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Standard Reinsurance Intermediary Questionnaire

1. Organization and Personnel

a) Give legal name, if partnership, corporation, managing general agency, or other and date of establishment or incorporation.

D. W. Van Dyke & Co., Inc. This is the name change for D. W. Van Dyke and Company of Connecticut, Inc. date of incorporation April 7, 1989. D. W. Van Dyke and Company of Connecticut, Inc. succeeded the original company, also known as D. W. Van Dyke & Co., Inc., incorporated October 28, 1978.


b) Who owns your organization?

DDR Holdings, Inc – which is owned by Donald W. Van Dyke II, Donald K. Drelich, and Christopher Koehler.


c) Please list all officers of the organization and their respective titles:

Donald W. Van Dyke II – Chairman and Chief Executive Officer
Donald K. Drelich – President
Christopher Koehler - Executive Vice President
John W. Dunleavy – Senior Vice President
Frederick J. Miller, Jr. – Vice President
Kimberly A. Kulesh – Vice President
Ronald P. Charette – Senior Vice President and Chief Operating Officer
Nanette Torres – Vice President, Financial
Jonathan P. Cole – Vice President, Information Technology
Walter B. Roland – Vice President
Kenneth R. Broad – Assistant Vice President
Stuart D. Silfen – Assistant Vice President
Anne S. Hurley – Assistant Vice President, Contracts & Marketing Support


d) Is it a company, partnership or corporation?

“C” Corporation.

Please describe subsidiaries, affiliations, directorships or other close business relations, management pools, etc., if any.

• DDR Holdings, Inc., owned by Donald W. Van Dyke II, Donald K. Drelich, and Christopher Koehler. This company owns D. W. Van Dyke & Co., Inc., a company operating solely as a Reinsurance Intermediary specializing in the Life, A & H, Special Risk Accident and Casualty forms of reinsurance, including Workers’ Compensation.

• Quality Health Management, LLC, located in Miami FL., is a medical case management company, principally for foreign employees traveling to the United States. A principal of D.W. Van Dyke & Co., Inc has a minority interest in this company.

• International Credit Management, LLC, a Connecticut limited liability company organized in 1994, is a company specializing in Credit Life and A&H business. While operating as a Managing General Underwriter, it has the capability of assisting companies entering this market to develop and market programs and to evaluate, underwrite and manage developing business and blocks of business. These activities are for and on behalf of insurance and reinsurance companies. This company is 70% owned by D² Venture 5, LLC, which is owned by certain principals of D. W. Van Dyke & Co., Inc.

• IRC Re, Limited, Hamilton, Bermuda, an “off-shore” Captive owned by a Managing General Underwriter with whom D. W. Van Dyke & Co., Inc. does business. The Captive also assumes casualty and A&H risks from other sources. Several individuals at D. W. Van Dyke & Co., Inc. have minority interests; with the total also being a minority interest.

• Life Settlement Strategies, LLC, an affiliate company of D. W. Van Dyke & Co., Inc. to specialize in the marketing of “life settlements”, the purchase of individual life insurance policies for estate and tax planning, alternative investment(s) and "life needs."

• Bosins, LLC, a Delaware limited liability company started in May of 2001 to develop “back office systems for insurance companies,” particularly for Managing General Underwriters and Managing General Agents. A shareholder of D. W. Van Dyke & Co., Inc., is the sole owner.

• InsuranceBlocks.Com, an affiliate company of D. W. Van Dyke & Co., Inc., formed for the purpose of negotiating terms and conditions for the purchase and sale, as well as “securitization,” of blocks of various forms of insurance and reinsurance business.

• Strategic Underwriting Solutions, LLC, a Delaware limited liability company incorporated on November 28, 2006, is an insurance underwriting management company for fully insured medical and self insured business. D2 Venture 11, LLC, formed in 2006 and owned by some principals at D. W. Van Dyke & Co., Inc., has a minority interest.

• Affinity Benefit Services, LLC, a Delaware limited liability company, formed in 2006, an affinity insurance/benefits program marketing and distribution firm, focused on offering proprietary medical benefit trust programs to members of trade associations, franchise associations and purchasing groups. A minority interest in this company is owned by Greener Pastures, LLC, a Delaware limited liability company formed in 2006, which is owned by some principals of D. W. Van Dyke & Co., Inc.

e) Is it chartered? Where? When?

Yes; Connecticut; 1989.


f) Is it supervised by a regulatory authority? Where?

Yes, all states where licensed as a reinsurance intermediary.


g) Is it licensed as an insurance broker, reinsurance intermediary or other insurance or reinsurance organization? Where?

Reinsurance Intermediary – Alabama, Arizona, Arkansas, Alaska, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming and pending at all other states where this licensing is applicable.



h) Are producers sub-licensed? Where?

Yes, as above.


i) Do any individuals have drawing accounts? If so, are settlements made at least annually?

No drawing accounts.


j) Does your organization loan money to officers and/or employees?

The only loans are Travel and Entertainment Advances.


k) Please list any individuals, other than officers, who have authority to negotiate reinsurance terms and conditions.

None


l) Do you maintain fidelity coverage over all officers and employees? If so, please indicate the limits.

Blanket Crime Policy - $5,000,000


m) Do you maintain errors and omissions liability coverage? If so, what limits?

Yes - $5,000,000


n) Please enclose a copy of the auditor's most recent copy of the audited financial statement.

Sent upon separate request.


o) Does each officer and individual named in No. 1 file an annual Conflict of Interest Statement with your organization's secretary? Are such statements reviewed by the Chief Executive?

All Employees sign a “Conflict of Interest / Non-Disclosure Agreement” at time of employment and all officers sign an annual statement.



2. Handling of Funds of Ceding and Assuming Companies

a) Are premium, loss, and other funds owned by reinsureds and/or reinsurers (fiduciary funds) kept separate; that is not commingled with other funds?

Yes, separate.


b)Do you invest such fiduciary funds and, if so, in what type of securities?

Funds are held by Wachovia Bank as custodian/fiduciary and invested in pools of short term U.S. Government Securities. All funds are completely liquid.


c) Are these fiduciary funds audited in detail by a certified public accountant on a quarterly, semi-annual or annual basis? If a separate letter of certification of financial statement applies to these funds and is not included as part of the letter of certification referred to in question No. 1 above, please attach copy.

- Comprehensive internal financial statements are prepared each month.

- A year-end review is performed by an independent audit firm, Grill & Partners, located in Fairfield, CT. The company maintains its records on a fiscal year end of December 31st.


d) Is check signing authority on fiduciary accounts limited? Are two signatures required?

Check signing authority is limited; two signatures required.


e) Do you withdraw from the fiduciary account your commission monthly as earned? If not, how do you handle it?

Commission is withdrawn as premiums are paid.


f) Do you remit to reinsurers in strict accordance with contract terms even if special remittance is required?

Yes.



3. General Information

D. W. Van Dyke & Co., Inc., operate in accordance with the State of New York Insurance Department Regulation 29 and Regulation 98 and in accordance with the regulations of all states that require the licensing of reinsurance intermediaries.