COLORADO DEPARTMENT OF REGULATORY AGENCIES Division of Insurance SYNOPSIS OF ANNUAL STATEMENT FOR...

Denver Post, COLORADO DEPARTMENT OF REGULATORY AGENCIES Division of Insurance SYNOPSIS OF ANNUAL STATEMENT FOR PUBLICATION Required pursuant to 10-3-109(1), C.R.S FOR YEAR 2014 As Rendered to the Commissioner of Insurance FAILURE TO FILE THIS FORM BY MARCH 1 WILL RESULT IN PENALTIES PURSUANT TO 10-3-109(2), C.R.S.: If any annual report or statement from any entity regulated by the Division of Insurance is not filed by the date specified by law or by rules and regulations of the commissioner, the commissioner may assess a penalty of up to one hundred dollars per day for each day after the date an annual statement or report is due from any such entity. DSM USA Insurance Company, Inc. NAIC Number 67636 465 Medford Street, Boston, MA 02129 Assets $ 8,510,668 Liabilities $ 813,257 Capital and Surplus/ Policyholder Surplus $ 7,697,411 DIVISION OF INSURANCE CERTIFICATE OF AUTHORITY To Whom It May Concern: This Is To Certify that the DSM USA Insurance Company, Inc. organized under the laws of the State of Texas, subject to its Articles of Incorporation or other fundamental organizational documents and in consideration of its compliance with the laws of Colorado, is hereby licensed to transact business as a Life (Accident & Health Lines) insurance company, as provided by the Insurance Laws of Colorado, as amended, so long as the insurer continues to conform to the authority granted by its Certificate and its corporate articles, or its Certificate is otherwise revoked, canceled or suspended. IN WITNESS WHEREOF, I have hereunto set my hand and caused the official seal of my office to be affixed at the City and County of Denver this first day of March 2015. Marguerite Salazar , Commissioner of Insurance