--·.. 0612212011 L .......... 0411612013 l..... 05/2412012 l...... 11112/20t2 L....... 0012712013
.......
1
L..... ...... D1/2B/2013
----. L.. •... ····- 1011012012 . L...... 1011212012
. u ..... ·-··· 1112612013 L.
.,L.. .. 1110712013
04/1612013 L. 07!1212013
L ....... -... 0711612013 .
1
u....... 03/1512011 . L.. 08122/2012
u .. ····-··· 1211912013 L...... 08/1212013 L ......
L.
1111212013 0212012013
L. ·········- 11/2712012 L... • 0712212013
.. (1,447) . -- . ·-··· .... 2,067 ........................ .
.3,435 ................. .
........ .5.308
[1,447) 2,067
• .. 3,4-35
···- ....... 16,709 ···-·····---4,241
___ .3,319
--·- L.... ....... 1210212013
_
1
L... ....... 0511012013
···----------·~--- ~::::::::~::::1 ~~~v:~~ ..16,709 ··-·····-·- ···-···
........ 4.241 1:: :: ::: ....... 3,319 .. 1,480
I····· ...... -------... 1,480
L .....
L. .. 07/16/2013 09!1612013
L ........... I 0711212012 L ... 01/1012012
Statementaso1December31,2013ofthe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D • PART 2 ·SECTION 2 Showing all COMMON STOCKS Owned December 31 of Current Year
CLISIP
lcleniffi""tion Desccl ·on
803<!66 30 0 SASOL LID-SPONSORED ADR ...
80S85Y 30 81 SBERBANK-SPONSORED ADR ... ·--·····--···-···
'--'$ I s I 4
~ R. R.
Number oi
~ _____ 717.000
955.01JD
!look/
Rate Per Share
Used to Adjusted I Oblain Q!nymg Fair
ValuB Value
-----35,456 I -----4.9.450 •.. 12,004 _____ 12.S70
.21,481 ....... 114.£60 .... 154,62S ..... 90.110
18,512 ... -2S.OOD ::: ~~ :I :~~~~!iJ::~~~~-- :::~~~::-~:~:-~:~::~:~=:~:~:::.~-~ ~-=-==-~-=I:::: I:: :::~::::~:~~:~~~~~~ 81S79<: 10 2 SEGASAMMY HOLDING-SPONSADR. .. ____________________________ _
B1748l 10 0 SERGO GROUP PLC-UNSPONADR-----···-·····--·-··--··-·-··· 61762P 10 2 SERVICENOW INC..·-·····- ·····-·-··-·----·- ________ ----·····--·- ··-·· 826197 50 1 SIEMENS AG-SPONS ADR.·-·-···-··--··----·-·-·-----·--···-··· . 8:>421A 10 4 SCLERA HOLDINGS INC ____________ --- _ ------------····-·-·-··
842651/ 10 ~ SOUTHERN COPPER CORP •. -·-···-·-··-·-····-····--····-··· 855244 10 9 STA.'<8UCKS CORP ___________________ ------------·--··-·-·--···-·---· 85771P 10 2 STATOILASA-SPONADR. ______________________________________________ _
R. ·····-----1,830.000
R. ····-·····----225.000
------11,657 --------~-~70 - __________ 1_886 _______ 6.360
.238.000 ~---· ··-·····--·---13,330 ~-----..56.010 R ··--·-···---243.000 ····- ··-·····-·····.33,85.8 ____ 138.510
----1-····-····-··--129.000 ··-- -------------9.128 ------70.760 R. ·······----.2,388.000 _____ _ ___________ 68.ff~ ....... .28.710
R.
FeirValue
"'' ~ ___ 35,451l
Dividends
" 11 12 "
Amount Nonadmitted Unrealized Received Der:laJed
Actual During but
COst Year Un id
______ .29,170 ··········-··---1,191 -------------·
____ 10,923 ······················-··· ·····- ·------ ----- ···-··· ·····- ·····---1,082
Char.Qe in Book/Adiusled Carrving Value
14 I 1s
'""'"' Yeats Other-Than--
Total Change
;,
BJA.C.V.
13-14] .4.417
-----------14004 ___ 21A81
__ 10,383 ···- ···············-··· ··- ........ -... -·-· ··············-··· ············----6.3621-················
_____ .1,082
___ .B,362
__ ..26,515 ____ 1,663
___ .3,958
...... 154,629 - 11!,512
___ 11,657
___ 123,194 ................ 498 ·········------1.500 ··········- ·····-··· ·····--------.2a,515
10,84<! -- ···-·- ··-·-··· --- --------16 ···- ···-··· ············----1.663 9,553 ·-·-· -- -------·-····-···142 ·····-·- ···--·- -------------3,958
-····-··-··--.1,880 1- ___________ 1,1128 ···-····-·- ···--··· ·····- ···············-·· ·-·- ---------------.56
-····-··--1~.330 ···-··-···--11,163 -- ----·-··· ---- ···- ·····-·-·· -····--··- ···-····- ···---------.2.168 __________ 33,6581 _________________ .19,375 ------------- --- ···- ·······-·· ·- ·····-·- ···-··· • ·-- .14,263
=:=;:~: :::==~~:l~~ :~ ::.::: :::~:-:1~ =:.:~.::~: :.~=~:t== .......... . ----·------58
--..2.168
-----·-···---.14,283 ···-·····---.2.230
------------·(19.981] ------11,458
···-·-·--·····.(ml
" ""' For&ign
Exchange Change
;, BJA.C.V.
H 1S
"'"
u ____________ 0710312013
L- ··-·- 11/1&2010 L_ ··-·- 1212712013 L.- ··-- 1111!il2013 IJ____ 07/1212012 u__________ 12/3'll2013
L ···-- 0813012013 L._ ·····- 07/27/2012 L__ ···-·· 01119/2012
L._ ·····-·· 04116/2013 L__ ···-·· 1112012013
!1!1 ::: :~ : ::~:co~:~;-~;;~--~~~~:~-~=--------~~:::::: .. :~~~~~~--:::~~~::. R.
632JJOO ~-----------65.220 849.000 ··-·-····-·····-----.2Cl,4a6 S25.000 ---------------------60,969
.... -78.390 t·······-·-··-·····--$5,220
..:::~:: ~~ :~:~:~::~:~:~::~~!::: S,062JJOO 26.778 I ___ _5290 .26,778
.48,530 ···- ···-··· ···- ···············-·-· ·-··· ···- ·····---· -------------12.017 12,017 _______ .25,1)18 ------------(0) ····- ........ 197 ·-·- ···-··· ·····--- . --.750 ---------·····---760
, _______ ,u __ _ 0711212012 07/1312012 07129/2013
"' "' 869587 40 21 SVENSKA CS.LULOSA AS-SP ADR. ... ·-··· 870123 10 S SWATCH GROUP AGfTHE.UNSP ADR---·-·--···-····
87160A 10 0 SYNGENTAAG-ADR.. •.... ·-·--·-····-·····-·-·-·-··-·-·- ··-····-·- ···-····--872S40 10 9 TJX COMPANIES INC _____ ···············- ···- ·····--··-·-·-··--·----874039 10 0 TAIWANSEMICONDLICTOR-SP ADR·-·····-····-····-·-·-··-····· 876568 50 2 TATAMDTORS LTD-SPONADR .... - ...
67944W 10 5 TELENORASA-AOR.. _____ ······-·-·-·-··-·-····--·--·-··---.. 880320 10 9 TENC:NT HO!lliNGS LTD-UNS ADR.. __ _
881575 30 2 TESCO PLC-SPONSOREDADR. .. -·-····-····-·-··-·-····-··· 88152.4 20 9 T~A PHARWICElJTICAL-SP ADR.·-·-····-·-·····-···
88732J 20 71 TIME WARNER CASLE. _____ ·····-·····-·-·····-·--·-·-···--·-·-····
F(. ··-·-···----B20.000 FL _______ 669.000
R. ------------..302.000
------------1 ,248.000 R. ______ .z,ose.ooo FL -·-·- ____ .967.000
R. ··-- ···-···170.000 R. ·············--.395.000
____ 19,148
•.. 22,211 24,142
_____ .79,408
.36,415
---- ------------.29,784 -----12.167 ____ .25,446
... .30.880 ··············-·····---1g_14~ __________ _9,598 --- ··-·-··· ···-- -----28~ ··-····-·- ···--··· ------------.5.708 _____ .33.200 -------------...22.211 ···--·-----------12.968 ······-·- ···-··· ................ 139 ··- -· --- - ----- ····-·-····---5,357
··:~::~~~: ::~:~=:~:~_:::::~~;~ ~--:=:~:~ ·:::=:~:: ...... ::::::·~ __ ::::::: ···- :·::·~-: :·:~-~=:~::::::: -~:~::~-=:~:~~~:) 1--- ·····- ···-·-··· ....... 17.440 ·····- -·····-·- .36.415 -----------------32,400 -···-··- -·--··· -·--·----·----297 ··- ····--·--·----··· ............. (S15Jf-··········- ·····-··· -----30.800 ---- ··-····----.29.784 ---------- ______ 22,216 ··----- ··········-··· ········- - --120 -- - ---------- ----------.4.152
.... 71.57ll ·····- ··--- ·- .12,167 ----- ________ 11,568 ··-·- ···-··· -----·-···-----440 -------------·-· ·····--····-····500 -------64.420 ---- ···-- ____ J.5,44S --------- ______ 8,111 ·····················-··· - __ 46 ---·-····--··· ------------12,756
R. ··- ... - ... 1.348.000 ···-·····-·-····----22.700 ......... 16!40 ············-·- ...... 22,700 -·····-·- ....... 23,638 ···- ·····-··· ··-··-·- ..... ...283 ·---···-·- ···--···· ·---···- ..... -(958) R. ··········-----521.000 ··········-·- ........ .20,882 ......... 40.060 ···-- ______ 20,882 ............. ····-----.21,634 ·--- ·····- ·------·· ·········- ....... .506 --- ······-··· ·····-·····----1,428
---- ------500.000 -----------·-···-··67,750 ....... 135.500 ······- ····- ····---67,780 _______ _45,927 -- ···-- ···-·-··· ············----1.300 ------- ---·-· ··------.21,623
~~l ~ ll§g~:g~~~:~:~~~~=-~=:~~~~~=.=.j~:~l:=.: I~ ~:~~~f,l~ ::==~::=~ili ::~~E ::: :=:-~2~~ :~-=~;~~J:l~ ::: ·:::0~~; ~-~~::~~l; ::::~:~: :-.-~:~ 9013M 10 1 ~N1Y-FIRST CENTLJRY FOX-A ......• ·-···
903846 30 3 LIL TA SALON COSMETICS & FRAGfL ______ ··--····-··· 903914 10 9 LILTRAPETROLEUMCORP .. ___ , ___ _
904214 10 3 UMPQUA HOLDINGS CORP ............. - ... ---·-·----·---·-····-··· 907818 10 8 UNION PACIFIC CORP •. - .....•...
911271 30 2 UNITED OVERSEAS 6ANK-SP ADR. .•.. _ ··-···
911312 10 6 UNITED PARCEL SERVICE-CL 8_ ··-·····-·-·····-·-·-·-····-·· 913017 10 9 UNITED TECHNOLOGIES CORP ... 91307C 10 2 UNITED THERAPEUTICS CORP ..
91324P 10 2 LINITEDHEALTHGROLIPINC ...
-- I =:~:~:=:.1.~~:~~~ I ::~=:~:=:~:~:~:~~:: ... ..35.180 ____ 96.520 ::::::; I ~::::=:::::::~~:S~ "" 1·····-······· ____ 1M78
....... oo•l···· ............... .
R.
___ .2,055.000
···-·-····S27.000 --------1.033.000
···-----639.000
... ·-------485.000 .299.000
·----610.000 -----703.000
---:~=:~~:: I ::::~::~: I ~:~:==:~~~~: ____ . .21.4831 ________ .33..520
________ ..50,904 -----105.080
_______ 21.483
_,50,954
__________ _34.0261 ....... 113.BOD ~--··-·-····- ____ .34,026 , ________ 68,979 __ 113.060 --------- ________ 68,979
... .52.936 ______ 75.300 -------------------52.935
_ _______ 40,608 ·-·- ······- ·····-·· ············-··· ... ---- ------------.3~83
~.17~ ··········-···· ..... 79 ·······- ···-----237 ·- ··------- ····-·---------.3.873 ___ 94,022 ··-··- ·····- .. 816 .. ____________ .2,691 ···············-··· ·········---..41,222 ___ 19,581 --------·-······-··· ___________ 708 -------- ···---·· ·····--·····-----757f-··-···
______ 40,393 ------------- ______________ 902 --- ·············-··· ··········-----10,571
_____ 20,331 ·-·-····-··- ------·· -·····-- ______ 6!i6 ········- ···-··· -····-·····---.9,505
. ... 43,440 ·-·- ...... ····--- . - ------- --------- ----- ·····-··· -------------25,539 -------51,487 --·-·-·-·- ··-·-··· ·······-·- ... _ .. 370 ·---··-····- ·---··· ···----·-·--1A4S
- 5.708
-------------.5.357 -------(3411)
------------19.951 - -----------(915)
-------.4.152 . .599
-------12.756 -------~938) ____ 1,428
_____ .21,623
___ 2,428 ____ 9,117
--1.363 - _____ 4~
....
1
u .... ·------~ 0711212012 _ u ____________ 0910412012
···-·.- L------ 0712612013 _,L...
__ ::1~. 04/1SI2013 1112012013 0411712013
---- 1 L--···--· 05/DB/2013 u ____________ 111221:2011 u ___________ OS/28/2013
L--····-·- 0810712012 L. _________ 1111212012
L----- 0711212012 L--····-- 02109/2011 L--··- 10/0112013
L--···-·· OS/23/2013 ----------10,0781------------·-lu ________ l1112rl2013
-··-··--·-----{306:] ----····-·-····-·-· L------- 06123/2013 ------------.3.683
-----.3.873
·--·----------.41.222
...
1
L _______
1
1111S/2013
- L--···--·· 1111512010 _: .. L--·········· 1110112013
_____ :.:=:;~:I _____ =:::~:==I~ ·.:~-~-~---1 :~~:~ ______ .9,505
________ 25,539
----1.449
·--1'-····-·111115/2010 1012812013
__ ,L.. ... 11/01/2013
I II
S1atementasofDecember31,2\l13oflhe Mid-Atlantic Visiort Service Plan, Inc.
~
Number Cl!SIP g " Identification Description Code n "'"'' 91&204 10 8 VF CORP---·---·---··--·- --·-·····-·- ······-··-·- ···--·--·- .. , .. ,_ ··-· ··-··· .......... 1,11>4.000
91912E 10 5 VALESA-SP ADR.----·-- .. ·--................. _, ____ ···-·-·····- ................... ' . ......... 1,582.000 S2220P 10 5 VARI.'J>J MEDICAl. SYSTEMS INC .......... _, ____ ....•. : ................. ....... ·······-----1,363.000 92345'1" 10 6 VERISK ANAL YTICS INC-CIJ.SS A .................................... --................. .............. 1.12!).000 92826C 83 9 VlSA INC-ClASS A SHARES ......... _____ ................................................ -·-·····--··891.000 930059 10 0 WADDELL& REED FINANCIAL-A ................. ..... ···-·-·····-·--·····-··· -··-·· - 1,074.000 949746 10 1 WELLS FARGO & CO-. .............................. . -. -·- ···········-·-···- ·-··· ·-·--.• 1.711.000 958102 10 5 WESTERN DIGITAL CORP .............. _ ······- ····- ···-·· ........ 1,038.000 9$602 10 9 WESTERN UNION CO ........... ····-··-·-·····- .......................................... ...... . ............. 3.442.000 96206T 10 . 4 WEX INC ... ·--·····--·····-·- ............................................ ................. ·-··· ····-·-··--··.89.000 9633.20 10 6 WHIRLPOOL CORP .. - ......... ···-··-·-·-··--· ........................................ ·-·- . .............. .325.000 9B13BH 10 1 WORKDAY INC-CLASS A ... ··········-·····--·····-·-·--·-···-·-·-·-·-·-.. -· --··· .................. .BS-.000 9!!3134 10 7 WYNN RESORfS LTD .................................................. ·······- ...... ........ .. .•.. - .• 135.000
m I """ " o YAMANA GOLD INC ................................................... - ........................... I ................ 2.625.000
..:r. 98B49B 10 1 YUMi 6RANDS INC .. _ ... ···--·····-·····-·- ·····················-·-·····-······ ....... 1,0:JO.OOO !'l 9B918V 10 3 ZOETIS INC·-····-·-·····--··-··-............... - .... ·-·-·-·-·····-·····-·- ......... ··-·- ·--· .999.000 ...... 98!<8Z5 10 4 ZURICH INSURANCE OO.OIJP-ADR. ............... _ ......................... R. ·-··-- •. 1,356.000
018190 89 8 DEUTSCHE BANKAG-REGISTEREO .............. ·······- ·····- ········- R. ............... 463.000 G06921J 10 9 AXIS CAPITAL HOLDINGS LTD ....................................... ......... R. -·- ....... .sn.ooo G1151C 10 1 ACCENTIJRE Pl.C-CLA. .. ··········- ·········--·····-··- ····--··--.... ···- --··· R. ............... 897.000 G2554F 11 3 COVIDIEN PLC ..................................... - .............. ·-····-·~··- ............... ., . .... 727.000 GZ9183 10 3 EATON CORP PLC.-.................. ···················-··-·····-·- ....................... ··-··· R. ................. 676.000 G3157S 10 8 !Or-JSC:O PLC.CL A.. ........ ····-··--·- ······-···-··-····~·-·····-·-·--·--·-··· . ....... R. .....•......•..•. 185.000 134412G 10 1 HERBAUFE L TO ............................. ~·- .......................... ,. ......................... ··-··· R. ................ 344.000 G7496G 10 3 RENAISSANC:ERE HOLDINGS L TO ........................................................... """""" R. ...•..•...•..•. 126.000 G7945E 10 5 SEADRILL L TO ........... - ....... ·-·-·~·····-·--··-·- .................................. R. -·····--··1 ,064.000 G81477 10 4 SINACORP ......................... ··········-·-···--·-·····-·-.. ·~·~·-··-- ··-·-·-··· R. ····- ......... 126.0110 G!l7822 10 3 PERRIGO CO PLC.-.................................................................... ...... ·-··· ····- ..... -.660.000 HOOZ!R 10 5 ACE LTD ................................. ·············--··--····--·····--·-·- ........... R. -··-··· 1)17.000 N07059 21 0 ASML HOLDING NV-NY REG SHS .... ···-· ...................................... _ ..... .,. ... R. . ............... 259.000 N53745 10 0 L YONDELLSASELL INDU.CLA.. ... --,.. ~·-··-·-····-··- ··········-·-···-·· ' .......... 351.000
I N6596X 10 9 NXP SEMICONDUCTORS NV.·-·-·-·-··· ............ - ..................................... ·-··· R. . _ .... 496.000
N97284 10 a YANDEXNV-A.......................... ........ ........ ...................... .. ........... R. . .......... -.056.000 90!l99B9. Total - COmmon Slocks- Industrial and Miscellaneous naffiliate .. ~ ..... _ .......................................................
9199S99. IOUU-9799S99. Total-
9690099.
(a) Forallcommonstocks ~: the r
SCHEDULE D - PART 2- SECTICilN 2 Showing all COMMON STOCKS Cwned December 31 oi Ctt~nr YP.tu
6 10 11
Rate Per
"''" Boo< Used to A!ijusted Obtain Cal!)'lng Fair Value ''"" ------ _______ J2.,564 _______ 62.340
····-·-··-·····----.24, 126 ......... 1~.250 .. ......... , .. ,_ .. 10ii.S91 ........ .77.690
. ....................... .73,606 ......... 05.720
--··-·--.. -·-··196,408 ...... .222.680 .. ...................... 69,939 ......... &5.120 • ......................... 77,679 ....... ..45.400
....... ····-·-·---67,088 ........ .83.900
······-··- ............ 59.375 ···-··17.250 ···--·-·-······-····.8,614 ......... 99.030 ···- ................... 50,980 ·---156.860
.................. 5,2:!9 ... ..83.160
··-- .......... - ... 2B,2.18 ....... 194.210 . ....................... 22,628 ........... 8.620 ··-- ............... ,.70,403 ... ..75.610
··-- ··-····--.. 32.657 ....... ..32.690
····-·-·- ........... 39,555 .. ..29.170
·····- ...... - • .22,335 ... ..48240
··--·-·- ··----21".448 ..... 47.570
····-··· - . - .... .73,751 ......... 82.220
-··-··-·- ........... 49,509 ......... 68.100
··~- ···-·-··--··.51,6ll9 ......... 76.120 . .......... 10,578 ........ .51.180
......................... 27,073 ......... 78.700
. ....................... 12,265 ......... 97.340
····- ·····-··- ..... 64,249 ........ .41.080
···-·-···- .... 10,7!!4 ......... 84.250
--·-·-·-·---·101 ,284 ....... 153.460
···--·····-····63,878 . ...... 103.530 --·····-···2.4,268 ......... 93.700
···-- ··-·-··--.28.178 ....... ..80.260 .................. ..22,781 ........ .45.930
···--··------• .28,306 ....... ..43.150 . ............ 12,937,356 ....... XXX. ......
~~·
''"" ····-·- ----···-· ····-·- ...........•... 24,126 ....................... .105.391 ........................ 73,l06
.................. 196.408
-- .......... - ••• 69,33!! .77.379
.......................... 87,)86
·············-····-····59,375 ·······- ................ .8.314 ··--·· ............. 50,~0 ·······- ................. 5.239
.. 26.216
......... -·- ....... 22,;1.26 ··········- ............ 78;1113
....... ···--·-- .32,!l57 ···-·- . _ .. 39.555
····-·-··-- •..•... 22,335 .......................... 27_448
····-·- .............. 73,751
·-·--··~--· ... .49,509
·······-··· - .51.609
.......................... 10.578
........... •••••• .27,1)73
····- ······- ....... 12,265 -·-·- ............. 64,24S
-··--· ·- ·---10,7E4 ·····-·· .... 101,264
noonM ooon oon~no63,1l76
·············-----.24,266 ······- ................ 28,178 --.. -·--··,.~---22.7E1
................ 28.308
-··· ............ 12,937,359
"'""I com
Declared bm
IJn~id
I::.~:·::::::~::::::::~:: )i::: :-24,171
...... 9,543 ............... 81.251 ·-- ........ 7,615
····- .......... 99,752 •... 55.532
16,95"8
. 21,532 10.020
Amount
Received During y~,
... Bil
"
II Nonadmitted
I Daclared
bm
Unpaid
"
IJnreanzed
Valuation
Increase!
(Decrease)
.10,154 16,520 63,350
.. .25,971 17,419
...... 819 ........ 2,106
___ 55"
..... 7,293
I
I
" " Cummt YRar's Total
other-nan- Change
Tem)l'lrery '" Impairment SJAC.V. Recognized (13-14)
.~ .. .ll.22S ............ ·····~····· ... - ........... 9,22S
........ 352. ························-· ....................... .352
.... .3,497 ·········- ......... ·······-· •....•... 3,497
...... 1,094 ·-·· ····- ................... ~·- •. _ .. 1,094 .... _,. ......... 7,461 ...... ·--··· -··· .................... 7,4S1
13,210 ....... ····-·-··· ................... 13,210
.. 6,431 .............. ·--... ··- ... _, ... ,.6,431 ... 16,587 ·····- .......... 16.587 ....... (941)
.......... 2,902 ... 2,028
0,149 3,169 1,531
................. 8,346 .......... 5,252
""'"~ .......... 6,047 ..... 7,701
[1,25B.914)
r1.zsa.g14-l, ~···
3,952
16
Total
Foreign
" "
~hange I NAIC Cha"!J~
'" BJA.C.V.
MarkBI
Indicator Date
a A uired
L~ ......... 1111212012 L... OM1312013
L..... 07/13/2012 I) .......... 07113/2012
L... 0711312012
L.-····-· 0411612013 L...... 05/24120t3 u......... 0411612013 L ........... 1111812!l13 L........ 08102/2011
........ 04/1SIZ013 ....... 1212712013
08121/2{)13
10/1112013 10/0912013 0711512013 0711212012
···--· Q4/3lll2013 0711212012
........ 002912013 .............. 07101l.12013
1210012012
L ....... ~. 0512912013 L.... 12102/2013
.... L..... 0711212012 L... 0812612013
.................... _. 1...... ....... 01;11712013
I······.-- .... I L... 12119/2013 1..-·-···-·· 0912712013
·~·· L.... ....... 07/0S/2013 L....... Oil"/10/2013
L .... ··-- 02/0412013 0312712013
.. .XXX. .... I ... YXX.
m ~
"'
statem~nt~5ofDecember31,2013oflhe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D ·PART 3 Showing all Long-Term Bonds and Stocks ACQUIRED During Current Year
T Cl.ISIP
lden!iiicatlon Descnlllion Bornis -Industrial and Miscellaneous
02SBM0 DG 11 AMERICAN EX?RESS CREDIT_ ............... . OS56BP 3G 0 BMW Bank of North Ameriea ................. . 931142 OF T WAL-MARTSTORES INC ..... ______ ,.
~ ~ 839S9S!l.
Total- Bonde -Industrial and Misr:ellaneous Tol!li-Bord5-P:rl3 Total- Bonds __________ _. ............. .
Pl'lli>!rred Stocks- Industrial and Miscetlanaous
928662 40 21 VDLI<SWAGEN AG-SPONS ADR PFD"'-··-···
~ ~ B!l.99.99.'l
Total- Preferred stocl\s -Industrial and Miscellaneous. Total- Prelem!d Stock.:s- Part 3 .. . Total- Preferred Stocks.--....... _ .............. .
Common Sloeks -Industrial and Miscellaneous 001055 10 2 AFLACINC .. , ____ .. ,, ............. - .. . 00130K 10 5 AESCORP ..... _,_, .. __ , ............... __ _
001317 20 Sl AlA GROUP LTil-SP ADR.-................................. .
Date Foreign I A~uired Name ofVenoor
07125121J131WEL1S FARGO SECURmES LLC-.... . 0611012.013 WEllS FARGO SECURmES LLC ........ _ ..
06/1012013 WElLS FARGO SECURmES llC_.
R. ........ I 04/09120131 Morgan Stanley 15. ...
0411612013\Morga~ S!anley 15 ........... . 11112120131 MolJlan S!anley 15 ..... ..
R......... 0713012013 MorganS!anley15 .. .. 0812612.013 MolJlan Stanley 15 .. OO:W6R 10 21ATB.TINC-... - .................................. - ------......................... . = ~~ ; ~=~~p~~~~~=:=~~ .::~~:~:-_·:.:~-~-=~===~:~.:~.:~:~-~- ----·-·-·1--0111512013 VARIOUS. ____ ,., .... ..
1010312013 Morgan Stanley 15.. .... _.
11/1Z'2013 Morgan Stanley 15 .. . 022098 10 SIALTRIA GROUP INC ............ _, ______ , ______ _. ...... - ... .
02263T 10 4IAMADEUS IT HOLDING-LINS? ADR. .. __ ........................ - ....... _ ........ . 0231&5" 10 s I AMAZON. COM INC ... ,_, ______ , __ , .................. .
li2503X 10 5 AMERICAN CAPITAL AGENCY CORP ............. - ............... - .... . 025815 10 SIAMERICAN EXPRESS CO ............... ____ , _______ ............................ _,,..,,_, •.•. -
03027X 10 0 AMERICAN TOWER CORP ....... - .• - ... --···-·····-.. ····-... 031162 10 0 AMG~N INC-~ ... - ................................ ______ ~ ....... _____ ............ . 03524A 10 S ANHEUSER-BUSCH INBEV SPN ADR .............................................. .
037411 10 5 APACHE CORP ..... - .... --···-··-··"·-·-.. ··----· . 03748R 10 1 APARTMENTINVT& MGMTCO-A ............... . 037833 10 0 APPLE INC ........ - ..... _,,,_,, .... _ ............ . 038222 10 S APPUED MATERlALS INC .......
042068 10 6 ARM HOLDINGS PLC-SPONSADR.-... --···-· .... ..
R ....
R ...
04/10/2013 Morgan Stanley 15 ... . CT/3112013 Morgan Stanley 15 ... 12106/2013 Morgan Stanley 15 .... 04/'1512013 Morgan Stanley 15 .. ,_ .. , 07123/2013 Morgan Stanley 15 ....... - ....... .
0711012013 Morgan Stanley 15---·----1111412013 Morgan Stanley 15 .. .. 10/2412013 ~IJlan Stanley15 ...... - .. . 0411012013 Morgan stanley 15 ........ . 04/1612013 Morgan Stanley 15. 07{{)812013 Morgan Stanley 15. .......... . 0912712013 Mol!lan Stanley 15 ....... ............ _ ...... ,_ ........ ..
R.......... 1111BI:2013 Morgan Stanley 15 ... --... 055752 10 B BAIDLIINC- SPON ADR-.•.• _,_, ................. _ .... . _ .......................... 1 R. ..... ,_,_ 1112912013 Morgan Stanley 15 ......... .
OSS46K 10 1 BANCO BILBAO VIZCAYA-SP ADR. •. - ..... _,,, ..... -----... 06400"8 10 0 BANKOFNEWYORKMEllONCORP .............. . Oll736E 20 4 BARCLAY$ PLC-SPONS ADR..-... - ................................ .
071813 10 9 BAXTER INl"ERNATIONAL INC·--------~--.. ---.. ·--···- ......... _ .. 09062X 10 3 BIOGEN I DEC INC..---.... - ......................... .. 09247X 10 1 BLACKROCK INC .• --------........................................................ - ............... -
096813 20 9 I BOC HONG KONG Hl.DS-SPONS ADR .............................. . 110122 10 8 BRISTOL-MYERS SQUIBS CO ..... ________ ................ .
~=~: ~ ; ~~~~EH~L~~:LII:~-~~~~-~-~-~~:::~~~:::~~:~:~:~:::=-~~:~~~~:=-·~:~:: __ _
125269 10 0 ICF INDUSTRIES HOLDINGS INC ......... ________ _
~= ~~ ~ ~~~=Pc~:.::~~~~:::~~~::::~~:~=~:~:~ ..... --..
fL-------· 1112S/2013 Morga~ Stanley 15-...... .. ........... 1112012013 MorganStanley15 .. R........... 11/06/2013 Morgan Stanley 15-...
0713112013 MolJl2n Stanley 15 .... . 0512312013 Morgan stanley 15 .... . 07110/2013 MolJlan Stanley 15 .... .
R. ......... 11112712013 Morgan Stanley 15 ... .. ____ 1013012013 Morgan Stanley 15. ..
R.. ·-· 1Z/3112013 Morgan stanley 15. .. . IM/1012013 Morgan Stanley 15. .. . 0411BI:2013 Morgan Stanley 15 ... . 01/2212013 Morgan Stanley 15 ... 0411S/2013 Morgan Stanley 15 ....
Numb.,- of Shares of Stock
...... _ ..... ! ..... ,_ .............................. 582.000
.m.ooo 1,623.000 205.000 .341.000
.1,329.000
- ------·-·- ................ 15.000 ...... .................... 1 ............... ..... .. .............. 308.0aD
--........................... 1,477.000 . ......................... - ... 425.000
• .. .55.000
.......... - .... 1 ,41S.OOO • ..... ..360.000
·-----116.000 - .429.000
• ..... 236.000 • ...... 569.000
.. ........ 1,698.000 ....................... ..... 2:44.000
------· ....... - ........... 1,328".000 ..... __________ ......... 649.000
...198.000
·------·-·····-·--·- ........ 1,614.000 . ..... 1,852.000
................. - .... --- ......... 197.000 • ........... 2:B5.aDD
....... -----· ·---...... 59.000 • ...... 06.000
.368.000 .. ..... 418.000
264.000 -·-·-·-................... ____ 1,332..000
199.000 - _____ , __ ,_ ..... _ .... ..38<1-.000
, .. ________________ .,,_ ..... 980.000
' _, Cost
- ........................... .250,585 - ______ .250.000
---·----................ 493,600
~ ....................... ...994,185 . ............ _..!l94,1SS
• .... ___ , ...... .23.353
.. ............ 2:3.353
•. -----------2:3.353 ---- ........... 23,353
·---·----....... 39.115 ·---............................ ________ ,23,355
.......... _. ·--·-------·--------.. .3,878
'" Value
_____ 2:50,000
_ ........... .250,000
~ ---1,000.000
·---.. --1.000.000 ...... 1,000.000
----~ .... .XXX. __ _
- ......... .XXX. .. .
__ .xxx_ ___ ,_
..... .xxx. .. _ ....... .. .XXX ...... - .......... - ..
Paid for Acmred lnter<~st and DMdends
.. ........ _ .... , __________ ,, ____ ..... .9
................ ..!l69 ..... .978
•. -·-· ·-·-·-·· .. ....9TB ·---........................... 978
t= ........................ . -.. ~
.......... 0
.. ..... .0
11,581
-- . .44,369 • .•.. 1,629
........ =.---·--·-"""!::= =:=~=~==::===:~ .XXX_ - ____________ ,
XXX ....... _,., ......... .
• ... .30,664
• .... ..52.410 ______ 13~75
--·--·----18.308 - ......... .46,01 1
.27,230 ........ .S,108
......... 40,569 -·-·---~ ............................ 2:3.879
-·- .. 4(1,600 ....... 53.220
105,631
...2:3,627
XXX. ... - ..... ..xxx. _____ _ XXX.,., ____ _
-= ·-·---XXX. ..... .. ........... XXX. ..... _. _,,..XXX ....... .
_.XXJC ..... .. ....... ...XXX .• _______ _
.xoc
.XXX .... - ........... .. XXX ...... ..
_____ ,XXX. ..... ~ ........ .
-·-·~"·"' 1 .............. --= ............. .. 31.168 ............ _)()()(_ .......... ..
·-----·---- ..... :~:::::;::;: ~:~~:~:~ :·~::::~_::~:=:::~=::· .. __ ........ ..2,365
21,671
-·----·---10,118 15,194 2:4.718 .22.058 13,2!10
............................ 48.949
- ···-···-·-·--·--.35, 100 ...... - ............ 19,987
-----~--------.. --.-45,432.
~:-=s::=:== ········! -- - -- --- ---........ ...XXX ............ _. __ ,
"'"""'.XXX .•. - ......... .. - _ _xxx _____ , ..... ..
. .XXX .. . . .XXX. .... _______ ..... .
. .xxx. .... _ ............ . .XXX. -- --
---- -- ..XXX.. ·-- ........ .
m -!" -
' "
statementasofDecember3t,21l1Joflhe Mid~Atlantic Vision Service Plan, Inc.
ClJSIP tc!el1tificalion 143658 30
Descrlpfion 0 I CARNIVAL CORP ____________________ _
149123 10 1 CATERPillAR INC _ ~ ~ --·-... 148887 10 21CATAMARANCORP-- -
151020 10 4 CELGENECORP~-- _ 1!i639K 30 0 CENTRICA ~LC.S~ ADR.-- ~ ~ ... ~.~ ... 156782. 10 4ICERNERCORP_ .................. ~ .. --....... - ............... .
SCHEDULED· PART 3 Showing all Long-Term Bonds and Stocks ACQUIRED Durin9 Current Year
Foreign ' D.re
Acr1uired
0411912013 Morgan Stanley 15 .. 10/3112013 MorganStanley1L_ .. __ _ 0710812013 Morgan Stanley 15 ...
1112012013 MorganStanley15 ............ . R.. ..... -.1 12/3112013 Mol!'anS\Snley 15_
1112712013 Morgan Stanley 1L ..
Name of Vendor -~ · n Number of
Shares of stock . .......................... 109.000 + .............. ..
. +·-·- .................. 423.000 +--· 256.000 f--
..................... _ .......... 106.000 .3.70.000 ..70.000
_ ___ .. __ .. __ ..... 1,565.000
16M 1M 10 9 CHINA MOSILELTO.SPON ADR.--... . 168919 10 SICHINA CONSTRUCT-IJNSI'ONADR ..... _,_ R. ··-----~ 07/300013 Mol!lan stanley 16- ··-·-··-···
-·-·····-- ···-·-··- 1 R. .......... 1112a/2013 Morgan Stanley 15. ........ .917.000
1(>g65S 10 5 CHIPOTlEMEXlCANGRilLINC. .......... - .... . 189754 10 4 COACH INC .. - ......... ._ ................... .
~= ~~ ~~~~~~~;!COHL~~L~~~~~~~:::~:~~ .......... - ........................ - ... . ~!144SX 20 3 COMPASS GROUP PLC-ADR ...................... - .......... . 212015 10 tiCONTINENTAL RESOURCE INC/OK ............. _
~~;: ~~ :l=~~~rE~~~~~ _ ~.~ .. :::~:::~~:~~:~~:~~~::~_ .. :~~: ......... . 247361 70 2 DELTA AIR LINES INC .....
249030 10 7 DENTSPLY INTERNATIONAL INC ...... . 254687 10 6 WALTOISNEYCQIT}!E. ........ - ......... .
254709 10 8 OISCOVER.ANANCIALSERVICES .... . 256677 10 5 OOl!AR.GENERALCORP ......................... .
257651 10 9 DONALDSON CO INC ...... -·-· 268648 10 2 EMCCORPIMA .............. . 278265 10 3 EATONVANCECORR ........... . 278642 10 3 EBAY INC ....................... - ......................... .. 271l865 10 0 ECOlAB INC ................................ _ .......... _ .. _ ...... . 2S264F 20 S ENDO HEALTH SOWTIONS INC ..... _ ............... . 30215C 10 1 EXPERIAN PLC.sPONS ADR.... .. .............. .. 30231G 10 2 EXXONMOBILCORP ..... _, .................. .
R ............ .
10114/2013 Morgao Stanley 15 •...
0411612013 Morgan Stanley 15. ..•
07111/2013 Morgan stanley 15 .... 08{1212013 Morgan stanley 15.-.. 07IOS/2013 Morgan Stanley 1L_ 0910312013 Morgan Stanley ts._ __ _
1010112013 Morgan Stanley 15 ......
,-............................. 32.000 ..~08.000
1.039.000
..639,000 ..579.000
.. 4Q21JOQ
R--···-···· I 01129120131 Morgan Sl<m!ey 15.-____ _
Oi/2912013 Morgan stanley 15-...
.. ...... 21.000
....... .35.000 ........ _ .............................. 693.000
0512.112013 Morgan Stanley fO . ........ • ............................................. - .............................. .l... . ........ 49.000 08J2912013 Mol!lan stanley 1S.. ....... ..... ................................ . -·- ·-·- ........... .. .............................. 394.000
1010412013 Morgan Stanley 15. .. _ ............................ _ ......................... - ........................... !.. ........... 206.000 1012412013 Morgan stanley 15... ................ ................ . ........................................ ~ .... --............... _.3,065.000
04/16/2013 Morg:anS!anley15... .. .. ·-·-·-·--.... ·--· .......... .,..... ........... ___ -· ............ .1).19.000 0710912013 MorganS!anley15 ................................................. --.............. ........... ................. ................... ..1B2.DOO 1211812013 MorganStanley15-......... --.......... ........ ......................... .._ ...................... .L .......................... 14.000 0411612013 MorganS!anley15 ................................................... __ ....... -.. ............. .. ................................... 1,330.000
.,R ..... 12/13/2013 Morgan Stanley 15._, __ ................. --- ......................... . .................... ~ ...................... - ........ 915.000 0411612013 Morgan Stanley 15 .............................................. _ .................. _ ........... .. ........ ~.............. .. ...... - ...... 66.000 .~ ...... .
7
'"'' Cns! ...3,63B
""' •. .21,196
. .. 16.23S
. ...... 7,448
30303M 10 2 FACESOOKINC-A ......................................... ..
307305 10 2 FANUC CORP-UNSP ADR ............................. . ::~! ::: =~= :~-:::~:::::::::_:::::: .. ::~~-.. :::::: .. ::::::.: .... ::::::: :::~ .. ::::::~:::::: ~ .. ::::·::·::~: .. ::::::::~.~:::::~:~~·~:::~~~ -~-..... ··-~·~~-.M',111
R. .... - ..... 35171Q 10 5 FRANCE TELECOM SA-SPONS ADR ..... .. R. .. . 02/2112013 Morgan Stanley 15 ...... _ ................................................ _ .............................. ! ....... - ................... ..824.01)1)
36£651 10 71 GARnJER JNC ...................................... __ ........... --.............. _ .................. .. 375558 10 3 GIL.EAD SCIENCES INC ... J=:::=:=:::=::~:::~~:~~:~~~ .r ........ .. =~~I::~:~::~~::::::~:=:=~ .... -.... -...................... . 380787 20 0 GOLDEIII AGRI-RESOURCES-UN ADR ............... ---............... --.... .. 38259P 50 6 GOOGLEINC.c!.A.. ............ - ...................... - .............. - .................. -. ·-·-·-·--·
.. .......... ; ....... - ............. - ..... ..244.000 + ............. .. 1 ................................ 21.ooo H ................. .. R ............. l :~~~~~::~:~:~~- ,_ ... :=:==::::::::::=~:=:::=~:=:~:=~ .. .
43300A 10 4 HILTON WORLDWIDE HOLDINGS IN ........ -- ................. .. 436106 10 6 HOlLYFRONTlER CORP ................ .. 43SS16 10 S HONEYWB.L INTERNATIONAL INC ...... . 451680 10 4 IOEXX LABORATORIES INC. ...
=~: ~~ ; :~=~R~~~~.~P~~~~~~~~- ....... ::::~:: .. :=- ·~:~:::::~:::::=~·.:~:~~:~:~.==.~::~!~.~::::~:: 459200 10 111NTL BUSINESS MACHINES CORP~ ................... - .......................... . 46'115H 10 7 INTESASANPAOLO.SPONADR ...................... . -·-·-·~· I R.. .. ,_ .... , = ~~ ~ I ~~:R:~c~~~~~.:~.~-~~.~.:~ ~~.·.~~~·.~~~~.~·.:~~.~~~~.~~.--.·.~-.·~·~:~-.=~·.~.~.~.:·~ 1 R ..... -... 431155 10 SIJOYGLDBALINC ......... . ... --.. --·-·-- .............................. - ..... 1 ............ _,
1211312013 MorganSianley15 ............. - .......... - .. _ ........................ _ ............ _ ......... _ .. ............................. 923.000 + .............. . , ......... ·-·-·-·-...... 1,062.000 t .. --...
- ....... 578.000 04/10/2013 MorganStanley15, .. _ .~ .............. - ........ --.. ·---.. --... . 0611412013 Morgan Stanley 15 ...... _ ...... - .............. - ....... --.. -·- ..... _ .. _ .... ,_ ........... . 1010212013 Morgan Stanley15 ........ --.......... _, ___ , ........ . . ...................... - .. ..78.000 + ................ ..
........ ~·::~:::.: ..... _:::~~~-.. ~~~~~: ~.~::::::~""" 07/1612013 Morgan Stanley 15 ... . 11126/2013 llorgan SlanBy 15.... .......... .
11/1612013 Morgan Stanley 1S .... . _ ...... ---·----·-.. ---I ..................................... - ... 169.000 f ......... .. 1112612013 Morgan Stanley 15 ... . 0910412013 M~rgan stanley 15 .. .. 1210412013 Morgan Stanley 15 .. . 0710812013 Morgan Stanley 15 .. .
_.1,360.000 j..i ..................... . ' ... ..370.000 !: .... ..
_ .... ! ...... --.. --..... _ .... 4.:Js.ooo 11··· ................ . . ..L.......................... 1,080.000
... 8,022
7,407 ......................... 7.446
.. .. 12,74{1
..16.510
..20,25!!1 ...... .. ..... 60.685
·--..4S,323 .7,230
.. ...... 6,259
........ 27,~90
--~.32.79S
18,923
.. ....... ..22,5.:9
.. . .24,874 ,_ •. 1)5,835
p., Value
.... YXX .. . _.xxx .. .
= _.xxx ............ . ... XXX. ... .. XXX .. ..
.... .XXX. .. . . .XXX. .. .
.XXX ... .. .XXX .. .
. .... ....XXX .. . .. ..XXX. ... XXX .. .
YXX .. . _XXX ..... ..
... XXX .......... ..
Paid for Accrued Interest and Dlvidends
~·--.. .XXX .. , ..... -............ .. .................................................. . XXX ............. ·-·-· ................ ·-- .......................... . .XXX........... . ............... _ .. _,_ ....................................... .
XXX.... .. ............................................. " ... . ... .XXX........ ................... .. ........................................ - ............ .
XXX .. .
.XXX .. . ..XXX .... -
·= .YXX .. .
.. . .XXX .. . .. .XXX ..
XXX. ...
=· ..XXX. .. . .XXX. ......... ..
. ..XXX .......... . ..XXX .. . ...XXX ....... - .......
....... ..XXX .. . ..XXX ................... .
.. .. .XXX ............... ~---·
-= ... .XXX .. ... XXX ...
.. ........ .XXX.. )OCC ..
.XXX .. . ..XXX ....... . ...XXX ..... .
.. • .XXX .. .
m ~
"' ~
statementasotoecerrbsr31,2013oftlle Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D • PART 3 Showing all Long-Term Bonds and Stocks ACQUIRED During Current Year
j CUSII'
ldentificatlon Descripiion
4S137C 10 &I JUUUS BAER GROUP LTD-UN AOR.. .•. ·--·····-··-·-·---·
Date Forei~n I At:tlulrad
R. ... ·-·-··· I 11/01120131 Morgan Stenley 15----
485170 30 2 KANSAS CITY SOUTHERN. ·- _ ---·-····-·---··-·-···--···--- ·····-·--·--···----·-·-··· ···-·--··-·· 1012212013 Mo!Jlan Slanley 15 ... 41!7tl6 10 B KELLOGG CO._ .. _________ ·------·-·-·····-·- ........................... ___ -····-·-····- ····- ........ 1012812013 Moraanstanley15---··
Neme ofVsndor
~6S 10 1 KINDER MORGAN INC ________ : ____ ·········-·-·-··--·-·--------··---·-····-·-····---· ................ 0912711013 Mol!lan Stanley1S-- ·-······---··-·- ··----·--·-·-·-··-···-·· 500458 40 1 KOMATSULTD-I.l?ONSADR. .......... - ... ···--·····- .............. ······-··-- _ -------·····- R--··· 0611312013 Morganstanley15-----·-··-··· S0048H 10 1 KONE OYJ-B-IJNS~ONSOREDADR-·····-·-··-····-·-··-····--····-·-----··-----···-·-··· R.... 0912ai2013 Mol!lan Stanley 15---·-·-··· 501173 20 7 KIJBOTACORP-I.lPONSADR.--.. -·-·····- ············-·····-·-··--- ---·-··-·--·-··-····· R. .......... 12/1SJ2013 Morganstanley15. .... .
501889 20 8 lKQ COR~ . __ -------·--·-··-·-····-·-·····-·-·-·-·-··- ·····--····-·- ·····-·····-·-··· ................ 10111l12013 Morgan Stanley 15 ... . 502441 30 s LVMHMOETHENNESSY.lJNSPADR. ··········-·-··----····--·····- ·······-·- ···-·-··--·-·· R.. ......... 0411612013 MorganStanley15 .. . 515096 10 1 LANDSTAASYSTEM INC.·---·-·-·····- ······- ·····-·····-·-·······-····-·-····-·- .................. ·····-·-··-·· 1010712013 Morgan Stanley 1iL..
518439 10 4 ESTEl: I.A(JDER COMPANIES-CLA ............ ____ ------- ··-·- ···-····- ............. ---· ··--- .... OS/0312013 Morgan Stanley 15 ... . 530055 10 1 LIBEFm'GLOBALPLG-A ..... - .. ·-·-·-·-·····-··----· ···--···-- ······- .................... R.... 11/0712013 MoryanStanley15 .......... .
5357aA 10 B UNKEDINCORP-A. ... -··--·-···-- _ ---·-···-·····-·--··-··-·- ···············-····- ··-·-·- ·----··· 12/"lll/2013 MorgEnStanley1L------·· 539ll30 10 9 LOCKHEED MARTIN COR? ............ - ········- ........ ·····-····-··· _ ------·-·--··- ·····--··· 04/1Si2013 Moryan Stanley 15 ......... . 548661 10 7 lOWE'S CDS INC_····--·---··--·-···-····--·-·····--·-·---·-·- ·--·····-··· ···--··· 1112711013 Mo!Jl'ln Stanley 15-.. 550021 10 9 LLllULEMON ATI-ILETICA INC........................... _ ------···-····-·-·- .................. ··-·· !. .......... _ 1211712013 Morgan Stanley 15 ... .
55261F 10 4 M & TBANKCORP. __ ···-·····-·-····--··--·-·-·--·--·-·-·~·~··-······-·-····--··· ........ ...... 12/1Si2013 Mon;Jan Stanley 15.-55S16P 10 4 MACY'S INC·--·····-- ······-·-·····-·· ........ ·-- __ ---·--·-·····- ········-····-·-·-·-- ...... ···--····- 1112012013 MoraEn Stanley 15 ..... .
S6035A 10 2 MARATI-ION PETROLSJM CORP .--····--·····-·-····--····-·-····-·-··-·--··-·--- ·--·· 570535 10 4 MARKEL CORP ...... _ ·····- .................................. .
0411012013 I Mol!len Stanley 15.---···-··· 1011812013 Morgan stanley 15 .............. .
580645 10 9 MCGRAW HILL FINANCIAL INC ····-·····--·-·--·-·--·-·--····-·-·-·----· 581550; 10 ~ MCKESSON CORP·----···--····--·····-·-········-·······~·····-··········--···--------
iXI733R 10 2 MERCADOLIBRE INC _____ ·····-·-·····--·····-··--·----···-·---··----····-·-····-·-·· I fL. ....
=~~ ~~ ! ~:~~~~~~~:~~-~~~-~-R~~---~-~-:~.·-=-~---~~-~-~::~.:~.:~.:~-=-~~-:~·~.:·.·.~=-·-~-~~---~-~- ~--··
D41'!0/2013 Morgan Stanley 15.- ---··· 1211812013 Morgan stanley 15. .. 1112012013 Morgan Stanley 15 ....
1112112013 Morgan Stanley 15 ...• --·--·-··-·--·--····-··· 0411612013 Morgan Stanley 15. ----·-·····--····--···
S05822 10 4 MITSUStSHIUFJ FINL GR?·ADR.. .. ---··---··~---·-·-·-····-····-···
606827 20 2 MITSUI & CO L TD-SPONS ADR... . ---·····-····-·-····-·-····- ········-·-·-·-·-··-- ...... S07.W9 10 9 M081Lt:TELESYSTEMS-SP ADR_ ....
6116SW 10 1 MONSANTO CO·---·--·····--··-····-··· 517446 44 8 MORGAN STANLEY ... - ............ . 61T700 10 9 MORNINGSTAR INC ............................... .
626717 10 2 MIJRPKY OIL CORP __ --···-···-··-- ···-·-·····--·····-·-····-·-·-·---·-·
R_ --------~ 04112120131 Morgan Stanley 15 ... _ -·-·-·-~····--·--·-· R-···-···· 0411112013 MorgEn Stanley 1S-R. .......... 1213012013 Morgan Stanley 15--
08,12612013 Mon;Jan Stanley 15 ....
0712612013 Moraan Stanley 15. 1011812013 Moraan Stanley 15 ..... . 1111812013 Morgan Stanl")' 15-.. .
Number of ShllresofStilck
1,661.000 _104.000
···-·-·-·----····--··- ...... 744.000 .. 442000
--------·-···-- ... 1S8.000
Acl!Jal l'ar cost Vallll'
....... 15,953 j ______________ .xxx. ... 11,94B
____ 45,5B1 - ·-·- ____ .XXX. ·--··
_.xxx ... 15,848 1 __________ .xxx _______ _
_ ... 3.957 1.--------------...XXX .. 15,083
- --------·-·-·····-·-···.21,492 - ---······.XXX ..
·-----..XXX ... ···-- ···-·-··.347.000
286.000
.245.000 124.000 808.000
-·--·------····-·····-·- ................... 6,175 .XXX ..
.XXX ..•
.XXX ..• -·····-·-····-·-··3,932
·-·- ·----------·---···-·····-44.240 ____ 40.000 1--·--·-·····-··-·-·-·--·····-·-··---2.673 .XXX ....
.. .••. .384.000 .86.000
···-····---·-"··-·------ ___ 450.000 ..629.000 ..404.000 .971.000 .970.000 , ___ _
---. .29~37 ____ .20,688
.XXX.---··-··-·· _.xxx_ ___ _
____ .43, 165 1--···-··-··---"""....xxx. ... .30,418 _.xxx. ...
.... n.m ,. ·--·-···-·····-JCC<....
-·=:::~~~=~ : :::::.~.:~~-~::::::: ..800 000 ,--- - - -- ---- -- - 62,1l:l3, ......... ·····-··· _ _xxx_ - 7 000 - - - - - 3,489 ····---~---·- •.. ..XXX ......... . .666 000 -- ~ - - - -- - - 34,697 ·····-·- - - - ___ _xxx _________ _
-•oH _______ .110.000
···--···--··.2!1.000 -----199.000
... 679.000
--··--1,500.000 . .. 16.000
·--····-·····..370.000 ------····-·····75.000
..1,S35.MO
-·-··-·-···-47.000 - ____ 731.000
-:~~:~:~~=:=::l~ I =~~:-~~-I=::=: ... 9,406
--~------ ......... 4,502
--···-·-·-··---1 $Tll
----····----1.407 ----------~.246
.3,480
................... 44,850
... .XXX.·-··--····-··· .XXX.. .• ____________ _
-----.XXX.---~~---·· _.xxx ______ _
=·· .XXX ..
=··
Paid for Accrued lrrterest and Dividends
6285311 10 71 "'"''' "''··-···--·-····-····--·····-··················-···········--·- ---------·-·-····-····-·-····· 0811212013 Morgan Stanley 15.----0810612013 Morgan Stanley 15 .... 04116/2013 Morgan stanley15-.. 01101/2013 Moogan stanley 15.---· 10/0112013 Morgan stanley 15 ....
·----··---1.308.000 ··-··· ---·-------4-2.444 =···--·-·--·-·---1--······-······-·······-····-·-···-------· 641069 40 6 NESTLE SA-SPONS ADR. ... ·-···-····--··------·----·---·-·····--··-·-··· 6'51587 10 7 NEWMARKET CORP __________________ ...................... ·----- ___ ·····-····-··---··
65248E 10 4 NEWS CORP.CLA.. .... ·-·-······-··-·-·-·····-·-·-·--···--- ........... ·-·-·····-·-····-··· 654106 10 3 NJKEJNC-CLB ·····-·-··--··- ········-·····-·------ -----·-····-·-··-·-·····-·-·····-----·-···
~=~ ~~ : ~~: ~~::~~C~-~-~--::::= .. ··:~:~::~:~-~~:::-- ::=~~=~-~:::~~~:~~~~~::~~::~:~~~~-! ~ ···- ·.·.:: I ~~~~~~~ I ~:: =~: ~~::: 670100 20 51 NOVO-NORD!SKAIS-SPONS ADR.---····-·········· 674215 10 8 OASIS PETROLEUM INC.·-·-·-·-·-"""""""""-"""""" 677862 10 4 LIJKOIL OAO-SPONADR.. __________________________ _
69367LI 10 5 BANKMANDIRJ TIIK.lJNSPONADR.. .... - ... ·--· ··-·-·-··---·--··-·-··
R ...... - •. 12130120131 Morgan Stanley 15 ....... . 1210212013 Morgan Stanley 15 .... . 1212612013 MorgEn Stanley15 .... . 07130121l13 Mo!Jl'ln Slanley 15_ .. .
R, ______ _
R ..•
69480ll 20 si?ACIRCRUB!ALESENERGYCORP ........ --- ______ ----~R. ___ 11212012013,MorganSlanley15- ··--····----·-·-··· (!95156 10 9 PACKAGING CORP OF AMERICA. __ _ _ _ __ _ _ __ _ _ .. ---- -- ---- 0812312013 Morgan Stanley 15
703481 10 1 PATIERSONIJTIENERGYINt; ... ___ ---- -- .. .. - ---- 04/1612013 MoraanStanlev15-
_______ 5"4.000
-·-··--·---145.000 ..948.000 .484.000 997_000
255.000 ...24.000
... ..520.000 _402.000 ..893.000
··--·····-····--··-·- ___ 1,25!!.000 ---------------···-634.000
- ------------····-·····..2).75.000
.................. 3.813 .. ....... 37,952
···--·····---.24,362 .. .• .32,844
-- ···-·- ......... 8,063 -·····.26,624
----4.405
·---23,762 - ____ .24.659
-····-·-·····- ................. _7,1170 _ ..... 25",379
-·-·····- _______ 32)_73
------------------52,043
.x:oc. .......... . •.. ..XXX._ ··-···
..XXX ..• .XXX ..• .XXX ..•
.•. ..XXX. .• .. .XXX. ..• .XXX. ...
... .XXX. ..• _.xxx .... =· =· -=·
m ~
"' "'
' "
sta!ementasofDecember31,2013oflhe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULED. PART 3 I
' CUSIP lden!i!icatlon I Descri?lfon
718172 10 91 PHIUP MORRIS INTERNATlONAL...,.,,._ ............. . 718545 10 4 PHILLIPS 61L .................................................. - ....... .
7= ~~ : ~~~~~SM~~~~~~-~~:~.~:~~-~:::::~:::::~:~~::~.:~:~ .. ~:~::~~:::::- .......... ::~~:~~:.~~~ .. . ;;~~~ ~~ ~~~~~~-;co·~;:~:::::~:~:~ ............ -.. .-............... . 75281A 10 9 RANGE RESOURCES CORP ....... - ..... ~-·-·-· .. 771195 10 4 ROCHEHOLDINGSLTD-SPONSADR.. .. .
774341 10 1 ROCKWELL COLLINS INC .................. - .... . 778296 10 S ROSS STORES INC ...... - ....... _,_ .......... .
780259 20 6 ROYALDLITCHSHELLPLC-ADR ....................... ..
784117 10 31SEll!INESTMENTSCOMPANY .. ----- _ 78442P 10 6 Sl.M CORP .. .. ..
78454L 10 0 SM ENERGY CO- - - - -7S572M 10 5 SABMILLER PLC.SPONS ADR- .... .. .. ............... - ........... _ ............ .
7MS6L 3fl 2 SALESFORCE.COM INC.-....... - .... _ ............ ..
7954SE 10 4 SALLY BEAUTY f-IOLDINGS INC ............................ ,_ .......... - ............ .
B0585Y 30 a SBERBANK.SPONSORED ADR. ..... _ ........... .
806857 10 8 SCf-IWMBERGERLTD... .. .................. .
808513 10 5 SCHWAB (Cf-IARL.ES] CORP ..................... .
Showing aU Long-Term Bonds and Stocks ACQUIRED During Current Year
:r:: • Fo Atqulred
R. .......... ..
R ............ .
0912712013 MmgBn Stanley 15.
0112912013 Morgan stanley 15 ................. ..
1112612013 Morgan St!lnley 10 .. ..
11/0712013 Mon;]an stanley 15 ... ..
04/1612013 Morgan Stanley 15 ... .
07/1:21:2013 Morgan stanley 15. ...
07/1612013 Morgan Stanley 15 12/1912013 Morgan Stanley15 ........ .
0811212013 Morgan Stanley 15 ...
1111212013 MorganStanley15.- ....... .
Name o!VH~dar
,.,R.. ... 0212lll2013 Morgan Stanley 15-... ·--·-·-.... 0712212013 Morgan Sta!lley 15 ...
O!l/1012013 Morgan Stanley 15-... - ... __ ...
1210212013 ~o;gan St!lnley 15'... ........... . R. ............ I11!2SJ2013 Morgan stanley 15 ... _, __ .. .
07/16120131 Morgan Stanley 15 ................ . 09/16/2013 Morgan stanley 16-.......... .
R-.......... I 0710312013 Morgan Stanley 15. .. . 12127/2013 Morgan staoley 15. .. .
11116/2013 Morgan Stanley 15 ....
' • Numberof Shares of Stock
......... J ........... . 502.000 .J ............................ 717.000
. .. L .................... -..... 537.ooo .J ....... _____ ,,_,_ .. 594.000
... L.. .. .......... 3.224.ooo ... ~~ .......................... ..29.000
' ..32.2.000 l ............................. 473.000
l ...................... 2S6.000
}· ............................. 300.000
.. T .. , .. ,_ .. 98.000 ....... .52.000
1,018.000 ... L ___ ·--·- .... m .. ooo
,_,...,!,_, __ ................... 158.000
.. 1
........... !.. ............................ .2.90.000
·-~ .. -~ .. --.--....................... 84.000 .. ...... .905.000
B174BL 10 0 ISERCO GROUP PLC-UNSPON ADR.. ............. . --·-·"'"""'"""'"" 1 R ... 12/3112013 Morgan Stanley 15'... ... - .. ·-·--·-·--·-·-..
- ...... .535.000
......... 712.000
........ ..225.000 .. .... .238.000
----..2.43.000 = ~ ~ ::!:~~;~;~~::=~:::=:=·:~==:::~::::::·:·:~::: .................................. . R.. .......... .
855244 10 9 STARBUCK$ CORP ......
86562)( 10 6 SUMITOMO MITSUI TR-S?ON ADR ......... .
0813012013 Morgan Stanley 15 ..... .
07J25/2013 Morgan Stanley 15 ... . 0411612013 Morgan Sta!lley 15 ..
11/2012013 Morgan Stanley 15-...
.1,192.000
... - .. ~·---.. 349.000 . .... .5,062.000
87160A 10 0 SYNGe-ITAA!MOR ......... .. _
1
R.. ........... l 07129120131 MOIJj.an Stanley15 .... . ,_ .... _.................... . - ... R............. 0712S12013 Morgan stanley 15 .... . ....... .......... .192.000
872540 10 9 TJXCOMPANIES INC .. ~.--.......... ..
874039 10 0 TAJWAN SEMICONDUCTOR.SP ADR. ..... --·-·-· .. 870568 SO Z TATAMOTORSLTD-SPONADR ...
87944W 10 5ITELENORASA-ADR. ............ _ ...... __ ............ .
881575 30 2 TESCO PLC-SPONSOREDADR .. . 893641 10 0 TRANSDIGM GROUP INC .. , ...... .
899896 10 4 TUPPERWAREBRANDSCORP ...... .
90130A 10 1 TV\IENTY·FIRSTCe.JTURY FOX INC ....... ..
903845 30 3 ULTA SALON COSMETlCS & FRAGR ...... .
903914 10 9 ULTRAPETROl.EUMCORP ........... .
907S18 10 8 UNIONPACIFICCORP ....... - ... -·-·-................................ .. 911312 10 6 UNITED PARCELSERVICE.CL B.
91307C 10 2 UNITEDlllERAPELITICSCORP .. ..
91324P 10 2 UNITEDf-IEALTH GROUP INC ...... .
91912E 10 5 VALESA.SPADR. ..................... ..
930059 10 0 WADDELL& REED FINANClAL-A.
949746 10 1 WELLS FARGO & CO ...
958102 10 5 WESTERN DIGITAL CORP ...
959802 10 9 WESTERN UNION CO
963320 10 6 Wf-IIRLPOOLCDRP .......
R .. .
R .. .
1'!. ..
R ...
04/1612013 Morgan stanley 15.. ..
1112012013 Morgan stanley 15. .. .
04/1712013 Morgan stanley 15 ... ,
0510812013 Morgan stanley15 .. ..
0512812013 Morgan stanley 15 .. .
1010112013 Morgan Stanley 15 ......... .
0812312013 Morg:e~ sta~ley 15 .. .
1112712013 Morgan Stallley 15 ..... .
0812312Cf13 MorganSlaflley1L ..
11/1812013 Morgan Stanley 15- ......... _,_ .... , ...
.. 1,246.000
-1.347.000
.................................................. .536.000 170.000
- ................................ 1 .348.000 .. 11.000
.... 410.000
........................................... 4&2.000 ' 126.000
-·- ..... _ ..... 4.413.000 - .92..000 11101/2014 I Morgan stanley 15 ......
~=~: :~:~ =~:: ::::::::::~:=::: .............. .. ....................................... •·· 465.000
610.000
.103.000
R ........... I 0610312013 Morgan 'stanley 15 ..... -·~· 11/01120131 Morgan stanley 15. ......... ..
,, __ ....... - ......................... .564.000
04/11i12013 Mmyan stanley 15 ........... .
0512412013 Morgan stanley 15·-·-·-- ......... . ..:=I:=~~~:=:~~:=·~:~~~~:~~~ ............. ....... ............... .. 1 ,038.000 04/10120131 Morya~ Stanley 15 ........ - ........ ..
~~~:::! ~~:: ~=~:~~:~:~=:=::~~::~:::=.~----.. ~-=·~::~::::........ -~ ......... 1 '"""'""t"'"""- ......... -........ 382.000
-·-·~1... ........................ .4.629.000
' Actual Cost
·~·1..-....................................... 46,:>89 _ L..... ................... .. .. 43,140
.... L~ ..................................... 12,2e1
.L.. ...................... ·-·- .......... .39,137 __ [' .......... _. __ ............... .-......... 46,394
... L. .. .................. o,s1s
.. ..l ......... -.--.. -·- ,._ .. ,_ .... 25,283
.. .. l ........ ,_, ___ ........................ 28,983
.. .. l ... ~·- ......................... .2.1,456
.J ....................................... .2.3,584 .... l .......... ...................... .. ... .5,493 ...! ........... ,_ .. ____ , ___ ·-·~ ... 1,636
...L................. . .................. 21,445
.J .. --·--~·- ..... - .. --.. ·- ...... 2.4,053 . L ........... -........................... 7,879
.. .1 ............................ - ........... - .. 11,763 .... L................. . .... _ ............ 2.2.oa ... .L. __ .. ,_ ........................... 10.92:>
_I ..... - ...... --................ Aa,531
... .1 .................. - ............ ~ ..... 16,849
.. .l ......... -.............................. 1.828
...l. . _...... ........... ...11,163
~~~~~ J ...... ~ .................................... 13,164
...L ....................................... 11.s68
.. .J ......... - ................... ·-·- . .2.3,638
. .. L ..................................... 1,543
.. l ........... _ ............ ~ ......... 33,809 15,848
_ .. , ..... ~ .... - ... -.... - .... 12.309
... 89,844 ................ 14,019
40,M~
. 43,440
• '" Value
.XXX ........... . XXX ..
.. . .XXX. ................. . .. .... - .... ,_, .... .XXX. ......... .
.XXX. .. . ,..)()()(, .. .XXX ....... ..
... xo: .. . .)()()( .......... . .XXX .. .
.. • .XXX ..
. • .XXX .. ,.)()()(,.,
. .XXX .. .
..XXX. .... . XXX. .. .
..XXX. ... .XXX .. .
- ..... .XXX .. .. xo: .. .
_,_ .... ..XXX .. .
owe .. .XXX ...
• Paid for Accnleti ln!Eres! and Dividends
.. .XXX... .. ....... - - ............................... - .... .
.. .. .XXX ......... --· .. ·-.. ~-· ..................................................... _ .. ...XXX ...... ........ .. ................................................. .. ..XXX.................... . ............................................. ..
= ..XXX. ..
... .XXX .. .. ..XXX ... .
. .. .XXX ................. . ,_, .... ..XXX ..... ..
..XXX ... ..
..XXX .. .
·= .. ... .XXX..
.XXX ... ......... .XXX ...
. .XXX. ... .)()()(...
. .XXX. .. . .XXX .. .
.XXX .. . .. • .XXX. ..
.XXX .. ..
.)()()( ....... -.... -... , ...
statementasofDeoember31,2013of!h~ Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D • PART 3 Showing all Long-Term Bonds and Stocks ACQUIRED During Current Year
1 CUSIP
[den!ilicil~on
gg13BH 10 1IWDRKDAYINC-CLASSA __________ _ Dascriotion Fvrni1
=~ ~~ ~I =~E:~~~N~T-~~=--~---~--~~~-~~~~-=---~-~-~-~-:~-~-_::~~:.:~~~~~--~-~-~-~::·.~-~-~~:~=::·.~=-·-·1 ;~--------98S<:SB 10 11YUM! BRANDS INC .... _. ______ _ 98!l711V 10 3 ZOETIS INC------·------·--··
018190 89 B DEUTSCHE BANKAG-REGI~EQ ____ ...... ---····---··--···-------··-·····-··· Ft. ........ .
G1151C 10 1 ACCENTUREPLc-cLA...-................................ - ····- -- -------··-·····-·-·· R .... _ .... .
G25ii4F 11 3 COVIDIEN t>LC.... - ....................... _______ ------ ·-···--·····-··· l't ..
o.re lif!!d Name of Vendor
1212712013 Morgan Stanley 15._ .. Dll!Z112013 Morgan Stanley 15. ___ _
1011112013 Morgan Stanley 15
11JJ0012013 Morgan Stanley 15-----·--·------07115/2013 Morgan Stanley 15 •..•.. _____ _
04f.lll/2013 Morgan Stanley 1'5...---·--~·--··· 041W2013 Morgan Stanley 11L. ..
071(1812013 VARIOUS .. ·····-·······--···--· •
G3157S 10 s ENSCO PLC-CLA ....... ···············--------- ···--·····--···
G4412G 10 1 HERBAUFE LTD ...... -····-·-·········---··--··---·· .
R ···········1 05129120131 Morgan Stanley 15 ....... . R ........... 12/02/2013 Moraan Stanley 15 ..... .
G7945E 10 5 SEADRILLLTD.----· __ ............... _____ ·········-··--·---·-·---·-···
881477 10 4 SINACORP ....... ---··--·-·-·······-·-·-·--···-·-····-··· R ... R. ..
G97!l.2Z 10 3 PERRIGO CO PLC ···········- ___ ···---- ···---·-·- ······---··---··-----·-·-·-····-·· H0023R 10 0 ACE LTD--··--··---·····--····--···-··· N07059 21 0 I ASML HOLDING NV·IIJY REG SHS ·····-·-··--····--···-----·----· 11153745 10 0 LYONDELLBASELLINDU-CLA_ ......................... . N6596X 10 9 NXP S~ICDNDUCTORS N\1 _____________________________ _
11197284 10 B YANDEX NV-A..------·····-··· ........... ---·----9t19!l.999. Total- CommDil Stocks -lndi.IS!!ial and Miscellaneous--
Common Stocks - Parent, Subsidiaries and Affinat.s
000000 OD 0 I VSP Op~r:al Gro'-'P. Inc.. .......
R., __ _
R. ....... R... _____ _
R._ _____ _
-----· !R.-... .......
-1 ---· Total- Common stocks -Parent Subsldlarias m1d Affililrles. ·········-·-·····- ---------------·---·
08.126/2013 MollJan Stanley 15 .............. --~ ........ .
05/1712013 Moraan Stanley 15 ..... .
12119/2013 Morgan Stanley15 ...................... ----··--······- ...... .
OS/2712013 MorganStariey15 .•.. _ -------··-·-·····-·- ······-----------···-··· 0710512013 Morgan Stanley 15..---··---------------- ...... . 0511012013 Morgan Stanley 15. ......... . 0210412013 Morgan Stanley 15 ...... ______________ _
0312712013 Morgan Stanlev tiL. ........ .
04/04120131 VSP 0! ,[ GroUil-----------·····-·-···
Numtlerof Shares of Stoct
. ••• 63.000
···-----------··------ ..• 158.000 --------·-·····-1,287.000
--- -------------- ... 789.000 ________ 999.000
···-···------------------ ..... 154.000 .... 83.000
.727.000 ..... lB-5.000
··---·······-·····- ·········-- •.. ..344.000 ___________ 74.000
-·····-------128.000
----------660.000 ···-·· - - ___________ .617 .000
________ 193.000
- _________ 351.000
···-·····-···--------- ............ 578.000
---·---1--------- ~
.......... I ....... ---·--·-·-----4S.ass.ooo
Al:tual
'"' '"' Value
. ..XXX .•.
=·
' PalO for Accrued Interest and Dividends
______ .5.174
---------.22.150 ......... 12,516 ______ S2,n1
-·-·-··= ··-----·-·--··!-···-·-·- --··--·--·-·-·-·-····-·· .XXX .... _ ····--·----
---------------------- •..•..•... .32,306 ___ , __________ ........... 7 ,5"~5
···-··-------------- .................. 6,410 -------------43,078
11,519 . ...... 24,171
.xxx _______________ _
.xxx. ............. -------.xxx. ________ _
=·· .... .XXX..---··-···
···- •..• .XXX. ···-·····-···
~~~~;;~ I::~==~~::=:~---------------""'
____________ _.xxx __
14,766 ·····---------··---.XXX ... ···-···--------------- ... 21,532 - ____________ ..xxx_ _____ _
17,47!1 ------------..XXX .. . -----------------------------3.348 ···--··· ..... .XXX. .. .
--- ·········-·-·-----.. ---.4.8S4.081 ---- ·······---....XXX.. .. --- t=· .
~ .30.000.000
___________ .xxx_ __ _
....... .XXX •. ' ·:~-=-~:~----
----------.0
.0 ~ 9799997.
~ ~ ~
TO"Il!l· C:ommon Stocks· Part3 ..
Total- Common Stocks- Summary Item trom Part 5 ..........
Totai·CommonStocks. --- ·---
----------------··· ----····-------- -----------------· ····----- --------- ---- ....... ---------------------- ....... -----1 :==-~-----=~:~-~::~:~::::~::;~ ...... .XXX .•..•..•...
.:::m!::::. -=~
- ··f· -·-· ·-·-·-·····-·-·-·-·-·- ...... 0
Total- Preierrerl and C:ommon Stocks ......
9999999. Total- Bon:is, Preferred and Common Stocks ..
..... .46,160.283
.... 46,173,646
.... 47,167,831
--------------------0
.XXX ....... -·"'
' "
S!atementasofDecernber31,2D13~flhe Mid-Atlantic Vision Service Plan, Inc.
CUSIP ldenlificatio
20n2G MY 11' 452152 iiJJ S IL
~~2 NR B IL
I 64966K XB.
101045 GS _ 75845H JB 0
~1999!l9. Total-Bonds-
2
Descriotio1
4
I I D~~~~ ·H:
··-'"·--·-·-.......... _
...
1
07/ll112013.
1
,
... 1010112013. ~
SCHEDULE D- PART 4 Showing all Long-Term Bonds and Stocks SOLD, REDEEMED or Otherwise OF During ~urrem n::1ar 5 I 6 I 8 B 10
12 13 I' I 14 15 " " I " " I " I " Bond
Number of
'"~ o!Sfor I Conslderatio
P,;
" Actual
""
Prior Year Eoof(f
Adjusted Carrying
Value
c~rrent ' 1 Year's ' Total
I Unreanzed I Cu~~Snt Otller-Th2r;.l Total lilreign Valuation Year's Tem~ora~- Change in Exchange IncreaSe/ (Amortization)/ Impairment BJA.C.V. Change in (Decra~el Accretion Rec~Ulniztl~ 111+12-13) BJA.C.V.
'00" Foreign Adjusted Exch2nge Carryln,g Gain Valtie I'= I
at Disposal '" ,,. Disposal
lnteres~ Reanzed '"'' '""' Gain Gain Dividends I staled
(Loss) (Loss) Reoe_ived Contractual
'" '" Ounng Maturity Dis~osal Disposal Year Da+•
-I:::~:::=:::~ I :::::::::::~ I :~~ I ::~~:::~::~~~ I ::::::::::~~!~~I:= -- ..t 1- :~=:~::~~~ : ::::::::: .. ____ ....... ~--~~:~~~ .... 90.000 ..... - ..... 90.000 ..... - ... 95.50S ............... 93.049 ........... (3.04Sl ............ l ........ ,049 .......... -----· ............ 90,000 ....... .
..... -13,000 111/15/2013 . . ... 13,a50 1010112013.
...4.725 1010112013 . ..... !21.173 ..... 0 ............... 610,000 __ .. ..
~~-:-~_-1 .1
........... 100,000
1
........... 100.000
1
......... 110,698
1
........ .
... ..2SO,OOO .......... .250,000 _____ ..277,S:!D ·----
0 1·-- ..... ·1--··-······i·· ·········- .o 1·········'·000 1""'""'·1 0 ............. -... ..................... .. .0 ....... 12.500 10101120'1'3 .
......... -----· ..... ........ .. ................ 0 .......... 5,600 Of/0812013. 4 GOLDMAN SACHS GROUP INC ___ _ 1-:~:~:;~~~::~ ::=~:;·:::~~ :::~:;·;:::~ ~:~~~~:~:~:;: .... :::~;;~~~::; ............... .. I ----·-·1'"~
.......... ~36,699), .. ...................... ---· ...... -- ·---..... 0 ........ 78,750 1011512013.
381428 RH 0 Goldman Sachs Bank USA ..... --.--.. -------·-·· 4426£R AA
~ 724479 AG
~ 94S"MS FJ 389!l99Q.
839!l997.
839;)99.']_
002D6R 10
002824 10
00281Y 10 007627 10
I~!~-~~
10 • -------·
--'"""-'"""-'''""-····- ........... I ...
Y LTD- UNSPON ADR..-........... ..
/11/lU
I 0510112013.] Morgan Stanley 1 01/0212013. •• -·
........ ...200,000 ----- . .200,000 .......... .217.515 .. _ ........ .206.044 ...... (0,044) ....... . __ ..... .516,529 ...... --... SOO,OOO ........... 632.105 .. _ ........ .514,5B1 ...... ,_,(0,405) ........ --..
...... 841,944 ......... 8oo,ooo .. --....... 858805 ............ ..l:!~~.uoo ........... (4.417) ........ -- .. . .... 1.000.000 ........ 1.000.000 ........ 1,(188575 ....... -.1.022.019 ......... (22,0191
.. ..... .4,764743
.......... ....... ................... ___ ., __ . .0 ........ 10,000 1012S/2013.
. .... -----.. - ...... 7,342 -- .... 7,342 ........ 16,531 0910112014. .. ....... 10.210 ......... 1n,zm ...... 22,989 0311m2015.
. ..49.500 1011612013.
:~;:: ) ~:.~-~:~:~:: ~-:~~=-: _:~~-~~-~~~.:;: .::::~-~~~-:-::~::~~! ::::~~(;1~~~ ............ ·::~~~-~-~~~.~~ >::.~.~--:::::· -.~::::.~~:~-~:~:;~ ...... .>,nsl ::~::::::~:~~~ I :.·::.~::.·::.·~~-0
-1·:-~:~---_______ 20,558 ........ .XXX.. . ....... 19,618 ... - .......... 18,355 __ , .... 1',202 - .......... 1,262 ............................... - ... 19,6.18 ------ .. .2,802 ........ .XXX. ...... • .......... 1,085 ................ 2,082 ............. (997) ................. ___ , ___ (997) ..... . ..... 1,0B5
... ..9,735 ........ .XXX........ .. ......... 9,567 -·-- ...... 10,686 .......... (1~119) ........ .. ..... (1,119) ...... - ........... __ , ......... 9-,567 ....... 158 ............. 205 .... .XXX .... . 006252 008918
015351 016490
10 'IAGRiuM·'· 10 9 ALEXION f 10 . --·
, .. UUO O~LU '"' "'"'""''' ""''""' ~~""'" '""""""""" """'"""162.000 '"'~ .. :::~~:~: .:,:.~:~~: .... , """:~::::= '"""' ...... 14,800 ~~-~--~:·.~:~' .. :'_(;~ ::::::::: ..... .,, :::::::::~.~~ , .. -.. :~--:~~:.... "''::::::~::::~!:~! • ""'"'":::;:~ ::::::::::::~~~; :::::=~:· 025537 10 04/16/2013. Morga~Slanloy15 ........................ ,_, .. , .... 586.000 ........... ..28,677 ........ XXX.. ____ ............ .24244 ........... _ .. 25,010 .......... (2,766) ............ (2,766) .................... ~ ... - ... ~.22.244 ........... 6,433 ....... 6,433 ............ 275 ... .XXX ..
025816 10 0512412013. MorganStanleytS....... .. ..... 957.000 ........... 63,179 ....... ..XXX ..................... .52.071 ...... 55,008 .......... (2,938) ........ (2,938) ............... - -"------..52,071 ........................ 11,100 ...... 11,108 .......... .322 .... .XXX. .. . 03027)( 10 11/25120f3. Morga<i Stanloy 15 .... -·-·-·-·--.... - .......... 85.000 .......... - 6_542 ........ XXX......... .. ............. 4,189 '"""" ...... ..6,568 .......... (~.379) ......... (2,379) ....... ........... .. ..... --....... 4,189 ........... 2,352 .... , .. .2,352 ............. 19 ..... XXX. .. .
o:mac 10 031100 10
I!. INC. ~~~:;::~: ~:=~=~:~~~~:::·'""'""'""' """:::=:::~: ... --.. ·~-~::~~~ ~::::~::~'""" ·::::~~:~~ ::~:~ •::::::~!:=~ """:~::;~;!~ ·::=::i~:: H ...... :::::::: ·:::::::~::~:~~~:~~~ "'"""'" -·~:::::~:~~: :::~ __ :::~::: :::::~~.,~~~~ :~:~::. 032511 10
037853 10 o/APPLEI 042068 10 • ------- :ADR.
04{1612013. Morgan Stanley 15 ____ ............ - .............. ..219.000 -----17,958 ........ .XXX....... .16,780 .... _ ....... 1B,z7'~ .. --·--;.505 .. .506 ............................. ____ 16,780 ........................ 1,178 ........... 1,17S .......... .20 ... .XXX ...
1212612013. MllganStm'ey1S...- .. _ .. ,_...... . ....... 171.000 ............. 79,580 ........ .XXX..... • ............ 68,544 .......... 91,002 ........ (3~456) ....... -(32,458] ................................. .58.5'44, ........ 2!,036 ... .21,036 ........... 690 .... .XXX.. .. .
·------- .... 125.000 ............ .5,388 ·-----.XXX ........................ 1.421 ............... 4,729 .......... (~.3()8) .... - ...... (3,308) . . .......... 1,421 ........ .3,957 .......... .3,!!67 ....... , .. ,_ .. 7 ___ _xxx ___ _
045387 10 _Aml.OOO ........... 11,362 _____ .XXX ........................ 6,842 .......... , __ .9,31a .......... (2,474) . .. ......... (2,474) ......... .., ..................... 6,842 .... 4,520 ..... .4,520 ...... 124 ... ..XXX .... .
~s: ~ ~ ~-~~ ~~~-~-f 0Srni2 10 8 BAIDU INC • ;,~;,; 1~;~, "'" ;;= ~ = r =-~~:: =~ s:: ==:=-= ~= ~F.:: 1 =:~~:;:, :::·J~ -- :: ~:~ :~ :: :~: :~.: ... ::=:. :: ::-~:: : ~~ -"' =:~
Sta!ementasoroecemtm31,2013oflfla Mid..A.tlantic Vision Service Plan, Inc.
SCHEDULED· PART 4 Showing all Long~ Term Bonds and Stocks SOLD, REDEEMED or otherNise DISPOSED OF During Current Year
'" ChanQe In Book/Adillsted C;
" 12 13
Number of
CLISIP 1'1 Disposal I I Shares I I Par Actual ldentffication Description n Date Name of Purchaser oi stock COnsicreration Value Cost
071813 10 9 BAXTER INTERNATIONAL INC.~----.----·-·--- OSJ0312013. Morgan Stanley 15. _ ---------------- ............... 10.000 ------------692 ----.XXX......... .. ................ 135
Prior Year Book/
AdjUsted CarTying Value
Unrealized Valuation IncrEase/ ~crEase'
084670 70 Z <IERKSHIREHATHAWAYINC-CLB _____________ ..... OZ/25!2013. MorganStanley15_. .. , .. , ___ ---- --------..350.000 .......... ..35,024 .... ...XXX......... .. ..... ..23/.01 .......... -31,395 ------~1,90B)
09062X 10 3 BIOGEN IDEC INC .............. __ ·----· ................ Oi/3012013 Mmg<~n Stanley 15 ........................ ----------90,000 ............. 1S.1B-9 _____ .XXX... . ....... 8,839 _ ............ 13,173 ---------(4,284)
09227Q 10 0 BlACJ<BAUDINC ........ - ..................... ------·-·- 10/1812l113. Morganstanley1S ............................ ____ SOJIOO ............. ..2,408 ...... ...XXX---- ... - ... 1,325 -------------1.370 ............... (45)
Current Years
(AmortizaVon)l Accretion
09247X 10 1 SLACKROCK INC................ ................ ...... .. 1013012013. Motyan Stl!nley15.-- ------------ -·-·-·--63.000 --------.21.531 ........ .XXX.. ---- .14,848 -----------..49,404- .......... (0,180) 1···
1=~ l~ 1 ~:::;::~~~~~~~~;~~:~~=~:~ R ~~~~~:~: ~~==~:~L~-::==:=~::~ :::::::::=:~:.~~~ ::~~-::~:: :~::::::~~~~: ~~:~~~:~7! ::~:~~:=:~ ::~=::~;: :::--12613~ 10 9 CNOOCLTD-ADR.-... - ... ------------------··--·-- R OSI27/Z013. MorganSt:anley15...... . .......... ____ 112.000 ............ 21,052 ....... ..XXX. ___ ............. 17,872 ............. 24,640 .......... (6,768)
126650 10 0 CVSCARE!AARKCOR~- ................... ---------·--- ... 0911!3JZIJ13. MorganS!anley15...... ..... .......... . ...... 1.068.000 ............. 50,592 ------XXX.... . ........ .41.1T7 ........... 51,538 ........ (10,461) 1 ...
127097 10 3 CABOTOIL&GASCORP.-------------------- - 0912612013. MorganS!anley15 ................... ____ 538.000 ............. 23,222 ........ .XXX ...................... 12.932 ........... 1S,867 .......... (2,936)
136375 10 Z CANADIANNATLii.AlLWAYCO ........................ - .. L 1210412013. MorganSt:anley15 ........................ ------12.000 ----------·009 ...... -.XXX......... . . _. 339 ................ 546 ---------(207) 139098 10 1 CAPGEMINISA-UNSPONSORADR.. ................... R 1210412013. Morganstanley15.... ................ __ .... 196'.000 _________ .6,201 --·--·.XXX.·-·-· ............. ..3,1$ --------------4,245 .......... [1,090) 14001H 10 5 CAPITALONERNANCW.CORP ... - .. .------ .. 0312512013. MorganStl!nley15 ........... _ .. , ___ - ...... 386'.000 ----------.20,963 ......... lO::X. ____ ............ 23,000 ................ 22,361 .. _ .. , ...... 699
~= ;~ ~ ~~~~~ ~~~~~c~:~:~:~~::::.:::=:~:~~~:~----- :~ ::~~~: ~::: =~:: ~::::::--: __________ ~ ~.::::.;~~~~~ :::::~~-::::~~:: ::::::::==-· ::~::.-:::~:::~ :~==:~-~:;~::: :::.:;~~:~;I~=:~:::--·
§I j§ j~ i ~:§:~~-~:-=~~:-:-=~--~~~:- ~~g ~~g~j~jj~= :=~= ~~Ji~~ ~~:~1~ ~§:: ::il~~ :::::::~: =-:~~: 166704 10 0 CKEVRONCORP... ................. ........................... 04/16/2013. Morganstanley1~ ..................................... 10:.7.000 ............. 17,171 ........ XXX.... .. ........... 15,658 .............. 15,897 ........ (337). 16941R 10 8 CHINAPETROLEUM&CH::M--ADR. .... -------- .... il. 0710312013. MorganStl!nl~y15'..... .. ........................... 0.231 ------------22 ........ .XXX. ... ~-- .................. 20 ...................... 27 . -.----0 --------172967 42 4 CmGROUPJNC ....................... _.. ------- _ 0411612013. MorganStl!nley15-------·--· .... 1,133.000 ·-- ..... .52,.536 ........ .XXX.. .. ........ .38,0!4 .......... 44,821 ....... -(6,747) .. , 189754 10 4 COACH TNC.. ...... ------------·-···-----~-------·-· 0112312013. Mil!glln Stl!nlBy 15 .. ------------------ __ ...... 340.000 ............. 18,365 ....... ..XXX, ___ ........ _ . .19,00! ... 18,873 192446 10 2 COGNlZANTTECHSOLUTJONS-A._ . ............. 091041Z013. MorganSt:anley15 .. ----·-·-- ....... 520.000 ............. 39,375 ....... ..XXX ______ .......... .29,753 ---·- ...... 38,419
194162 10 3 COLGATE-PALMOUVECO .... ---------------------- - 11/151Z013. Mo!l<lln Stanley 15. ..... ....... --359.000 --------.23,138 ........ .XXX......... ------..21.323 ----------·---·---·
Cl!ITIIni Years
Dther-ThanTBmpotllry Impairment Recognized
W030N 10 1 CDMCASTCORP-ClASSA .................................... 0412412013. MorganSt:anley15. ---------------·- -- .. _.712.000 -·----~.2.9,427 ......... XXX .................. 1B~S .............. 28,5\lO W825C 10 4 CONOCDPHIWPS. .... _ ................. --------- .......... O!i/1012013. Mor!lan Stanley 15.----------------· ............. 741.000 .. _ ... 45,77B _____ .)(XX......... -- ..... 39,8B6 .. _ .. ,_, .. .42,971 ·::=~~::i I ::~:~::: ------- I ..
231021 10 6 CUMMINS INC. ................... - ...... _... ... 01/ll912013. Morg~n Slanley 15 ...................................... .215'.000 ............ .31,040 ----.XXX.... . ....... .24,271 ............ .2.9,796 235851 10 Z DANAHER CDFU' .................................................... 0712512013. Morgan stanley 15................. .. ........... 122.000 ............. 8.200 ......... XXX. ........ ------------3,821 .................. 6,820 237545 10 8 DASSAULTSYSTEMESSA-ADR. ................... R 10/16/2013. Morganstanley15 ... ----·- ....................... 47.000 ............... S.ZSS ......... ,'OC<. ....................... 3,156 ................ 5,2.19 244199 10 5 DEERE&CQ _____ -------------------------------- 05101/2013. Morgan stanley 15 ..................................... 161.000 __ ... 13,397 ____ _;.co;_______ ............. 12,946 ............. -13,!n4
24736'1 70 2 DaTA AIRLINES INC·-·-·---·------· ................ __ 10123/2013. Morgan Stanley 15 ............ ------- -------113.000 ............. 2,887 ........ .XXX... • ........... 1,51i4 ........................... .
....... (5,525)
......... [2 .• 999)1 ........... . ... (2,063) -----·
(968) ....
251542 10 6 DEIJTSCHEBO!:RSEAG-UNSPNADR.. ..... - ... R 11126'12013. MorganSt:anley15 ................. - ........... 2,150.000 ........... 15,897 ...... ...XXX .................... 10,965 ·---·----13,098 -------(2,133)~-----
251568 10 5 DEIJTSCHETB.EKOMAG-SPONADil. .................. R 0312512013 Morg.anSt:anley15 .. - .............................. 831.000 ............... 9,062 ........ .XXX----· ......... 9,294 ................. 9,417 ............. (122) ..
25243Q 20 5 DIAGEO PLC-SPONSORSJ AIJR..-·-·---·--·---·--· R 0212212013. Morgan stanley 15...-. . .............. 97.000 ........... 11,661 ...... ...XXX... .. ............. 7 .2~6 ............... 11,308 .......... (4,092) ..
254687 10 6 WALT DISNEY COJTHE.. __ . -------------------· 0411612013. Morgan Stl!nley 15 .. -- --·--·-·-·--- ........ -..819.000 .......... A9,355 ........ .XXX ---· ..... __ 2B,2S6 .......... 40,778 ------(12.,462) .. 268648 10 2 EMCCORP!MA..---------------- ...... - ................ 04/19/2013 MmyanStl!nley1S..... ........... . .... 1,205.000 ....... ... :n,m ....... ..XXX ................... .27,4'7 ---·- ....... 30,487 -------(3,069) Z6875~ 10 1 EOG RESOURCES INC.......... ................. 0413012013. Morgan stanley 10 ......... - ... -......... ----- ..... 183.000 ............. 21,480 ....... ..XXX.... .. ......... ..20.178 .............. 22,105 ... - .... (1,927)
m:~ 1~ ~ ~:~~:~~~:::~~==~==~:~~::~::_~~:~~~~ :_ ~~==~~: :: =~: ~~-~~~ __ ::~:=: ~=::::=:~~1: :::==:~:~::: ::::=E::=:: ·---:~~:~~:r~ ::~:~::~=:~~= ---- -~~-: 1
281020 10 7 EDISON INTERNATIONAL............................... ... 0413012013. Morgan stonley 15............. ........ -----------190.000 ............. 10,130 ..... _.XXX.__ __.Jl,1~5 ................. 11,857 ....... .... 218
•fnoValue
" Total
Change in BJA.C.V.
(11+12-13)
......... 0
" Tornr
Foreign Elcc~ange Change in BJAC.V.
To
Boo" Adjusted Carrying
''"" at Disposal , .. ............ 735
_.29,487 _ ....... ..8.889
'if
Foreign Excha1ljje
Gain !">•)
00 DispOSal
... Mo6)
1
.... -.--[4,284) ··-·---....... [45) ... ........... 1,325' ··---
- (5,180) ----------- ... -----------141148 (2,895) .................... ·-----------16.096
16
""'"" "'" (L=) 00
Disposal
" '"' Gain (Lass)
00 Disposal
---·---(43} I -----------(43) , __ ..... 5$37 ....... __.5,537
-----10,300 ______ 10,300
" Bood lnteresti
""" Dividends Reeelved
During ,~,
"
-d COntractual Maturizy ,..
... .XXX. ..... ... .YXL. .. .... .XXX. ...
1,083 -------1,083 --------. .22 .... .XXX. .. . .. 6,683 ........... 6,683 ________ 151 .... .XXX. .. .
---5,849 .......... .5,849 -------122 -XXX ..... .
(1,402) - ·---------- ----- ...... 17.855 ....... ---··- I ·- ... ..2,(182 - ....... .2,082 .......... ..237 . ...XXX .... . ----- ...... (126) - ----------· -------·-..2.454 _ .......... (6,768) _ ................ ................. 11.an
..(10,461) - ..... ---- .. -----------..41.177
--(2.936) ---- ---· ................. 12.932 ..... (207) - . - ----·-· -------- ....... .339
-------(1,090) _,______ ------ ........ 3,156 _ . __ egg ------- _____ ............... ..23,oao
-------(sst) ............. . ................. 1.017 (1,590) ------- ----· ------ ____ 9,919 ........ 0 ------ ................... _ .. 10,81<!-[3,398) ................................. 14.572
(389) . --- ....... ----- ....... 13,890
··-.-------[3,748)1 .... : ............. (337) ... .
_____________ (7) ... .
.. 4,701
.. .. 15.559 ............... ..20
-----~:~:i I~:==~::~:~:: I ::::::~ .. :::~:~:::~ , __ .. ____ (8,666) -------------- ----------...29.753
---------------0 ---------- ................ .21.323 ... (8,061) ·-. -----·-· ___________ .. 18.539
________ (3,084) ------- .. ----- ____ .39,896
----------(5,525) .......... ------- ...... .24.2.71
.. ... (2.999) ------- ------- ------ ...... ..3,821 ..... (2,063) . . ............... ..3,1fffi
---- --(956) ---------------- ________ .12,946 ...0 ......... ____ _ _________ ... 1.564
.... (2,133)
--------·-·(122) . -------(4.092) ----------(12,482) .
--------(3,069) ---............. (1,927) ----
---------(30) ---· ... (1,Z70} .
--(6,265)
"'
,_10,965 .. ..... .9,294
,_ .. 7,216 _______ .28,296
, ___ .__.27.417
.20.178 _____ ...53,642
5,105
.............. -9.625 ______ 9,135
--------.. &48 ____ ., __ 848 --------55 .. ...XXX .... .
... ..3,181 -----.3.181 ........... ..3DS ... ..XXX ... ..
... 19,415 ......... 19,415 -------..26'9 ... ..XXX .. .
..... .10,291 ......... 10,291 ----20 ... ..XXX .. . ________ 329 ............ ..329 . -. __ .a .. ...XXX ..... .
------..3,048 ........... 3,046 --·-·-81 .... .XXX .. .
... (2,097) .......... (2,097) ............... 19 ... ..XXX. ... .. 1,205 --------1.205 ....... _ ....... 8 .... .XXX ..... .
--------1.210 ..... 1,210 ________ .185 ... ..XXX.
... ..427 -- .. , __ 427 .......... .229 .... .XXX.
... 9.34<! ..... 9.349 -------------· .... .XXX. .. . {1,072) .......... (1,072) ......... _.197 __ .XXX. .. .
.5,462 ......... ..5,452 ...... .......... .. .. .XXX. .. . 1,612 ........... 1,612 ........ 132 .... .XXX.. .. .
------------2 ---------...2. -----·--·-1 .. ...XXX. .. . ... 14,462 ......... 14,462 ---------.11 .... .XXX.. ... .
--------[1,518) ------(1,518) .... - ............. ..XXX .... . ____ ..9,623 .......... .9,623 • ------ .... • .. ..XXX... .. .
______ 1,815 -------1,815 -------..361l ... ..XXX ..... .
----10,888 ..... 10,888 ........... .255 ... ..XXX ..... . ... 5,B-91 . - ... --5.891 ________ 402 .... .XXX ..... .
_____ iJ,769 ..... 6,769 .................... -.XXX. ...
... 4,384 ... ..4,384 ................. s .... .XXX. .. ..
.. 2,098 ......... ..2,098 ............. ..34 .... .XXX. .. .
........ 450 - - . - .450 ............. 155 .... .XXX. ... ..
·---.. -1,322 _______ 1,322 ................. 7 ... .XXX. .. . .... 4,932 ........... 4,932 ---------386 .... .XXX. .. .
........... (233) ---------{233) ---------- .... .XXX..
'·"' ~-·-·--'·"' ____ ..21,059 ----21,059 .... 362 ________ 362
... 1,302 _ ........ 1,302
.... .XXX .... ..
.... .XXX. .. .. .. ...XXX..._
~\ .... .XXX .....
"' ~-·· -'" t··---·-·-·-,··=·-· .... 1,52_6 ........... 1,528 ...................... ..XXX .. . ... .8,245 ________ 8,245 __________ .31 .. ..XXX ..... .
.... 1,001· ------1.001 ______ 132 ... .XXX .. .
-------·- ----·-· . --·--· -------- --~ ..... ,_ --------
' "
StatementasofDecem!>er31,2013ofthe Mid-Atlantic Vision Service Pian, Inc.
CUSt~ ldentiliC!Itloo DescJiDiion
281i'f!E 10 8 EDWARDS UFESCIENCES CORP ...... . 28617Y 10 1 El.EKTAAS-!ISHS.UNSPONADR. .. . 29082A 10 7 EMBAAER SA-ADR. ... 291011 10 4 EMERSON ELECTRIC CO ............ . 292fi4F 20 5 ENDDHEALTHSOWTIONSINC ............. .
SCHEDULE D ·PART 4 1 Showing all Long-Term Bonds and Stocks SOLD, REDEEMED or Otherwise Dl~POSED OF During ~rrentYear 5 I 6 I 7 I S I 9 I 10 I I ChangetnBcok/Ad]ustadCarirvinoVal~e
Disposal Date I Name of Purchaser
0210612013. Morgan stanley 15 ................ . R 111/0B/2013. Morgan Stanley15 .... , ... _, .... . R 1013012013. Morganstanley15.-..... .
0411912013. Morgan stanley 15. 1210212013. Morgan Stanley 15.
PriorY,..,, eoo'
"m'· • I I I I Adj.,., Shares Par Actual Call)'ing of Stock COnsideration Value Cost Value
............. 1B7.000 ·-·-·-···17.228 ........ .XXX. ..................... 14.812 ........... --17,7f!3 . ............ 897.000 - - .14,258 ····-·.XXX. .................. -13,134!! ··--·-·---13,981 --~-~--~--376.000 ............. 12,206 ....... ..XXX ... - ............... 6,095" --·····-·---10,720 ·-·····- nn.ooo ............. 41,064 ....... ..xxx .. ___ ............ .38,773 ............... .4!1,779 -·---1.077.000 ............. 71,008 ......... XXX..... • .. ..... - ... 37,311 ................. ~.~·-
111 12--~ 13~ 1 Current
16
Unrealt.edl Current O!her-Tila~-Valll!IOOn I Year's Temporary
, I ,..,, Increase/ II {Amortizafion)l lm;Jairment 'Deerease) Accretion Recognized
.... (295"1)1--- --·- - (132)
__ (4625)
_ (2DD6j --
'
Total Total Foreign
Change In Exchange BJA.C.V. Change in 11+12-13] BJA.C.V.
~!~ :::.·::.·~~~~; ~ =~=-~··~-·· I ••• ...... (4.6.25JI···
~-···· ... (2.CD6) 1--~·~·~··-··~·
" 17
Book/ Foreign Adjusted ~hange Carrying Gain
Volue (Loss) at Disposal on
Dale Disoosal __ 14,812)
..13,B4g ...6,095 .38,773 .37,311
" Realized
Gain (Loss)
" Disoosal
" '"'' Gain (Loss)
'" Disposal
.......... .2,416
~
Bond Interest/ Stock
Dividends Rece).red
During Yw
"
'"" Contnm!ual Maturity o.•
.. ...XXX~ ... .....2,416 ....... .408 _Ana I ............. ..87 l .... .xxx. .. .
......... 6,111 ~--..... .6,111 , .. 2,290 .......... .2.~0
....... .33,698 ......... 3M98
... 671 ... .xxx. .. . .. . .316 ... .XXX. .. .
... XXX. .. . 302130 10 9 EXPEDITORS INTI. WASH INC... ......... ..... ....... 0511612013. Morgan stanley10. 31l219G 10 8 EXPRESSSCRIPTSHOLDINGCO....... ....... 08109/2013. Morganstanley1S.
1,720.000 -------~55.240 ....... ..XXX......... .. ........ 64,681 .......... - 68,026 .. ...s22.ooo ............. 33.583 ...... ...xxx ..................... 26,74e -~·--------.28,1ea
... (3,~, ... ....... (1,440)
L~:~:(;~~ ········~ L::~~:::~::~ :::~-~ ···~ ~::~:~!~ I:::::::::~:~ I::::::;::: ...),559
.... .6,!136
. .. .:l,305 .. .3,444 ...6,991
... 1,427 A481
...1,64!)
... .JOC<. .. . • .. .XXX .. .
30231G 10 .2 EXXON MOBIL COR?_ ........................................ 0312512013. Morgan Stanley 10 ...
30249U 10 1 FMC TECHNOLOGIES INC .. -............. ... 1013112013. Morgan stanlay 15 ... -.~----30303M 10 2 FACEBOOKINC-A.... .................. ............... ....... 1212312013. Morganstanley1S ... . 3t621lM 10 6 FIDELITYNATIONALINFORMATIO.- .... ,_ ......... OBI28W1S. MorganSt:mley15 ....... . 316n3 10 0 FIFTH THIRD BANCDRP .............. __ -· _ ........... 0112812013. Morgan stanley 15 ....... .
343412 10 .2 FLUOR CORP ...... -·-------~·--------·--·-·--.......... 0411512013. Morganstanley15 .. _ .. . 343793 10 5 FLSMIDTH & COAIS-LINSPON ADR.... R 0110812013. Morgan stanley 15 .. _, ... _ ......
351770 10 5 FRANCE TELECOM SA-SPONSADR ............... ~.~ R 05/11312013. Morgan stanley 15 .. _ 354613 10 1 FRANKLIN RESOURCES INC .... - ............. _ DT/251:2013. Morgan stanley 15 ......... .
m 13ffi71D 85 7 FREEPORT-MCMORAN COPPER-----............. ~. _ 0510112013. Morgan stanley 15 .. _ i! 359556 20 6 FUJI HEAVY INDUS-LINSPONSADR. .................. R 07108/21l13. MorganSianley 15 ....... . N 369604 10 3 GENERALELECTRICCO ...... ~.-· .......... _......... 04125J2013. MorganStanley15 ...... ..
371901 10 9 GENTEXCORP............. ............. ........ .............. 1212312013. Morganstan!ey15 .. .. 375558 10 3 GII.EADSCIENCESINC ....................................... 11/08/2013. Morganstanley1S.
37733W 10 5 GLAXOSMITI-IKLINEPLC-SPONADR .... _ ......... _ R 0711112013. MorganStlnley15 ..
36141G 10 4 GOLDMANSACHSGROUPINC- ....................... 04116/2013. MorganS!llnley1S ... _ .. ~·~--· 38259P 50 8 GOOGl.E INC-CLA ............................. _ ....... ~ ...... OS/2012013. Morgan stanley 1g __ :)34602 10 4 WW GRAINGER INC .......................... - ... 1211212013. Morgan stanley 15 ................. .
40412C 10 1 HCAHDLDINGS INC ................. ~ ..... ~ ..... -........ . 0410512013. Morgan St:mley 15. ........ --.... - .. . 404280 40 6 HSBC HOLDINGS PLC-SPQNS ADR .................. R 12/11/2013. Morgan stanley 15.._ .... _ .. __ .. ..
41043C 30 4 HANGSENGBANK-SPONSOREDADR .......... - .. R 1210212013. Morganstanley15 ........ _ 41043M 10 4 HANGLLINGPROPERTIE8-SPADR............... R 1012212013 MorganS!anley15 ......... .
4251!83 tO 5 HENNES & MALIRilZA~LINSP ADR. ................. R 1211912013. McrganSianley 15 ........... .. 437076 10 2 HOMEDEPOTINC .................................... ~ ........... _ 09/1912013. Morganstanley15 ......... .
438516 10 6 HONEYWB.LINTERNATIONII.LINC.... ............... 0411612013. Morganstanley1S._, ......... .. 40167R 10 4 IDEX CORP ...................................... - ........... ~ .. -· _ 08/2112013. Morgan Stanley 15 .. 455807 10 7 INO&COMMBKOF-UNSPONAilR._ __ ............ R 09106120'13. Morganstanley15 .. . 459200 10 1 INTLBUSINESSMACHINESCORP ... ~ .................. _ 0911012013. MorganStlnley1S.
461202 10 3 INTUIT INC ................................... ·------- 02108121l13. Morgan stanley 15. 46120E 60 2 INTUITIVE SURGICAL INC ..... ~·-·--.... -_......... 0713012013. Mo'!lan stanley 1S. 465562 10 6 ITAU UNIBANCO HLDNG-PREF ADR.... .............. R 10/111201l Mcfaan stanley 15. ...... .
46625H 10 0 JPMORGAN C~E & CO ....... - .... ·~~·--- .......... 0413012013. MollJan stanley 15 ... . 469614 10 7 JACOBS ENGINEERING GROUP INC.- ............ 1DI03/2013. Morgan stanley 15 ..... .
478150 10 4 JOHNSON &JOHNSON ................. - .... -... ...... . .. 03l25/2013. Morgan Stanley 15 .. .. 48667l 10 6 KDDI CORP-UNSPONSORE!l AllR. ...................... R 12130/2013. Morgan Stanley 15 ......... .
..... 147.000 ---·~---13,094 ___ . ..xxx. ..... . _ ........ ..325.000 ............. 16.707 ...... .XXX ...... .
... 1.435.000 ............. 41,S90 ........ .XXX ........ . . ............ 162.000 _______ , .. 7,071 ........ .XXX ........ .
.. ........... 831.000 . _ ........ 1S,3B1 ........ .XXX. ...... ..
............. 430.000 ,_ ........ .24,022 ........ .XXX. ..... .
....... 2,196.000 -- ·- .. 12,758 ........ .XXX. .. ..
1,233.000 1 ..... ~ ...... 13,236 ........ .XXX. .. .
...9,79C
13,262 - 1.2,723
-13,SW
.34,9951""" ...... ..32,077 .. ...... 5,644 ........ 41,424
. ..8,890 ... 2:2,38:<
13,07o
... 15,507
........... 12,631
...25,258 12,697
--13,625 ...248.000 ____ ,._.:l5,504 ........ .XXX.... _______ Zf)li ............... .31,174
_017.000 ... - .... -18,142 ....... ..XXX. .................... .25.120 -.21,101 ..... ssa.ooo .......... .:lo.sro ......... xxx ..................... 10,418 .............. z4,ros
. ... ~ .. ..2.198.000 ........ ...50,509 ........ .XXX.... .. .......... .27,22S ............. .46,136 . ... 212.000 ............... 6,035 ....... ..XXX....... ·--· ....... 3,99£ ................ 3,996
1,520.000 ............. 94,264 ....... ..XXX.... .. ........... 44,729 ..... ~ ....... 04,820
......... 430.000 --·~--22.0aB ....... ..XXX......... .. ....... 19,007 .......... --18,592 ..... 170.000 ............ .24,406 ___ _xxx .. ____ ......... 17,780 .... - .... - .. 21,665
........... T<.OOO , •••.•. -.63."0 ,-.--= ..... .. ............ 99.000 ____ ....... 25,270 ........ .XXX.. ...... .
....... ~ .... 616.000 ·--.... 23,635 ........ .XXX ........ . S6.000 .............. .5,203 ........ .XXX ........ .
.43,Sa!i 19,787
- .52JA6
--..20,1l35 19,9231 .............. 18,045
.4,28< I . --~---.... 5,{)95 ... 702.000 ·-·-· ... 11,:>!!7 ,_,.,.xxx. ..................... .9,56' ........ .10,781
-·----948.000 ........... 15,764 .... .XXX. .................. 1S,919 ................ 18,836 ...1,358.000 ............. 11,403 ........ .XXX. ...................... 7,498 ................ 9,373
...... 429.000 ............ .31,992 ........ .XXX ..................... .26.710 ............. 26,534 ..... 2!!2.000 -- .21,275 ....... ..XXX......... .. ......... ~17,093 .. _ ........ 18,533 .. ... .:lO.OOO .~ ........ 1,810 ......... XXX.... .. ............... .918 ....... 1,396 _ .. 541.-000 ............... 7,337 ......... )00(..-.... ,_ .... _ .... 1>,2."9 ................ 7,060 ... ...562.000 ...... _ .. 10a,13S ....... ..XXX.... ______ 10S,21T ............ 107,051
........ 370.000 ........... .22,942. ....... ..XXX ..... ~ .. ~--·- .. 17,113 .............. :u.oos -~-... ...55.000 ____ .. _.22,410 ........ .xxx .. _ . .20,529 ...... _ ..... 26,970
_ ...... ..B11.100 ............... 9,7SJ ... ~ . ...xxx._- ........... 12,020 ................ 12,139 .. ........ 1,263.000 ............. 00,1344 ..... -.XXX... .. ........... 42,355 .............. 55,533
...165'.000 .. , __ .... .9,328 ____ .XXX .... -~ ...... __ .,5,675 ....... ,_ ...... 7,024
_ .......... 510.000 ........... 40,!135 ........ .XXX ...................... 32,501 ............... .35,751 .. .... .2,1588.000 ....... 41,760 ........ .xxx. ... _, ..... - .... .29,8S. --·-·- ..... .31,272
.... (2,9~1" .. (651\-·
... (4,650) 1-·- ... (657) .... . • .......... ..j4,600) ..... .
... 9.190 ... 13,263
34,999
:~:ru: ~:~~~-:-::_1= f: __ ~-~E :_~~= -_:: .. ~~
~~~~~~~~-....... (247) .......... ,_, ........ l- -- (247) ....................... --·~-19,7S7
_____ 1,278 -----~--.. - '"" ______ .. ,_ .. l: -- .. 1,27B ................................. 19,923
"=~~~;~~~~;~ .. .. ~ . ..56\i ............... . . . ............... .. .............. .566 ............. .. ............. 1 08,217 .. ... (4,893) - _,....... ................... .. ......... (4,693) ....... , .... _,_ .............. -17,113
---.. [6,441) ·--·--·--·---· ........ ........... .. .......... (6:,441) -·-····- ................. .20,S2!J . .. (119) ...... _, ......................... ~ ............. __ (119) -----·-"· ................... 12,020
... [13,108) ·-- ........... .. ........ (13,168) .................................. .42,31l5 ............. (349) ........ .............. ----~--134!!1 ............................. -----0,1>75
(3,241 ............ .. ............... .. ........... (3.244) .................................... 32.507 -['l,4t ................. ,_ -................. :~ ........ ~(1,416) , .. ________ ............... 29,854
.. .:l,30S . ..3,444
... .$,9S1
1,427 .... 4,4S1
.. ... 1,640 .. (315)
... (2,271)
--~.376
---.. (8,981)
'"'I ..... ... (2,271) .. ... 8,:)76
..... (6,981)
... a4 1 ... .xxx .. .. ... ..XXX .. ..
.XXX ..... .
... -.71 l ... ..xxx.~ ...
.~I···=·
... 69 .... .XXX .... . ... .XXX .. ..
.... .XXX.. .. ..
... 128 .... .XXX .. .
386 .... .XXX .... .. ...15,152 1 ...... -15,152 ............ 165 .... .XXX. ... ... 13,2!16 ... 2,03<! .49,53£!
... 13,286 ... .2,039 .. 49,536
.a3s .... .xxx. .. . 104 .... .XXX. .... .
.... .XXX. .. . ..5:35 .... .XXX. .. .
..... 85 .... .XXX. .. .
___ 3.061
1
......... ..J.D61 ... .6,626 _ .... ...6,626
... 19,463
~."' .3,711
.19,463 ... .5,482 ... 3,711
.......... .. .. .XXX._ ..
.. • .255 .... .XXX .. .
............. ..:XXX ..... . .... 919 ............ ..919 ... 230 ... ..XXX .. .
- ... -1,636 ........... 1,836 .430 .... .XXX ..... . (155) ............. [15!;) , ... 421 .... .XXX .... .
...... 3,!)05 ........... 3,905 .250 .... .XXX .... .
.. .. .5,283 .......... 5,283 .... 450 .... .XXX .... . .4,182
........ - ... 892 ...1.036
.... 4.1821""'""""120 1··-.xxx-...... 892 .. .-....... ...20 ,_.XXX.., ... .... 1,038 ... .35i ... XXX. ...
........... (2.081) I " ........ (2.081)
1
.......... 1. 115
1
... .xxx. ... .. .... 5,829 ---------M29 .... - ....... 82 ... .XXX .. ..
...... - .. 1,880 .. [2.270), ..
-~---.. 18.479 - .2,65'3 ..... B,12S .11,906
ueol --I .xxx-(2,270) - ..26<1-1_ .XXX. ..
-.'"'~ !'""'""'"' =.2,S53 .......... _ r= _ - .. 8,128 ·-----·- 311 ..XXX
11,906 ........ 359 - _xxx_
S!:i!tementasofD~cemoor3'•,2013ot!he Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D • PART 4 Showing all Long-Term Bonds and Stocks SOLD, REDEEMED or Otherwise DISPOSED OF During Current Year
CUSIP ldentfficalion Descri~on
'
Disposal Date I Name ofPurch:!ser
Number of Shares oi stock '"' Considera~on I Velue
w
Prior Year Sookf
Adjusted Al!tual I Carrying Cost value
Chenoe in Sook/Adiusted C;
" 14 13
Un!l>altzed I Current Valuatio11 Yea~s
Increase! (Amortization)/ Decrease) Accre~on
,~,
Years Otner-ThanTemporary lmpairmr!nl Rscogn~d
4g3207 10 8[ KEYCORP _, •• , 0411612013.1 Morgan Stanley 15 ..... ___ _
495724 40 31KINGRSHERP1c-SPONS AOR.. .. ...... IR I Q;lf16/2013.1Morgan Stanley 15 ... - ............ ,_ .. 497266 10 6 KIRSYCORP .......... - ........................ ,,_ ... 0212012013. MorganStanlay15... .. __ , _____________ _
50M58 40 1 KOMATSU LID-SPONSAOR. __ ..... ·---- -------- R 1210912013. Mo<JlanStanley 15 ... - .... - ......... .
----·--1,535.000 . •. ..336.000 ......... :~~:~~ I ~:::::::::::·
........ 22.000 1"""_"_.1,671 1.-...XXX .. . ... 636.000 ............ 13,18S __ _xxx __
10.840 I ......... _____ 12.925" 1.848 ...... _ .. - ... 3,103
... 870 ........... -----1,362
S.393 ·----·--16,065
-::~::~1:::~--- ·------50076Q 10 B KRAFf FOODS GROUP INC ........ ----·----·- 04!1912013. Morgan Stanley1ii .. _ ......... . ..... 235.000 ..... _._12,015 ...... ..XXX ................... 8,582 .... 10,685 ........ (2,103) 501389 20 8 LKQCORP ............. ................ .. ....... _. - 0911612013. Morganstanley15 ""·"·--·-·-................ 20S.OOO .. ___ .5.521 ........ XXX.... --·-·---1.934 ............ 4,347 ...... (2,413]
501597 10 2 Ll & FUJIIG LTD-UI>ISP ADR.--·-·-···"·--.. -- .. R 0111812013. MoiJllln Stanley 15 ........... - ... ·-.... ..5,0ll2.000 ... - ...... 15,417 ....... ..XXX... .. .. ·---- 18,313 ··-·- ...... 17,60f -----.657 -.-.. . 517ll34 10 7 lAS VEGAS SANDS CORP _______ ........... -... - 0611412013. MoqJan Stanley 15 ...... . .... 506.000 ......... .26,406 ....... XXX .... _ .. --·- .. ~642 ................ 23;!57 ............. (715) . 526057 10 4 LENNARCORP·A ............. - .............. _.,_,__ 06120/2013. Mo<JlanStanley15 __ -.. - .......... __ ...... 392.000 ... -M .. -14,364 ·--..XXX .. - ................ 15,002 _ -- .. -... 15,159 ...... - ... !157) ..
544147 10 1 LORTUARDINC ........ - ... -.~-........... - ................. 0911812013. Mor(l<mStanley15 ................................. 1,290.000 ............. 58,380 ......... XXX..~'"" ........ 48,528 ..... 50,158 ..... M ... j1,640). 5486$1 10 7 lO'NE'S COS INC .... M••---·---·--· ................ 1110612013. Mo<Jlan S!anley 15 ........ ,_ ,_M, .. _ .... 767.000 ............. 33,370 .. ,_.XXX.____ ...... .23,128 ____ ,, .. ,.65,392 ......... (8,194) . 55616P 10 4 MACY'S INC ________ ............. --.. ·-·"'"'-"""'- ... 0411612013. Mo<Jlan Stanley 15 __ .... ....... .. .... .515.000 ......... ...22,559 .... -.XXX....... . ............ 18,331 __________ 20,095 .......... (1,764) 559.222 40 1 MAGI'-lAINTERNATIONALINC._ ....... -~-- ____ 1.. 0911612013. Mo<JlanStanley1S..--.... - ................... 94.000 ............ 7,317 ___ _xxx_____ ... 3,1160 .... - .... -..4.702 ......... !1,042) 56501R 10 6 MANUUFEFlNANCli\LCORP ........... - ... ___ ., 1.. 07/1812013. MorganS!anley15 ............. ______ ......... ..505'.000 .... _ .... 8,916 .... -.XXX...M-· .-........ 5,313 ....... M ...... 5,8B3 ......... (1,550)
57SJSQ 10 4 MASTERCARD INC-CLASS A.... __ 05/2'U2013. Mo<Jlan stanley 15-.. --.. ·-·····-.... - ........ A.OOO ............... 2,351 ..... __ _xxx______ ... 1.742 ................. 1,9135 .M .... M .... l223) 57!!780 20 6 MCCORMICK&CO-NONVTGSHRS ... --·-· ... 0812312013. MorganStanley15 ......... M ....... __ _ ______ 100.000 ......... _6,991 ....... .XXX...-............. _5,217 ... -47,648 .. ---(1,019) 1 ••
mi5B0645 10 9 MCGRAWHILLRNANCli\LINC .... _ .. ___ ------ ... -· 02106'12013. MorganStanlsy15 .. ,_,_,M ... - ... ·- ..... ..350.000 ....... 18,000 __ __xxx_ ........... - .... .19,419 ............. M19,135 __ , .. ,_..264
E E~ !ll ~§f!g~~~~~f~;=:~;:~:: !~~!l ~~~~E~~m =~=::=.: -:~:-:1~f~ ~= ;~l ~~ :·= ~:~~~~ ~~ ~~f~ :_-i!i~!;:: . 609207 10 5 MONOELEZINTERNATIONAL INC/\. ......... _ ...... , - 001612013. Mo'!lan stanley 15 .......... ........ ____ 707.000 ......... ...21,620 .... - . .XXX.·--· --·-M .. 15~8 ............ 17",995 ........ Mj2.057) 611740 10 1 MONSTERBEVERAGECORP..... .. ............ M .... 0611412013. Mo<JlanStanley15 ................. _,, ...... 155".000 ... _ • ., ... .9,287 ........ XXX.... ___ .7,381 .............. 8,190 -·---.... {009) 617446 44 8 MORGAIIISTANlEY __ , ................ - .. -·-·-··--· _ 1211612013. MorganStanley15....... .. ..... ___ __ ___ 145'.000 ............ 4,485 ...... .XXX. ... _, .M ......... 3.751 .................. . 635274 30 0 NATIONAL GRID PLC-SP ADR ..... _ .. _ __ R M/1612013. Morgan stanley 15 ...... ·--.. ·-·· ,_ ........ 422.000 ......... ..25,514 ___ .XXX._____ .......... .20,220 ........... -24,240 ......... (4,020)
537071 10 1 NATIONAL OILWEll VARGO INC .......... ,,M,_, ...... M/1612013. Mo<Jlan Stanley 15-_.__ -------··· ·-·-·-·..382.000 .......... ..25,366 ........ .XXX....... .. ......... .26,582 .............. ..26,110 ........ __ 472 641069 40 6 NESTI.ESA-SPONSAOR. ______ ................ - ... R Osn412013, Morgan Stanley 15..................... .. .......... .215.000 _______ 15,372 •.•.• .XXX....... .. ......... 12.~64 ......... -13,999 .......... (1,935) , ..
S4S445 10 3 NEW YORK COMMLINrTY BANCORP.-................. 0310712013. Mo'!lan Sf:anley15 ...... - ...... -... . .... 3,630.000 ......... -48,903 ...... .XXX •. -... .. ........... 46,32S . __ ...•.• 47,653 ....... (1,225) 65339F 10 1 NEXTERAENERGYIJIIC ......... - ..... _ .... _____ ,.., 0911012013. MorganStanley1S ................ _ _ _ .• 614.000 ... - .... .4S,9S!l ....... .XXX. ... M, ............ 40,079 ........... .l!1,57S .. (3,674)
=~ ~~ : ~~=~==~~~~~:~~-~~-~:.~::~-:.·~:~~-- ~ ~~::~~: ~:~::~::~ ::::::::~.~ .. :::::~~ ·:=~1-~::~ ::::::: ::~;: ::::::::: ::~::· :~:::.~::::!::;: :::::::::::~~=::;: ::::::::::::~::~1::· 67103H 10 7 O'REILLY AUTOMOTIVE II>IC ..... -... __ -------- _ 0411912013. Mo<Jl!Ln Stanley 15" ... - ....... M ..................... 68.000 ............... 6,701 ...... ..XXX._ ....... 3,£69 ............. -6,081 .... ~ ... ,(2,612) 674599 10 5 OCCIDENTALPETROLEUMCORP. __ .,, __ - 0411612013. MorganStanlay1S..... ...... __ , ...... 565.000 .. _ .. .45",801 ....... ..XXX .. _ .. ,_, __ M47,319 ........... 43,361 ........ ..3,958
682m!O 10 3 ONEOKINC.-................................. ------------ 1112012013. Mo<Jl!LnStanley15 .•. ,,. ............... ··-···--!KOOO .... _ ..... .5,368 ....... .XXX_. _____ ....... 4,162 ............ 40,613 -·---1,453
~= ~~ : ~~=~~~~~~~~~~~~~-:::::~::~:~::: ; ::1~~: 3riuE!:!~~~-~-~: .. ~=-~-~- =~:::=:~:~: ~:=~-~:~:: :::==:s:=: .......... :::~~~!; ~:~.~::==:~:= ~:::~ .. :~;:1: --M·-·M·-· ,_ .. 6B3718 10 B PACCAR IJIIC .... - .............................. ,_M,..,_ ... 041(]4/2013. Mo<Jlan Stanley 15 ........... __ . • ...... 1,0S7.000 ......... .53,225" ---.XXX. .. ,_, •••.•. 47,510 ................ 49,595" .......... (2,085) 714290 10 3 PERRIGO CO PlC .................................. -..... . 1211912013. Mo<Jl!Ln stanley .. .,,.................... • ....... 420.000 ........... 63,483 ....... .XXX.._,.,_ ........... .48,195 .... 43,693 ..... .4,S03
~~~ : : ~~~L~~~-~-~~~~~~-~ .. ~~~~--~-~-~-·:.~~-~-~~ R ~~;~~~~: ~=nLI:~~;;·;·~---~- -~---~---~-~~-~-~-~ ....... ::::~~~~~~ ..... :..:.~~~~ :::~:=::: .... ·-· ::::::~=:~::~~ :::::·~:~::;;~~: :::~:::(~~~~;~I::--· 718172 10 9 PHILIP MORRIS INTERNATIONAL _ .. _, ____ ..... 01a8/2tl13. MorganSianley1~ .................................. 67.000 .............. .5,962 .. _ ___xxx__ __, ____ ,5,775 ....... - •. 5",604 M.-... - .. 171 718545 10 4 PHIWPS 66_,,. ................... - ........ --.......... 04/1612013_ Morgan Stanley 15'.--.. -·-.. --... . ... ,..535,000 , __ ...,31,334 ... - . ..XXX ...... .. .......... .19,452 ·- _____ ..28,409 ....... (B,9SS) 1 ..
Value " 14 " Total Foreign Canylng
Boo"
,,., I -·· BJA.C.V. I Change in at Disposal
Ch111J9e in Exchange value
11+12-13) BJA.C.V. Date
(2.085) -. --- ................ 10,640 .. (1,255) ..... _. ___ , -·--·--1.84B
...... (491) .... ·----- '"'"""" __ .. 870
-·- ...... {6,674) .. --·-·-·-.. .. .. ..9,393 ..... (2,103) -- __ , ___ ., _ ............ 8,502
....... _.(4,413) -·-·-·-·-·-· ................. 1,934 - _____ .657 -- ...... - ... ,_.,,_ .. -18,313
__ ,, •.• (715) - .......................... ____ ___22,642
(157] - ................ ,_ .• 15,00Z
---(1,640) ................................. 48,526
• ... (6,194) ............ --· ............. ..23,128 ....... (1,764) - -·- ........................ 18,331
,_, ....... (1,042) .... -·-·-·--· ,, __ , __ •. ..3,660
(1,550) ........ _ ........ -- ..... - . ..5.313
-'"""""'(223) """""""'"'" H'MOH_, __ 1,742 .. ........ (1,019) . ---·--- ---5.217
""""""..284 '"'""'"'-" """'M onHo19.419 ,(1,094) - ............ .. .............. 6,446
-·------(6,219) - ··--·-·-....... ,_ .... 41,845 ........... (3,408) - .............................. --42.218 ... __ ,, __ (743) - ....... .. .............. 2,531
._.,,,_(2,057) "'""'" ...................... -15,938 (809) ............. _ ............... 7,381
·--............ 0 ........... '""'" .. - . .3,751 ..... (4,020) ................. ,, __ .... .20.220
... - .... -472 ........... ---- ----- .... .25,582 (1,935) . ., .. ____ ,., ···-·-·""12,064
... (1,225) .. _. ___ ................. 4S,3Z8 ---(3,674) ...... , __ ................ 40,079
... (50!!) ................. . ............... 3,516 ,.,(838) ..... _ ""'"" ................ 4,036
"'"""'"-(2,612) - ------.. ··--.. .. .......... 3,469
'""'M'_3,958 MO"O- ""'"" """" """"47,319 .. ,_, ____ 1,453 - --- ......... , .. _____ 4,162
__ (3,439) ............. _ ""'-"""'"19,985 ....... j2.712) .... _____ .............. 19,2.12
- (562) ............. _ .......... _ .. 12,500
-MI2.085) ""'-"""""' '"'""""'""47,510 -·-·-.... .4,603 .............................. _ .. 48,195
(319) ....... -......... ..... . .... 9,552 .... (15,135) ........ - ................... SB,087 _______ 171 -·--·-""'"" ............... 5,775
.. •. (8,955) .............. ,_ ..... --- -19,452
" Foreign
Excha!l!Je
'" (Loss) 00
Disposal
18
Rear!ZE!d Gain
'""' 00
~osal ,_., ___ 3,949
-----.2.43!! , ____ ..801
...... .3,794 ...... __3,433 __ .... ..3,587
... (2,896)
-5,764 ......... (618)
.... .9,852 _10,242
10
To!< Gain
'""'' 00
~_sal
'"" -'.~·
•. .801 __ , _ _3,794
"' Bond ,_, """' Dividends
Recel'led Durlng Y~1
_______ 77
-------51
"
-· Contractual
""""' , .. .•• .XXX .. .. ... YX< .. .. __ .xxx. ... ..
.2MI ... .>X<.. .. ____ ..3,433 ......... 235 ... .XXX...,,
HOM .... ..3.587 '""""'""""' ., .. .XXX.., _ ..... (2,896) .. , .. ____ ,, ... ..XXX ... .
_____ 5,764 ............. 133 ... .XXX ... .
- ........ (618) .............. 31 ,,..;o:x_,_ ...... 9,852 .... .2,129 .... .XXX ...
.. 1!),242 ·--. ....306 .... .XXX._ .. ,
.•.••... 4,2271,_ -'"'1·-·--·2061 •• = ..... ______ 3,657 """"".3,657 ••-MO..,OM77 .. ...XXX. • .,, ........ -3,604 .... ~ .. ..3,604 .. _____ _109 __ .JOCC ...
~~~~:=:: I =-~:~~: •.• A 1·-=-.. . •. 102 __ .xxx.. .. ..
(3,419) """"'"(3,419) ""-"""'H'MO .. ...XXX..,., ,.,.4,948 MOM"""4,948 """'""'"'.29 ., • .XXX...,, ... 13,228 ......... 13,226 ---... -1,010 .... XXX..., ..
......... 10,223 ...... -10,223 ............ .494 .... .XXX __
1,179 ........... 1.179 .............. 39 ... ..)CO( .... .. -·-·--5,681 _,,,,,5,581 , ______ 1S4 .... .XXX ..... _
_,1,905 """"""1,905 ""-"""""-" .,.,)()Q(_,M ....... - ... 734 ,, ____ _734 """ ....... 15 ... .XXX._
'"""'"'5,294 - ..... ..5.294 ........ _.485 __ .xxx., ... ,_,.,{1,214) ......... (1,214) """"" _ __5Q ... .XXX. ... .. ....... .3.308 __ .... ..3,l08 ....... .....298 -.XXX. ... .
....... ...2,575 ..... ..2,575 -- - •. 908 ... .XXX. ... .
........ 8,919 __ ,....8,9JS --•Mowo7Z9 ., • .XXX ... .
"M"'""1,771 ......... 1,771 ............. 34 ... ..XXX ... . .......... 1,948
--·-. ..3.293 ...... (1,45S)
........ 1,204 ....... 3,474
____ ,5,075
......... (274) _ ....... 5,715
........ 15.288 -·----(4,336)
·----.27,484 ...... ,_ .. 187
.......... 1,948 ............ 141 .... .XXX ... .
......... 3,293 ........ - --- .. ...XXX ... .
----.. (1,459) ·---... ..364 ... ..XXX .... . 1,204 .... _____ 139 ... .XXX .... .
__ , _ _3,474 '""'" '"""'" ,.,..)CO(,MOH • .5,075 ............ .316 .. YX< __ ... (274) - ____ ,219 __ .xxx. .. .. __5,715 ......... -219 .•. .XXX. .. .. 15".288 .......... 151 ... .XXX. .. .
-----!2.336) .......... -94 .. ...XXX.. •. .... 27.464
- -~-Sf •.• .XXX ..... . .187
......... 11,882[ ........ 11,802
"' l .... .xxx. .... .
_167 .... .XXX .. ..
' "
Sli!temenl as of December 31, 20·13 of the Mid-Atlantic Vision Service Plan, Inc.
SCHEDULED· PART 4 , Showing all Long-Term Bonds and Stocks SOLD, REDEEMED or Otherwise Dl?POSED OF During q s I s I T I a I 9 I to I Chan~a in sooi</Adiusteo ea,
rrentYear inc Value 16
-,-1 T 12 t3- 14 "
CUSIP Identification DesertpljQn
Disposal 0'" Name of Purchaser
737-0.'il to 7 POTASH CORP OF SASKATCHEWAN. .. ········---~'·I Oll/02/2013.1Morgan stanley 15. ___ ............ . 74018-9 10 S PRECISION CASTPARlB CORP ............................. 04/1612013. Mo~n S1anle.y 15 ............ -·---·· 74150:3- 40 3 PRICELINE.COM INC·--····-·--· 744600 10 9 Pl.IBLICSTORAGE. .................................. .
. 1 10/JJ9J2013.1Mo~n S1anley 15 .............. . _ 001S12013. Mot;~an S1anle.y 15 .. ____ _
747515 10 3 QUALCOMM INC. ... --·····-·····------·-·-··· 751212 10 1 RAlPH LALIREN CORP ......... _ ......... . 75281A 10 9 RANGE RESOLIRCES CORP ........................ .
1011512013.1 Morg<~n S1anley 15 ......... . 1011712013. MorganS1anley 15 ........ .. 0412912013. Morgan Stanley 1 S._,_,
756255 20 41 RECKJTT BENCKISER-SPONf>.!JR.. -·------~' I 0711712013.1 Morgan Stanley 1ii ...... 756204 20 0 REED ELSEVIER NV-SPONSADR.. --------·- R 1211112013. Morgan Stanley1~--
7SS1EP 10 0 I RE!";IONS FINANCIAL CORP .............................. 1···1 04/W/2013.1 Morgan stllnley 1ii ..... . 775109 20 0 ROGERS COMMUNICATIONS INC-S........ .......... L 0410212013. Morgan Stanley 15 ...
778296 10 3 ROSS STORES INC·-------------·---·---·-----· 780097 68 9 ROYAL BANK OFSCOT-SPON ADR ..
780259 20 6 ROYALOLITCHSHELLPLC-ADR. .. ~-~--.. ~--------783Ba.J 10 6 SBA COMMLINICATIONS CORP·CLA ...... 7M117 10 3 SEIINVESTJ.Ie.JTS COMPANY ..... _.
m 17ll440P 10 B SKTELECOM CO LTD-ADR .... -i!: 78663S 20 1 SA!";EGROLIPl'LC-UNSPONADR .... ~ 79466L 30 2 SALESFORCE.COM INC ...... .
803054 20 4 SAP AG-SPONSORED ADR. ....... .
80585Y 30 8 SBERBANK-SPDNSORED ADR..
806857 10 81 SCHLUMBER.t";ER L TO ........................ .
608513 10 5 SCHWAB(CHARLES}CORP ..... ..
1210212013.1 Morgan stllnley tii _____ _ 'I 0710312013. Mol!lan Stanley15. .......... .. R OSJ2712013. MoiJlan Stanley 15 ....... . . .. 1112512013. Morgan Stanley 15 ....... ..
.•
1
02121/2013./Morgan Stanley 15 .. __ _ R 11/26J2013. Morgan Stanley 15. ........... . R 0611712013. MorganS!anley15 ......... .
1112112013. Mot;~anS1anley 15 .. ~----·
' 110117/2013.1 MorganS1anley 15... .......... . R 0312712013. Morganstanley15 ........ ..
1112612013. Morg>:~n StarJey15 ...... . 10130!20n MorganStanley15 ... _ .. .
Num~erof
Shares of Stock
________ .551.000
___ ._ ....... 26.000
Consideration
............. 18-,688-.......... ..5,245
'" Value ... .XXX .......
____ .xxx_ __ _
.. ....... - .. 31.ooo 1 ............ .::.o,m l ........ .xxx ...... ..
Actual
"" ... 19%5 __________ 4,8"~
.18,322
....... 119.000 I ............. 1B,S£8 l ....... ..xxx. ........ l .... - ... 11" .221
Prior Year BooK/
Acijll5ted Carrying
Vattro
···-------.. .22..420 .... 5,304 ... 19,232 .. 17,250
.... 46,1051 ....... .xxx. ______ I ________ .:J3,m ~--- ........ .44,2S1 10,964 ____ ..xxx,_____ __ ________ .7,801 ..... - .. - 9,445
..20,1ff6 ...... ..XXX ..... _, ............. 17,602 ---- ....... 18,2!!4
............. 716.000 _________ 53.000
............. 291.000 ______ .. 324.000 ............. 4,Slll ______ .)(XX___ .............. 2,7"68
___________ 863.000 ........... ..34,988 ...... -XXX .. ~-- -------19,623
...... -.3,410.000 ·------~27,075 ........ XXX... . .... 21,1!4
............ .451.000 ......... 22,242 ........ .XXX... • ............ 19,1'6
-----------8.000 ·-·--·-·--604 , ....... XXX... .. ................ 829
..... 4.154 .. 25,528
..... 24,313
.. 20,530
.. ....... 1,329.000 ............. 11,142 ---~--.XXX .................. 13,2&3 ................ 14.340 ~------750.000 ___ , ....... 48,340 ........ XXX ... - .............. 51,641 ...... ----..51,7"13
........ ffS.OOO .............. .4,774 ,._, .. .xxx. ........
1
.......... -3,078 ................. .3.975 ........... ~ .. 87.000 ............. ..2,411 ........ .XXX. ........ - _____ t,SZl -------------2,031
----·:.~~~~= ::~:~.::::~~:~~: :::::::~== :: .·:~::~~~:~~ ::~:~:::::~~-~~~~~ 146.000
~ .. 214.000 1,14B.OOO
... -346.000 .. .5,7"25.000
.. 12,S81 , .. 15.4.27
...... .xxx. ........ l ........ ____ 9,4l0
.... XXX ....
···~ 14,231 l ........ xxx.. .... . ..26,5SB ...... ..XXX ....... .. 110,505 _____ _xxx ____ __
...9,600
12,2111 ..22.,450 .7Z,2W
... 11,137
...... 11,201
.... 13,971 - .. 22,591 ... 82,211
l Current Llnreallzed
Valuation
~=:J. Yeats
(Amortization)/ Accretion
_______ (3_315)
.... (488)1'''' ---------[910) •.•
··-·····-----(~S) ...... [11,119)1···
... (1,B44) .. .
·-··-····--(482) .. . .. .... -.[1.385)
----(5.905)
1
...
. •. - .. (3,1i'Ol .• ... (1.414) ........ i
.(1,0ipl
-------.. f!"1J ··-----(897)
·------[208) ......... (4,90.1)
......... ~1) . ...... (1,7)7) .
......... (7,601) ....
... (1,irOJ .
......... [1,7S5) ·----------....... [9,9~1)
Current Year's
Other-Than· Tampnll!ry Impairment Recognized
Total Forefgn carrying
Boo" Total I Adjusted
Change in Exc~anga Value BJA.C.V. Change in a! Disposal (11+~2-13) BJAC.V. Date
(3.345} ........... ,,___ ....... 1Jl,07S
...... (488-) ·················-· ·-·--- ...... .4,8-16
.. .... (910) ······- ....... 18,322 ____ (29) ···- --- ....... . ........... 17,2:21
~(11,119) ··-··-·-·- .................... ss:rn -------(1,134<:) ........ ·····-- ................ 7,801
--[482) ······---· . -----.. ·-----17,802 ... (j,M5) .................................... .2,768
..... (5,905) ................................... 19.623 ... (3,130) , ....... .. 1.1.184 .. .. (1,414) -~-----19,116
............ 0 _____________ 629
_, _ _. __ [1,057) ------------ 13,283
-.01,641 ....... .-.3,076
..1,823 ...... 20,126
. ... 16
-------(71) -
........... _.(6!17) ---
... (208) -
..... (4,901) --------.. ......... (1) •
-------1'!,717) ... ----------.. 9,420 .. .... (7,6tl1). .. .-.. 9,600
............. 12.201
.. 20,397
~~ ~ i 1~ff::~£1~~~j; -~~~--~~~: ~ ~~~~!1 §~,~~~;;= -~:·~;: : _-,~1~ ~:~]:§ 1::~·-= ··:~i~i~ :=~: ::: :--·~:~~I~:::::=:~::~~:, ___
.. ...... ('1,7"70) --
C1.785) . (9,921) .
(7,357)
···"""'!····
.22,45'0
..... 7Z,2SO .. 18,040
.41.752
.18,910 -.24,7"(]2
.... 3,481 .... 13,791 .. .... 5,030
... 5,309 .. .. 12,728
... .61
855244 10 9 STARBLICKSCORP ...... - .... --------------· ........... 0512412013 Morganstanley15 ...... --·- ......... ·--· ...... 94.000 .............. .6,032 _ ..... XXX......... .. ........ .3.481 ----~----.... 5,041 -------(1,560), .. fJ5l477 10 3 STATESTREETCDRP ............ - ___ ---------·-· ... 0411612013. MorganS1anley15 ..................... ___ .. .322.000 ........... 18;805 ........ .XXX..-•. ---·-----1~,n1 ................ 15,184 (1,393)
8rtl122 10 6 SWATCHGROl.IPAGITI-IE-VNSPADR ........ ~·---· R 03107/2013. MorganStanley15 .......... -----~·--· ~-· ...... 266.000 ............. 7,346 ........ .XXX.... • ............. .5,030 ...... ------~--6,701 .......... (1,6T1)~-----87160A 10 0 SYN!";ENTAAG-ADR ....................... ~.......... R 11118/2013. Morgan stmle)' 15.......... • ... 79.000 ............ .6,240 ......... XXX..-... .. ............ .5,309 ................ 0,383 .......... (1,07'4) ....... .
:;: ~~ ~ ~;::~:~~-~~~~~~:-~-~::~~---:~:~::: ~ ::::~:- ~=~=~:~~::~ .... :·------:::::~ ::~::~:=::~~~~~ ::~=:~--~;: --:--~:::::~--- :::::~:~~::~:: ::=:: :=::~::: ~::~::::~~~~; :::--87"6568 5D 2 TATA MOTORS LTD-SPON ADR. .................... _ ... R 1211312013. Mot;~an S1anley 15 ............... --· ............... 21.000 ...... _ ....... ..638 ....... ..XXX. ....................... .514 ............ - ...... • ....... 1 .. .
:s: ~~ : ::.:~~~~~~~~-~~:~~~---------- : ~~::~. ~:=~=~:~:-~::~::: _____ ------ --~::~:~:::~~~: =::::::~~:~~~ ~ .. :.::::==: :::::::::::~~ ~~~~-:~~-~~::; ::::~~::~~;:~1::· 88076W 10 3 TERADATACORP~--------·-·-·-·---~------· 0410412013. MorganStanley1ii.... ............................... 322.000 ............. 16,354 ....... ..XXX......... .20,831 ---- ....... 19.929 ............ 903 881624 20 9 TEVAPHARMACEUTlCAl-SPAOR.... R 1011812013. MorganSlanley15 .................................... .643.000 ______ ..25,$7 ....... ..XXX ............... -....26,685 .............. 24,010 ........... 2,556
::~~: lF:i~:::;,:;~~~;~:~~_:.: ··••- : ~::: ::::::::~=:=:::: ==:~::::: ::::i: ::s. ::::1~: ::J:E :~±~1 892331 30 7 TOYDTAMOTORCORP-SPONADR... ......... R 06127/2013. Morganstanley15 ................ _ ............. 06.000 ........... ..7,039 ........ .XXX....... .. ........ ..5,130 ------- .. _6,155 ---··-----!9;65) 89417E 10 g TRAVELERS COS INCITHE................. ................ _ 04/1612013. Mo~n S1anle.y 15.*·-·---------· ............. 473.000 __________ 40,5Til _____ .XXX... .. .. -24,5)¢ ~--- ._.33,971 ..... (8.17)
--------61 -· .......... 0
... (1,0110}, ...
----(1,393) • ... (1,671) •
(1,074) •
(2.733) . .•. (1,563) .................... ~ ............... 17,!l04
.................... 0
hi::==::::~:::~ 1:::--· _________ .903
_______ ..2,656
........... (2,600) , __
..... {2.440)
.......... >.••!···················· ---------hi·:=:~=~~~= ~:~:=:~-----1·
...... 514 ............. 9,5S5
... 9,971l
·-·*·--..20,831 ............ ..26.665 ........... _,9,774
.... 7.795 ..... S,11!5
- - .. 5,190 . 24,5M
"jj'
Foreign Exchang2
"'" (Loss)
" Disposal
'" " " BonO lnteresb'
" "'""' I Tornk I Srook Gafn Gam Dividends SlatEd
(Loss) (Loss) Received I Contraatual on on Durtng Matuaty
Dis~ossl DISPOSBI Year Data
···"'" r··········""' r···········~' r···-'OOL ... . ... .430 .............. 430 ________________ 1 .... .XXX ..... .
... 12,405 ..... -.12.455 ....................... .XXX .... ..
.. 1,447 ........... 1,447 ............ 14S .... .XXX. .. .. ......... 12,9~3
... 3,182
... 2,355 _ ........ 1,809
. ... 15,355
. .5,891 ... :3,126 ...... (25)
... (2,142) (2,31l1)
... 12,933 ............ 366 .... .XXX .. .. .3,182 ............. .50 .... .XXX ...
... 1.,35S _____________ 7 ... .XXX. .. .
... 1,8'J9 ............... 75 .... .XXX .. ..
15,365 ............ .891 .... .XXX . ..5,891 _______ ._, .. 68 .... .XXX .. , ..
... ..3,126 ...... .317 .... .XXX .. .
........ (25) ....... .... ..... • .. ..XXX ..... .
... (2,142) ----------------- ... ..XXX ..... . ... (2,301) .......... 1,122 .. ..XXX .. .
... 1.698
1
________ 1,896
-~--589 --------~--.569
.... 15,0. 22 ......... 15M2 ... 2 ................ ,:<
. .. ..XXX .. . .... .XXX .. .
... 1,061 ! ... .XXX .. . .... J',XI, ...
...... 3,461 1----------3,46'1 1------·--------·--1·--.XXX ... . .5,827 --------5,827 -------~--171 ... .XXX.. .. .
... 2,036 ... 2,036 .... .XXX. ...
·········'"I············'" 1·············"' r····=· .. .... 44,216 _____ 44,216 ............. 718 .... .XXX. .... .
__ ___ 11,154 -------11,154 -~-----440 ... ..XXX . .(1,374) .......... (1,37'4) .......... 1,287 .... xxx.: .. ..
_______ ,.5,372
(4,404)
.. . ..2,551 ... .5,014 ... .2,316
... .5,372 (4,41l4)
...2,551 ...... 5,014 .. .... 2,31s
.... .XXX .. .
.152 ... ..XXX ..... . ... Sfl ... ..XXX .•
... 162 .... .XXX .... .. .............. XXX .. .. ...102 .... .XXX.. .. .
XXX. .. . ..... 931 1 .............. 931
____ ,, .. 3,856 ........... 3,856
...... 4,492 ____ 124
1,482 ...... 15,182
____ ._.(4,477)
....... -(1,308) .6,051
2,948
.4,492 __________ _118 •. .XXX •.
.... 124 ...... 3 --~XXX .... .. ........... 1.462 - 345 ... .XXX. .... .
15,182 ··--- ---~60 .... XXX. ... .. ... (4.477) . . .. .XXX. .. . ... (1,SOB) .......... .395 .... .XXX. .... . ... 6,051
... .2,948 ... _ ... 58 1---.XXX ....
... ..xxx:.-.. .. ~.~1 ~··· .. o~k 1 ........... 10; l .... .kOO<.. ... . ... 1,B50 ·-·---1,850 .... - ........ 77 , ... XXX .... .. _16,t73 ......... 16,173 ............. 218 _ . .XXX .... ..
smremertasofDecerrDar31,2013of!he Mid-Atlantic Vision Service Plan, Inc.
'
CUSIP lden!Jffcalion Descrtotlon
58!?415 20 2 TllllDWC 900148 70 1 TIJRKIYE C
802973 30 9G3S4S 30
~=~: ~ ;~~~~~~~- -----···-807S18 10 6 1.11,.;:,., '" 913017 10 81324P 10 918W4 10 Bll
92345Y 10 82826"C S3 92S563 40
S2857W 20 93114W 10
849746 10 ml 959802 10 9jwos,"""o'"'"' :;;:.: 863320 10 -• 968223 20 B I WILEY (JOHN] (;.~N:;.;.;~..~~:;:; 11.---··-·-·· tn 868457 10
981063 10
9831:>4 10 984846 10
988498 10 1 -------------G1151C 10 1IACCENTUREPL~ G2554F 11 G291S3 10 G60754 10
G7S40E 10 -~---H0023R 10 5 AC:EL
M22.4Bii 10
N07059 21 N53745" 10 N6596X 10
10
Showing alii n-TA 'Ro 4 5 5
SCHEDULE D • PART 4 and Stocks SOLD, REDEEMED or Otherwise DISPOSED OF During Current Year
7 I 8 g I tO
" " " 16 17 18 19 20 2.1
Bond Book/ Foreign IJJ~eresli
PriorYear Year's Total AdjUsted Excimll!!e ReartZed Total stock Book/ UnrealiZed Current Other-Than· Total Foreign G:lnying Gain Gain Gain Dividends stated
I Numberof I Adjusted ValuaTion Year's Temporery Changein Exchan_ge ValUe (Loss) (Loss) (Less) Received Contractual
Disposal Shares Par At:tual carrying Increase/ (Amorlizatlon)l Impairment BJA.C.V. Change in at DO;poSill on on on During Mahm'ly Date NameofPurc:haser afStm:i< Consideration Value Cost Value I !Decrease) Accretion R!!co niZed 11+12-13 BJA.C.V. Date Dis Dis osal Disposal Year Oats
11/0712013. Morg<lnStanlay1S ... --···-------·· ·-· .. --1,385.000 ··-··-····-10,6&0 ...... __xxx_ .•. 13.567 ····- _____ 14,297 ·-·-···--[730) ····················- ------·-·-·· ··-·-····---(730) ··-··--·· _ ----- ____ .13.567 ··-·-··· ......... (2..907] ·-··---(2,907] ·--···---109 ..• :XXX. ..• 0410812013. Mo-rganStanley15 .. ······-·-·····-·· _ .__2,.823.000 -----------14,661 -----...XXX.·-·- -----------8.819 ·····---14,847 ____ (0.828) _____ ············- ---- ··-·-·-·· ···-··----(5,828) ······-·-··-- ______ ..... ..B.818 ··--·-·-·· •. --S,B42 --------.5,842 ·-·---------- .... :XXX. ..• 0411612013. Morg<1n Stanley IS.---·-·-·---- ..... .507.000 ·····-----16.502 - -...XXX......... ·····------11,579 ---- •. _16,194 --------(4,615) ····-·- ..................... (4,615) ----··-·--· ····-·- ...•. 11,579 ··-·-·. _______ 4,m4 ______ A,S24 ·----198 ___ _xxx ___ _ 1211212013. Margan Stanley IS .. -·-····---- - ....... .110.000 ···-·
101281201° ""-"
) I I ____ .... 0
1 ______ (505.501)
••••l"";t.OVI) ···-·~ IV0,-'0~) ............ 0 - ....... (670,855)
.1.(191,091
~ .1.108,703
_ ___xxx_ __ _
~
' "
statamanti!So!December31.2013oftne Mid·Atlan.tic Vision Service Plan, Inc.
CUSIP Identification Descrtpfion
Common Stocks -Industrial and Miste113n&OttS
00206R 10 2 AT&T INC·-·--····-·-·····""" 002824 10 0 ABBOTT LABORATORIES ...
00287Y 10 9 ABBVIE INC ... ·-·-·····-·····-·-03073E 10 5 AMERISOIJRCEBERGEN CORP-··-··--···
04585W 10 3 ATHENAHEALTH INC .... -- .. -·-··-·-··-··· 056752 10 8 BA!DUINC-SPONADR._.,,. __ ............... IR
071813 10 9 BAXTER INTERNATIONALINC...-..... - ................. . 086516 10 1 BESTBUYCOJNC ... - .. . 12646R 10 5 CST BRANDS INC ..................... .. 149123 10 1 CATERPILLAR INC .. _
172967 42. 4 CITIGROUP INC .. - ...... - ......... . 20030N 10 1 COMCASTCORP-ClASSA.. ..... -·-·"' 20825C 10 4 CONOCOPHILUPS ......... _ ..... _ .. . 247361 70 2 DELTA AIR LINES INC ..................... .. 2GS5M 10 S DUPONT(E.I.)DENEMOURS ......... .
m I 268648 10 21 EMc coRPIMA. .......... - ...................... . ....11. 26875P 10 1 EOG RESOURCES INC.-................. . Ul 281020 10 7 EDISON INTERNATIONAL ........... .
SCHEDULED· PART 5 Showing all Long~ Term Bonds and Stocks ACQUIRED During Year and Fully DISPOSED OF During qurrent Year
Date AtQUired ~meofVsMor
03l2512013 Moll)an Stanley 15 ........... .
OB/2012013 VARIOUS .. -·-·····-···-·-""""" 0110212013 Morgan stanley 15 ....... .
0312S/2013 MoiJlan Stanley 15.·-·····-·· 071191201.3 Morgan Stanley 15 .............. .
0210412013 Morgan Stanley 15.·-··-·-··· 0412412013 Morgan Stanley 15 .............. . 0410812013 Morgao Stanley 15.-........ - ... -0510212013 Morgan Stanley 15 ................ . 0411012013 Morgan Stanley 15 ............... ..
031151201S Morgan Stanley 15.·-·-··-·-·· 01/2612013 Morgan Stanley 15 .... _ ......... . 0411012013 Morgan Stanley15 .... _ .............. . 01!1612313 MoiJl•n Stanley 15-..... . 0312512013 Morgan Stanley 15 ... .
s-r· ~·ti 9 I " I' 11 ChaneinBoo!(JAcft.!SiedCal
ParValue i CJ.lrrent " 1"13 14
Disposal
'"' Name of Purchaser
05/il1/2013 Morgan Stanley 15 .. .
09127/2013 Morgan Stanley 15 .. . 013119/2013 Morgan Stanley 15 ... 04111312013 Morgan Slanley 15 .. . 1112712013 Morgan Slanley15 ... . 0412612013 Morgan Staflley 15 .. .
(Bonds) I iBootl ' Yea~s or }!.djusted Unreali<:ed C~rrerll Olher-Than-
Numberof Call)ling Valuation l[e•r's TempD!llry Sh•res Actual 'faiue at tncrwsel (Am~~on)l Impairment 'Siockl Cost Consideration Dl os.al Decrwse Accretion ReCOQfliZSd
... 228.000
1
... ·····-·--8.313
1
..... _ ...... 8.667
'.·515.000 ·- ......... 45,010 ·-·-·-· • .50.576 .500.000 - """""""12,621 .............. 21.207
I I I ••• .8,313
l ... -45,616
. .. 12,621
... .328.000 ~-·- .. -·-·15.4231 .............. 17,001 ~- ... ~ ....... 1S.423 .. .•• 81.000 ·-·-·· .. -·.9,120 ........... -10,353 ... """i ........ 9.120 ... -188.ooo ... _ ........ 21,020 .... ______ .16,13a ...... ~ ..... ..21,020
0910312013 Moraan Stanley 1S... ... - .... - .............. -2S4.000 .............. 20,451 ... _ ....... 20,332 ···-·- ..20.451 11/19/2013 Mo~>Jan Stanley 15 .... - ............ 826.0nD -·-··-·-··20,757 .. _ ......... 32,403 ... .l._ . ..20.7fil
=~~ :~u~~;~~-;~--.~~.~~~~~--~-~~.. ::::::~~::~ ~~:~=:~: :::~··::=;~: j:~::~;:~~ 04111312013 MQrgan stanley 15 ... ·--·-·-··· ······-····470.000 ···-··-·-··21.523 .......... ..20,609 .~.-. ..21,523
:~:~: =~= =~:: ~~.::-::·::~·-·- ~.-.~.~-~-~:;;~~ =-~··.~:::~~= ~:.-~·-~::.~:~;;~ ::.f·=--~-~~ .. :~ 1012612013 Morgil!IStanley15. ......... ······- ........... 437.000 ···-- _ .5,997 ......... 9,154 ···-··~·- ... 5,997 04111l12013 MorganStanley15 ···-····- ···-· .. 317.000 ........... 15,354 ........ 15.655 ...... ..'. ..... 15.354
0312512013 MoiJlan Stanley 15 ..... . 1010912013 Morgan Stanley15 ... .
__ , 04111l/2.0131Morgan Stanley 15 ... . 1211212013 Morgan Stanley 15. .. . ,_ . .2!.1,0~~ ........ - ... W.9~4
........ , ....... 8,Tr4 20.088
03125!2013 Moraan Stanley 15 .... _ .. - .... - .• 04/3Dn013 Morgan Slanley 15. .. . ...... 7,744 .. ___ ... _.7,912 ···- ....... 7,744 28B17Y 10 1 ELEKTAAB-BSHS.UNSPONADR. ... . , R I 03107/2013 Moraan Stanley 15 ... . 1111312013 Morgan Slantey 15 .. .
368.000 119.000
. .. 153.000
. .. 594.000 105.000
..8,7741 .............. 8,401
....... 6,906 .... _ ..... E,602 .... 8,806
···t ..... ~1.874 -4,929
29444U 50 2 EQUINIX INC ....... ~ ...................... .. 30249U 10 1 FMCTECHNOLOGIESINC .. . 314211 10 3 f'EOERATED INVESTORS INC-CL B .. .
31428X 10 6 FEOEXCORP .................................. - .......... . 315616 10 2] F5 NETWORKS INC ... ·-···
375558 10 31GILEAD SCIENCES INC--··-·····-····-·-··-406216 10 1 HA.LUBURTOI-JCO .... _ ......................... .. 421933 10 2 HEALTH MGMT ASSOCIATES INC-A. ................ 1 •••
42781!6 10 8] HERSHEY CO/THE._ ........ ············-·-··-·-··-·-··· 1 ... 444859 10 21HUW\NAINC_ ...... 459200 10 1 INTLBI.ISII-JIOSS MACHINES CORP ..................... 1 •.• 46120E 60 211NTIJmVESlJRGICALINC.. ........ - .... - ......
46S25H 10 0 JPMORGAN CHASE & CO ... - ........... --·-·--.. ·• 544147 10 1 LORILLARD INC ......... ·-···
0710212013 Mo~JJanS!anley 15 ....... .
01123/2013 Moraan Stanley 15 ... - ......... . 0710612013 Morgan stanley 15 ... . 0310512013 Morgan Stanley 15 .............. .
oa/1512013 Morgan stanley 15 .. - ......... . 0411612013 Mo~>Jan Stanley 15 ....
0211512013 Mo~>Jan stanley 15 .. - .... ·--· 04/1512013 Morgan Sll!nley 15 ....... . 0511012013 Morgan Stanley 15 .. - .. . 01128/2013 Morgan Stanley 15 ..... .. 0312112013 Morgan Stanley 15 ...... . 01310012013 Morgan Stanley 15 ...... . 06/2411013 Morgan Stanley 15 .. . 0310712013 Morgan Stanley 15 .... _ ...
oa/1S/20t3 Morgan Slantey 15 .. .
10/31/2013 Morgan Stanley 15 .. . 11/ta/2013 Morgan Stanley 15 .. . 0513112013 Morgan Stanley 15 ..
1110412013 Mo~>Jan Stanley 15 .. 0412412013 Morgan Slanlay 15 .. 0312712013 Mo~>Jan Stanley 15 .. 0412412013 Moraan stanley 15 .• 0711112013 Moraan Slanlay 15 .. 04126/Z013 Mo~>JanSianlay 15 .. 0712212013 MQrgoo Stanley 15 ... 07131/2013 Morgoo Stanley 15 ..
10131/2013 Morgoostanley15 .... .. 0911612013 Morgan S1anley15 ... .
550021 10 9 LIJLULEMONATHLETICAINC ..... 565849 10 6 MAAATHONOJLCORP ...
571!300. 10 4 MASTERCARD INC-CLASS A. •.. 651290 10 8 NEWFie.n EXI'LORATIOI-J en ...
I. ]01311212013 MoiJlBTI Slanlay 15... .. _ .. t1/t512013 Morgan Stanley 15. .. .
65248E 10 4 NEWS CORP·CLA ................ ,
052498 10 9 NEWS CORP- CU\SS A. .. . 655664 10 0 NORDS1ROM INC .......... .
08389X 10 5 ORACLE CORP ...... ······-·····-·· 693475 10 5 PI-JC FINANCIAL SERVICES GROUP ..
0312512013 Morgan Stanley 15.-. ___ .. _ ...
OSJ(l3f2D13 Moraan Stanley 1-5·-·-··-·-··--· 07108/2013 Mo:rgan Slaney 15. ...
04111l/2013 Moraan Stanley 15. .... - ... 11/il612013 Morgan Stanley 15 .. . 0910312013 Mlrgan Slanley 15. .. .
013111/2013 MoJJJ!!fl S!anley15 ....... ·-·····-·· 07/il1/2013 Morgan Stanley 15 .. .. 07/01/2013 Moraan Stanley 15 ... - ....... ·-- 07/11/2013 Morgan Stanley 15 .. . 0511012013 Morgan Slantey 15........ 07/DB/2013 Morgan Stanley 15 .. .
0510212013 Morgan Stanley 15 .. ·-·-··-·· 01312612013 Morgan Stanley 15 ... 0112B/20"f3 Morgan Stanley 15 ... - ..... - ...... 0510612013 Morgan Stanley 15 ...
..... 21,874 ... 17,854
. 106.000 1 ............... 4,9291 ................ 5,401
··-·-·1,657.000 ·--·--.42.930 """-···-·45.531 ...212.000
251.000 ...... 22.5521·-........... 20,616
... - .. 22,302 ......... -.H.774
-·-- .. ..260.000 1-·-··-·-··14,.:961 ............. 14.404 .. ........ .381.000 -··-··--··16,459 ""-·--·15.530
. ... 4.807.000 _ ..... _ .... 51.555
---·-736.000 .............. 65,!)37 .. .......... 135.000 -·····-·-··10,091 • ............. 30.000 .............. 6.375
. ......... 19.000 -·-·-·-... 9,482 .. .......... 414.000 .............. 21.542 ..--·-.229.DOO .......... - ... 8,734
···-····200.000 14,474
... 54,209 08,837
...... 10287 _ . ..5.845
.7,380
... 21,210
...• 10.36~ ... 13_410
~2.930
22.552 22,362
l _ .. 14.498
....... ~···--16.489 _ .... L .. ..51.SS5
···~·-··-60.037 L ...... 1o,o91 ........... 6.375
... 9,4B2
.. 21,542 s.m
···- ... 14.474 ............ 740.000 .. _ ......... 24,852 ··-····-·..22.649 ..... J ...... 24,852
_ .. .30.000 ............ 21,798 ···-··--·..23,428 ..... ..J---21,798 ... .2, 152.000 ........... _47,063 ............. .50.865 ······- ..... .47.0BS
···-····.948.000 ............ 27.536 ............. 27,536 ................ 27.530 .. ....... .237.000 ................ 3,154 ..... _ ......... 3,719 ...... ~ ....... .3,154
.743.000 1,346.000
-.42.575 _,_.46,220
. .301.000 1-........... 18,57S
...... 46.409 .42,474
_.19,442
... 42,575
I ... 46,220
·-.. t--18,575
I
·rn~ Value
" Toto!
Chana• in BJA.C.V.
[t2+13-14)
.. .... - ........... 0
16
Total Foreign
t;xchan{le Change in BJA.C.V.
" foreign
ExcMnge Gain
(Lo.ss)on Disposal
.. or· ........ . 0
·-···-··-·-.. 0 .. o
- D
-··0 _ ... 0
..... 0 ... 0
... 0
···-···-·- .. 0 0
···-·· .. -· .0 0
.0
....... ~ ..... ..0
............. - ..... 0
···-··-·-·-.. .0 ~
.... 0
.... 0 ............ 0
............... 0 .... 0
- .. 0
" Reslized
Gain (Coo) ~
Disposal
'" '"'' Gain (Loss)
"' DiSPOSill
" '""" ood
Dividends Received
During Y••
... 3541········-··~' 1 ........ ···'" A,9so ........... 4,esa ....... - .. 269
... _ .. .8,586 ........... 8,566 ......... .2!18
2.478 .. 2_478 1 ... - .. 44
....... \233 . (4,882) ........ .
... (119) ......•..... 144
... 11.707 ·····- .. 240
" Paid lor Accrued Interest
ood Dividends
........ 1,233 ..(4,882)
... (119) 11.707 ...... 91 ..(549)
... -(914) .. .... ..516
. ........... 91 I········· !················
... 299 3.156
.......... 301 (3731
..• [1,624)
... 168 •.. (305)
.... (4,020)
............. (649) ........... .4.51
"""""""""(914) -·- ···-···2 .... 516 ............. .63
..• .299 ... 3.156 ........ .26
........... 301 ............ BS ... (373) .
.... (1,624) ........... .22
... - .. 168 .............. 52 .. (305) .......... 109
... (4,020) . ...... 472 .. 472
...... _ .. 3,001 ....... 3,601 -·-.... 8:!9 ....... [1,937) .......... (1,937) _ ... M
....... (2,588) ..... (2.588). .......... (92) ......... (92) .
........ -(959) ···-· .... (959) ......... _48 .. .2.654 - _ .. 2.654 ... 1,600 ........... 1,600 ........... 218
... 196j .............. 196 .............. 35
..(530)1 ............ (53\l) ····- ...... 29 .(2.102) ........ (2,102) -·- ............... .
... _(232) ···-·-·····(232) ····- ... 2211
... 1,630 (1,084)
-(2,003) ...... - .. 1,630
. .. 1,630 1 ........... 252 ... ~(1,054) .................. , ..
(2.003) ··-··- . .55 ... 1,630 ... - ...... 21
~ .. :~~ I :.~::::·.~~~~ .565 __ .. _ ... 565
.. 59
3,833
(3,745) 857
... .3.833
(3,745) - ... 867
... .223
"'
Stoil9mant~ofDecember31,ZD13ofthe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D ·PART 5 Showing all long-Term Bonds and Stocks ACQUIRED During Year and Fully DISPOSED OF During Current Year
'" " p;o:::," I I I Boo< or Adjusted
i Number of Carrying CLISIP g DalE Disposal Shares .1\ctual Value at
Identification Oascriotlon I n I Acciuired I ~me oi Vendor DalE I Nama of Purchaser (stock) COst COnsideration Diswsal
69364V 10 6 PTT EXPLORATION & PFI-SP ADR. .• ·····--··· F1 0712S/2013 Morgan Stanley 15-- •..•.....•. 101ll412013 MorganS!Enley 15.......... . •..•......• 380.000 ·---·----3,967 ..•.•..•..•. ..4,024 •..•..•. .3,967
7142SO 10 3 PERRIGOCOPLC ............ ············-·- ··-·-·-·- 0910412013 MarganStmlay1S ..•..•..• ---- 12/lY/2013 MorganStanley ................................. ..241HIOO _______ ..29,748 .•..•...• .3S,2T6 .............. 2S.748 71S54B 10 4 PHIWPS66 ........... ___________ ,_________ 0112812013 MorganStanley15____ ....... 0411612013 MorganStanley15 ... ----·-·- ........ 116.otl0 .............. 0,589 • ___ ..6,794 .............. .6,569
723787 10 7 PIONEER NATURAL FIESOURCES CO .... ·--··-- 07/09/2013 MO!Jlan Stanley 15 ... - ... _ .. __ 111()612013 Morgan Stanley 1ff _____ - - -- .... 144.otl0 ___ ....... 20,BB5 ·-- ..... 27.043 ------ .2.D,SB5
" Unrealil:ed Valuation ,~.,
Decrea!!e'
CbanQe in Book/Ad~d Carrvinq Value 13 14 15
current Yem'B
(Amortizationlll Accretion
CuT!llnl Year's
Olher-ThanTempora!'f Impairment Recognized
To• Change in BJA.C.V.
(12+15-14)
.0 ......... _____ a
" To>l
Foreijjn
"'"'"'" Change in a!AC.V.
H
Foreign
-~· "' (Loss) on Disposal
" Reali>:ed
Gain (L=)
'" Disposal
.............. 57
....... .0,528
" To~
Gain I"= I
'" Diswsal
_ ..... --. .§! ______ 0,528
" Interest
M' Dividends Re.,..ivad Du~ng y~,
............. .64 ________ .22.
....... - .. 20s I ............ 2a5 1 ............ 36 - _ . .6,158 ___ , _____ 6
" Paid for Ar:r:rued IntErest
M' Dividends
75181A 10 9 RANGE RESOURCES CORP ..... -................. 021061:2013 Mo!Jlan Stanley 15 .• - ............ 0412912013 Morgan Stanley 15......... ...... .. ........ 103.000 ........... 7,344 -- - ...... 7,632 ................. .7,344 ... 0 '---------·-· ' ___ ,_
... 6,158
----268 _______ :_288 ............. ..4
771195 1a 4 ROCHE HOLDINGS LTO.SPONSADR.-------- R a112B12013 MoTJlan S!anley15-- -------- a4/1612il13 Morgan Stanley 15 ........ ---- -- ... .311.000 ............ 17,022 ---- ..... 19,30a - ........... 17",022 778296 10 3 ROSS STORES INC .............. ______ .......... --... 1012812tl13 Morgan Stanley 15 .................. _ 12102/2013 Morgan Stanley 15 .•. -- .... . ...... 1,163.000 --···-.. 77,762 ........ 79,903 ........ _ _ n,762
780097 66 9 ROYALBANKOFSCOT-SPONADR ... ----·--- _ R 04/05W13 Mo!JlanS!anley15 ................. 0710312013 MorganSlanley15.... ............ .. ....... 382.000 ..... .3,191 ............. 3,132. ,._, ....... 3.191
79084!) 10 3 ST JLIDEMEDICAL INC ________________ ............... . 0412412013 MoTJlan Slanley 15 .. --.. ------.. 0910312013 Mo<J;lan Slanley 15 _ ---- - ....... .499.000 .• - ...... 20,528 -----25,095 ---------..20,528
795435 10 8 SAUX PHARMACEUTICALS LTD... ........... 04/2~013 Mo!Jlan Slanley 15......... ......... 0910312013 Morgan Slanley 15... • .. .......... 409.000 ......... 20,445 ........... .26,966 ........ 20.443 S010SN 10 5 SANOFI--AOR. ..... _______________ .............. -... R 0610612013 MorganStanley15 .. - ............. 09103/2013 MorganSlanley15 ... ------... .. .... 1,185.000 -----..... 61,888 --- ...... 61.168 .......... .61,668
853fiB7 10 1 STRYKERCORP ...... ,_,.............. ............. ..... 0312512013 Mo!JlanStanley15.-............. 003012013 Mo!JlanStanley15 ......... _ .. __ ........... 2.33.000 ............ 15,008 ...... 15.137 ............. 15,008
868157 10 8 SUPERIORENERGYSERVICESINC .......... _ - 04/2412013 Mol;lanS!onley15............. 0511012013 MorganSlanley15 ___ - ------- ... 1,6U1.000 ----.. ---39,078 ........... 45.450 ............. .39,078
878568 50 2 TATAMOTORS LTD.SPON ADR. ......... - ............ R ll4/02/2013 Mo!Jlan S!Enley 15 .. ------ ...... 12113/2013 Morgan stanley 15 ..... - ................. ___ .31.000 ................. 763 - - - ...... .942 ................. 763
6a9556 tO 2 THERMO FlSHERSCIENTIRCINC ............ -... 01121l12013 MorganStanley15 .............. ---· 041161:2013 Mo!JlanSlanley15. ___ - ---·-· -----..... 91.000 ........ - .... 6,411 ............. -7.423 -·-·- ...... ..5,411
8S9415 20 2 TULLOW OIL PLG-UNSPON ADR..-.............. __ R OS/2112013 Morgan S!Enley 15 ... ------- ...... 1111212013 Morgan Stanley 15 ..... --·--··· ............ 014.000 ............. ..4,168 • - - - ..3,745 .............. 4,168
~~ :11:~~~ ~~ ~ ~:r:,~c=~L~~~:~-~~~~:~~=::::=~:::::~: ~=~ ~:~nu~~-~~-~~~::·.:~.:~ .. ~--=:~.- ~=~~: ~;~~"u~~~~:.-~-~~~::·.~ .. : ......... ::::~:~~:~~~~~~ ·-.. ~·::~~:~~ :~:: .. ::~::;~:~~ .::~:~·::.~::~ ~ 92343¥ 10 4 VERIZON CQMMLINICA1lONS INC ... ---·---- 03125I2013 Morgan S!onley15 ... - 0510112013 Morgsn Stanley 15 .... - ... ____ -----..514.000 .......... .3a,200 .......... 31,258 ...... _- _ 30.200
931422. 10 9 WALGREEN CO_ ........ ................................. OS/2412013 Morgsn stanley 15........ 0710012013 Morgan S!Enley 15,_., ____ ---.. .. .......... 433.000 ........... 21,878 ............ 19.319 ----------21.ll?a
966637 10 6 WHOLEFOODSMARKETINC...... ............... 09106/:2013 MorgsnSlanley15....... 12/!10/2013 MorganStanley15........ ........ .. ......... 243.000 ............. 17,233 ............ 20,295 ................ 17,233 98&4SB 10 1 YLIM!BRANDSINC .. ___ ,____________ 0413012013 MarganStanley15 _____ ............ 09/0412013 MorganStanley15_._ ---- --- ... 202.0110 ............. 12,887 ........... 14,126 ____ 12,&81
892393 9a 7 OS RAM UCHT AG..................... -- ..... _. F. 0712512013 Mol)<an Slanley15 .• - .............. 0712612013 Morgan Stanley 15 ........................ ____ ..24.300 ----------.519 .... - ....... 730 .. _ .... _____ ,619
G1151C 10 1 ACCENTURE PLC-CLA .... _,_, _____ ......... R 0710812013 Morg~n Stanley 15 _______ ---- 0811212013 Morgan Stanley 15 ..... -- .. ---- ·-·-·-.. 842.000 ............. S4,D43 .............. 62.aa9 ... ___ .. 64,0~ G2554F 11 3 COVIDIEN PLC. ................................. ----·---- R 03107/2013 Mo!Jlan Stanley 15 ........... - .. 071a1!2013 Morgan Stanley 15 .... -- ....... .. ........ 664.000 __ .43.241 ........ 43,241 ........... ...43,241
G5765G 10 7 MALlJNC!<RODT?LC ................................. R 0710112013 MOI!lan Stanley 15......... 0710812013 Mo<J;lan Stanley 15 .... -- .................... ..33.000 ............ .3,853 ................ 3,573 ............... 3,853 G60754 10 1 MICHAELKORSHOl.OINGSLTO ....................... R 0911712013 Mo!JlanStanley15 .. ------ ..... 1013112013 MoT!lanSlan[ey15....... .......... • ........... 249.000 _____ 18.1!79 - ......... 19.207 .......... 18,679
N53745 10 0 LYONDru.BASELLINDII--CLA ___ ----------· R 0312512013 MorganS!onley15 .. - ·--·-· ~1612013 Moi!lanStanley15 ..... - .......... - 180.000 ........ -.11,254 ............. 10,200 ... _ .. , .. 11.254 NB!'i96X 10 9 NXP SEMICONDUCTORS !IN ___ ,., .. ----· R 0111112013 Mo!Jlan Stanley 15 _ _ _ _ _ _ 1013112013 Morgan Stanley 15 .... - .... _ ... --·---211.000 ___ ......... 6,07!l ................ 7,716 __ .6,07!l
P31076 10 5 COPAHOL!liNGSSA-ClASSA................... R 04/1612013 Mo~Stanley15 ................ _, 1111612013 MorganStanley15...... ......... .. ......... 435.000 ............. !i0,983 ...... .62.725 .............. 50,983
9099999. Total· Common S!oclcs -Industrial and Misrellaneous ............... .. ................................. _ ......................................................................... _ .... ,.... ............ .. ....... 1.516.832 ......... 1,592.,226 ---..... 1.St6,832
Common
~-~~~:~~
1999£19£19.
"'ds
1RKE
.... 11,250,2(12
.... 11.2$,202
9.739,370 .... S.73S,370 , ..
-----~0 I ·-·-·--·-..0
---~ .... 0 d
0
----------0 ....... ,0
·--. .0 ____ .o ...... ..0
0
----~-----0 0
............... o 0
................ 0 __________ .o
---------.0
........ .2,27S _.2.,279 ____ .... 368
------2.140 -------2.140 _____ .. .145
......... - ... - ' ............. (59) ............. (59) ______ ,_
•.•.• .A.M< ~-····'"' , .•.•.•... ,~ .......... 6,523 .......... 6,523 --------...... .. ............ (500) ______ ... (500) ....... _ .. 420
--·-·----129 ....... - ... 129 .. , _______ 52 _, ____ 6,371 ... _ .. .0.371 ___ ml ____ ml ········'•-·
--1 012 - --1,012 - , _____ 14
·-- -(423] --- .. (423) - .......... 14 ............. .08 .......... (1,059)
______ 1,058
(2,558]
..... .3,062
______ sa
..•. (1,(159) , .......... 101 _ ... 1,(158 ---- .. 316
.... (2,668) ·-·-· ..... . .3,062 ............. 36
______ 1,239 .......... 1,239 1-------115
·--111 ....... - .... 111
~:;~~ :~~;,~~I::_~~-~~ ___ -(1.054) (1,054J I ............ .32
---1.637 ......... 11,742 ........... .200
... o I ..... - ...... o ......... 75.394 ........ s.J4s 1 .......... a
.. .. 75.394 1 ____ _75.394 .I,341
statsmentasofDecember31,2{)13ofthe Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE D- PART 6- SECTION 1 Valuation of Shares of Subsidiar~·. Controlled or Affiliated Companies
CUSIP lden~fi.
calion
OoocripUon i'lilme of Sub!lldiary, Canlrolled or
Affiliated C~ponv Common Stocks- Other Affttiates
000000 00 0 VSP Optical Group, Inc ....• 1799ggg. Total • Common Stc4s- OU~er Affilill1es.
1899009." Total· Commw Stocl<s ......
1999999. Total· Prefarrod and Common Stock ....
Forot n
4 NAIC NAIC Valuation
Company """' Code or Allen (So• svo Insurer Purposos ~nd
ldentifil:lltiOil p::;· Number
.. ......•..•... ..... 2ciB3 ...
St!ldl of Stich Do-Insurer's Company Owned by
Assets Include Insurer on Statement Oato Intangible Assets Total Amount 9 '" Connected with of Such Book/Adjusted Holling ol Such lnta~~gible Carrying Numbtlrol %of
Camparly's Stock? Assets Value Shares Outstmldlng
..NO •.••. ...... 28,741,086 ....... A9,B65.000 ......... 14.9
.. , ..................... 0 .. ...... 28,741,()tlll .... .XXX... .. ... XXX ...
.. ....... 0 ......... 28,741,000 ....... .XXX., ...... XXX .. . • ................... 0 .............. 28,741,000 ....... .XXX .................... XXX .. .
1. Amount of rnsurar s capital and surplus from tho prior por!od's statutory statement reduced by any admitted EDP ,goodwill Md not dolmred ta~ assets lncll!ded therein: $., ...... 0.
2. Total amount of inloogibte assets nonadnliUM $ ....... 0.
SCHEDULE D- PART 6- SECTION 2 ' 2 3 4 Slook In tower· Tier Company OWned
Total Amount <JI (ndlroott b Insurer on Statement Dale Name ol Company Usted In tntangibleAssels , I • CUSIP Secllon1 Included In
ldantlfi· Wrtcll Controls Lower-Tier ArnOU)II Shown In cation Name or LOI'/8{·Tiar Cam Jany. c~ Column 7, SecUan 1 Number of Shares % of OutstaJldi
NONE
E16
m ~ ....
StatementasorDecemtBr31,2013of!he Mid-Atlantic Vision Service Plan, Inc.
SCHEDULE DA ·PART 1 Showino all SHORT-TERM INVESTMENTS Owned December 31 of Current Year
ClJSIP ldentffica!ion Des~on
Exempt Money M~ Mutual Funds
'-""'CTT4 F
'I ,.. Code I n A_CQuired N~me ofVendm
Maturity Do>
:::h~!l&le in Book/
'" Eookl
I u'"'""j '"~"' Adjusted V2lootion Year's Carrying lr!CJ'ellsel (Amortization)/ Value fDecreasel _ Accretion
""" in Vall!!!
" Current Yeer's
Othar-Than-Ternpor~uy
lmpai!!Tient Reoo ntzed
" Total
Foreign Exchange Change Tn BJA.C.V.
TS
'" Value
14 Interest 21 15 I 16 17 I 16 I 19 I 20
Amount Due and
'~" December31 I ,. 4rnoorn
of Current Admitted Receioed
I Paid !or
'""' Year on Bond Due and I l,-1~.,1 During Accrued Cos! I NotinDefault ""ru" Rate of Rate of Paid y~, ,_,
OS71D1 20 8 SOFA TREASURY RESERV-A.D.
94975H 29 6 WFA TREASURY PLlJS MM~.~ 8099999. Tolal- Exempt Money Marl<st ME!tual Funds ...
......... 1··11213012013.1 Eank of America ............................. . -....XXX ... .. . ........... 6.859,617 ............... 912,114
.. ....... 6,609,617 j ........ -6,609,617 64 ..... o.o1o 1 .......... - ... I.N/A.-•--·-·-.. ··--.. , ..
""'" _liiiii_
........... 12131/2013. Wells Faroo .............. .. ·-..XXX ... .. .. .... _ . ..7,571,731 .. - ........... a ...................... o ... 0
.912,114
···-· 1---··-=-·-··-
=-........ ~
.912,114
........... 7,571,731 I ................ 64 1 ............... .. -·- ,_ .. __ ....... -.. 1-~~-~o_l.~:: :I~: ......... ..3
... ................ .3 I ......... . .o I
,o_j
s~tementaso1Decembar31,:W13olthe MidaAtlantic Vision Service Plan, Inc.
Sch. DB-Pt. A-Sn. 1 NONE
Sch. DB-Pt. A-Sn. 2 NONE
Sch. DB-Pt. B-Sn. 1 NONE
Sch. DB-Pt. B-Sn 1 B-Broker List _ _ _ _____ NONE --------- ------- ----- --- - - -
Sch. DB-Pt. B-Sn. 2 NONE
Sch. DB-Pt. D-Sn. 1 NONE
Sch. DB-Pt. D-Sn. 2 NONE
Sch. DL-Pt. 1 NONE
Sch. DL-Pt. 2 NONE
E18, E19,E20, E21, E22,E23,E24, E25
statementasotoacembar31,2013oflha Mid-Atlantic Vision Service Plan, Inc.
o en De oaltorles Bank of America . Checking ...... Morgan Stanley .... Morgan Slanlay Cash . Wells Fargo A<Mslors, .. Welts Fargo Bank lns111utional.. ........ 0199999. Total-Open Dowosllorles 0399999. Total Cashon De II
Depository
SCHEDULE E ·PART 1 • CASH
of Coda lnleresl
...... XXX ............. XXX .. .
XXX ............ .XXX. .•
Amount of Interest Recei~ed
During Year
Amounlol Interest Accrued D~cembef 31 ol
Curren! Year BallliiCS
.. ................ A75,fl08 XXX . .. XXX
• ......... 14,209 XXX • ........ 14,563 XXX
.. .............. 0 ................... 0 ................... 504,560 XXX..
........ 0 . ......... 0 .. ... 504,5BO XXX. • 0599999. Total Cash .... XXX ............. XXX..... .. ........................ 0 ...... 0 ............... 5D4,5BO XXX ..
!.January .. .. 2.Fabruary ... . 3.Maroh ..
.. ........... 3,585,152 ................ 4,109,062
.......................... 1,515,005
.......................... ,371,61!9 . ................. (2,135.247)
• ........................... 504,500
E26
Sta1eme~1asofDocem~er31,2G13ofUle Mid-Atlantic Vision Service Plan, Inc.
Sch. E-Pt. 2 NONE
Sch. E-Pt. 3 NONE
E27, E28
\