8-K/A 1 c67432a2e8-ka.txt AMENDMENT NO. 2 TO FORM 8-K ================================================================================ SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ------------- AMENDMENT NO. 2 ON FORM 8-K/A ------------- CURRENT REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 Date of report (Date of earliest event reported): November 30, 2001 FIRST FORTIS LIFE INSURANCE COMPANY -------------------------------------------------- (Exact Name of Registrant as Specified in Charter) NEW YORK 33-71690 13-2699219 ---------------------------- ------------------------ -------------------- (State or Other Jurisdiction (Commission File Number) (IRS Employer of Incorporation) Identification No.) 308 MALTBIE STREET SUITE 200 SYRACUSE, NEW YORK 13204 ---------------------------------------- (Address of Principal Executive Offices) (315) 451-0066 ---------------------------------------------------- (Registrant's telephone number, including area code) ================================================================================ ITEM 7. FINANCIAL STATEMENTS, PRO FORMA FINANCIAL INFORMATION AND EXHIBITS. This Current Report on Form 8-K/A is filed to amend the Company's Current Report on Form 8-K dated December 13, 2001, as amended on December 17, 2001, pursuant to Item 7(a) and Item 7(b) of Form 8-K. (a) The following financial information of Bankers American Life Assurance Company, as required by Item 7(a), is filed herewith: BANKERS AMERICAN LIFE ASSURANCE COMPANY BALANCE SHEET (In Thousands)
ASSETS BALAC BALAC 9/30/2001 12/31/2000 Unaudited Unaudited ------------------ --------------- Investments: Fixed maturities, at fair value $ 50,849 $ 44,733 Equity securities, at approximate market value 2,863 1,982 Policy loans -- -- Short-term investments 8,649 1,704 --------- -------- 62,361 48,419 Cash and cash equivalents (412) 110 Receivables: Uncollected premiums, less allowance 202 854 Reinsurance recoverable on unpaid and paid losses 51,811 38,400 Other 787 878 --------- -------- 52,800 40,132 Accrued investment income 651 603 Deferred policy acquisition costs 3,688 3,037 Property and equipment at cost, less accumulated depreciation -- -- Deferred federal income taxes -- -- Goodwill, less accumulated amortization -- -- Assets held in separate accounts -- -- --------- -------- Total assets $ 119,088 $ 92,301 --------- -------- POLICY RESERVES AND LIABILITIES AND SHAREHOLDER'S EQUITY Policy reserves and liabilities: Future policy benefit reserves: Life insurance $ 3,107 $ 2,942 Interest sensitive and investment products -- -- Accident and health 17,270 17,689 --------- -------- 20,377 20,631 Unearned revenues 45,932 31,019 Other policy claims and benefits payable 8,362 2,522 Income taxes payable 4,085 1,444 Deferred income taxes 881 601 Deferred gain on reinsurance transactions -- -- Other liabilities 247 2,406 Liabilities related to separate accounts -- -- --------- -------- Total policy reserves and liabilities 79,884 58,623 --------- -------- Shareholder's equity: Common stock, $20 par value: authorized, issued and outstanding shares - 100,000 2,000 2,000 Additional paid-in capital 4,100 4,100 Retained earnings (accumulated deficit) 32,069 27,503 Accumulated other comprehensive loss 1,035 75 --------- -------- Total shareholder's equity 39,204 33,678 --------- -------- Total policy reserves, liabilities and shareholder's equity $ 119,088 $ 92,301 ========= ========
BANKERS AMERICAN LIFE ASSURANCE COMPANY INCOME STATEMENT (In Thousands)
BALAC 9/30/2001 Unaudited ------------- Revenues: Insurance operations: Life insurance premiums $ 5,310 Interest sensitive and investment product policy charges -- Accident and health insurance premiums 10,388 --------- 15,698 Net investment income 2,502 Net realized (losses) gains on investments (167) Other income -- --------- Total revenues 18,033 Benefits and expenses: Benefits to policyholders: Life insurance 2,424 Interest sensitive investment products -- Accident and health claims 3,091 --------- 5,515 Amortization of deferred policy acquisition costs -- Insurance commissions 4,742 General and administrative expenses 807 --------- Total benefits and expenses 11,064 Income before federal income taxes 6,969 Federal income taxes 2,403 --------- Net income $ 4,566 =========
BANKERS AMERICAN LIFE ASSURANCE COMPANY INCOME STATEMENT (In Thousands)
BALAC 12/31/2000 Unaudited ------------- Revenues: Insurance operations: Life insurance premiums $ 9,093 Interest sensitive and investment product policy charges -- Accident and health insurance premiums 16,064 -------- 25,157 Net investment income 2,977 Net realized (losses) gains on investments 297 Other income -- -------- Total revenues 28,431 Benefits and expenses: Benefits to policyholders: Life insurance 3,717 Interest sensitive investment products -- Accident and health claims 6,586 -------- 10,303 Amortization of deferred policy acquisition costs -- Insurance commissions 8,315 General and administrative expenses 2,803 -------- Total benefits and expenses 21,421 Income before federal income taxes 7,010 Federal income taxes 2,340 -------- Net income $ 4,670 ========
(b) The following pro forma financial information for First Fortis Life Insurance Company, as required by Item 7(b), is filed herewith: FIRST FORTIS LIFE INSURANCE COMPANY BALANCE SHEET (In Thousands)
ASSETS FFLIC BALAC PROFORMA FFLIC BALAC RESTATED 9/30/2001 9/30/2001 9/30/2001 12/31/2000 12/31/2000 12/31/2000 Unaudited Unaudited Unaudited Unaudited Unaudited ----------- ----------- ---------- ----------- ----------- ---------- Investments: Fixed maturities, at fair value $ 119,907 $ 50,849 $ 170,756 $129,784 $ 44,733 $ 174,517 Equity securities, at approximate market value -- 2,863 2,863 -- 1,982 1,982 Policy loans 7 -- 7 4 -- 4 Short-term investments 34,644 8,649 43,293 9,450 1,704 11,154 --------- ------- -------- --------- ------- -------- 154,558 62,361 216,919 139,238 48,419 187,657 Cash and cash equivalents 2,152 (412) 1,740 1,659 110 1,769 Receivables: Uncollected premiums, less allowance (2000 and 1999 - $100) 2,908 202 3,110 3,417 854 4,271 Reinsurance recoverable on unpaid and paid losses 47,787 51,811 99,598 36,761 38,400 75,161 Other 194 787 981 1,267 878 2,145 --------- -------- --------- ---------- -------- -------- 50,889 52,800 103,689 41,445 40,132 81,577 Accrued investment income 2,054 651 2,705 2,215 603 2,818 Deferred policy acquisition costs 169 3,688 3,857 4,127 3,037 7,164 Property and equipment at cost, less accumulated depreciation (2000 - $1,732; 1999 - $2,287) 49 -- 49 78 -- 78 Deferred federal income taxes 6,020 -- 6,020 3,283 -- 3,283 Goodwill, less accumulated amortization (2000 - $460; 1999 - $414) 335 -- 335 370 -- 370 Assets held in separate accounts 61,161 -- 61,161 73,582 -- 73,582 --------- -------- --------- ---------- -------- --------- Total assets $ 277,387 $119,088 $ 396,475 $265,997 $ 92,301 $ 358,298 --------- -------- --------- ---------- -------- --------- POLICY RESERVES AND LIABILITIES AND SHAREHOLDER'S EQUITY Policy reserves and liabilities: Future policy benefit reserves: Life insurance $ 31,681 $ 3,107 $ 34,788 $ 32,443 $ 2,942 $ 35,385 Interest sensitive and investment products 4,319 -- 4,319 4,916 -- 4,916 Accident and health 81,663 17,270 98,933 76,830 17,689 94,519 --------- -------- --------- -------- ------- -------- 117,663 20,377 138,040 114,189 20,631 134,820 Unearned revenues 9,955 45,932 55,887 10,058 31,019 41,077 Other policy claims and benefits payable 10,951 8,362 19,313 14,205 2,522 16,727 Income taxes payable 6,904 4,085 10,989 1,035 1,444 2,479 Deferred income taxes -- 881 881 -- 601 601 Deferred gain on reinsurance transactions 12,875 -- 12,875 2,086 -- 2,086 Other liabilities 7,029 247 7,276 7,464 2,406 9,870 Liabilities related to separate accounts 61,161 -- 61,161 73,582 -- 73,582 --------- -------- --------- -------- -------- --------- Total policy reserves and liabilities 226,538 79,884 306,422 222,619 58,623 281,242 --------- -------- --------- -------- -------- --------- Shareholder's equity: Common stock, $20 par value: authorized, issued and outstanding shares - 100,000 2,000 2,000 4,000 2,000 2,000 4,000 Additional paid-in capital 37,440 4,100 41,540 37,440 4,100 41,540 Retained earnings (accumulated deficit) 8,924 32,069 40,993 4,223 27,503 31,726 Accumulated other comprehensive loss 2,485 1,035 3,520 (285) 75 (210) --------- -------- --------- -------- -------- --------- Total shareholder's equity 50,849 39,204 90,053 43,378 33,678 77,056 --------- -------- --------- -------- -------- --------- Total policy reserves, liabilities and shareholder's equity $ 277,387 $119,088 $ 396,475 $265,997 $ 92,301 $ 358,298 --------- -------- --------- -------- -------- ---------
FIRST FORTIS LIFE INSURANCE COMPANY INCOME STATEMENT (In Thousands)
FFLIC BALAC PROFORMA 9/30/2001 9/30/2001 9/30/2001 Unaudited Unaudited Unaudited ----------- ----------- ----------- Revenues: Insurance operations: Life insurance premiums $ 15,419 $ 5,310 $ 20,729 Interest sensitive and investment product policy charges 378 -- 378 Accident and health insurance premiums 29,852 10,388 40,240 -------- -------- ----------- 45,649 15,698 61,347 Net investment income 7,154 2,502 9,656 Net realized (losses) gains on investments (355) (167) (522) Other income 1,776 -- 1,776 -------- -------- ----------- Total revenues 54,224 18,033 72,257 Benefits and expenses: Benefits to policyholders: Life insurance 10,529 2,424 12,953 Interest sensitive investment products 479 -- 479 Accident and health claims 21,953 3,091 25,044 -------- -------- ----------- 32,961 5,515 38,476 Amortization of deferred policy acquisition costs 180 -- 180 Insurance commissions 4,654 4,742 9,396 General and administrative expenses 9,195 807 10,002 -------- -------- ----------- Total benefits and expenses 46,990 11,064 58,054 Income before federal income taxes 7,234 6,969 14,203 Federal income taxes 2,532 2,403 4,935 -------- -------- ----------- Net income $ 4,702 $ 4,566 $ 9,268 ======== ======== ===========
FIRST FORTIS LIFE INSURANCE COMPANY INCOME STATEMENT (In Thousands)
FFLIC BALAC RESTATED 12/31/2000 12/31/2000 12/31/2000 Unaudited Unaudited ---------- ----------- ---------- Revenues: Insurance operations: Life insurance premiums $ 24,399 $ 9,093 $ 33,492 Interest sensitive and investment product policy charges 1,197 -- 1,197 Accident and health insurance premiums 39,157 16,064 55,221 --------- --------- ----------- 64,753 25,157 89,910 Net investment income 9,330 2,977 12,307 Net realized (losses) gains on investments (1,883) 297 (1,586) Other income 1,032 -- 1,032 --------- --------- ----------- Total revenues 73,232 28,431 101,663 Benefits and expenses: Benefits to policyholders: Life insurance 18,031 3,717 21,748 Interest sensitive investment products 440 -- 440 Accident and health claims 28,657 6,586 35,243 --------- --------- ----------- 47,128 10,303 57,431 Amortization of deferred policy acquisition costs 360 -- 360 Insurance commissions 5,773 8,315 14,088 General and administrative expenses 13,208 2,803 16,011 --------- --------- ----------- Total benefits and expenses 66,469 21,421 87,890 Income before federal income taxes 6,763 7,010 13,773 Federal income taxes 2,416 2,340 4,756 --------- --------- ----------- Net income $ 4,347 $ 4,670 $ 9,017 ========= ========= ===========
(c) Exhibits:
EXHIBIT NO. DESCRIPTION ----------- ----------- 2.1 Stock Purchase Agreement by and between First Fortis Life Insurance Company and American Bankers Insurance Group, Inc., dated as of June 29, 2001.* 2.2 Agreement and Plan of Merger by and among First Fortis Life Insurance Company, the Voting Trustees under that certain Voting Trust Agreement dated June 1, 1999, Fortis, Inc., Bankers American Life Assurance Company, the Voting Trustees under that certain Voting Trust Agreement dated August 20, 1999, and American Bankers Insurance Group, Inc., dated as of June 29, 2001.* 2.3 First Amendment to Agreement and Plan of Merger effective as of October 30, 2001*
------------------------ *Previously filed. SIGNATURES Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized. FIRST FORTIS LIFE INSURANCE COMPANY (Registrant) Date: February 11, 2002 By: /s/ Larry Cains ------------------------------------- Name: Larry Cains Title: Treasurer