Document:

Exhibit 10.25

 

FLOATING RATE SURPLUS NOTE DUE
2034

 

THE
SECURITIES REPRESENTED BY THIS CERTIFICATE WERE ORIGINALLY ISSUED IN A
TRANSACTION EXEMPT FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS
AMENDED (THE “SECURITIES ACT”), AND SUCH SECURITIES, AND ANY INTEREST THEREIN, MAY NOT
BE OFFERED, SOLD OR OTHERWISE TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION
OR AN APPLICABLE EXEMPTION THEREFROM. 
EACH PURCHASER OF ANY SECURITIES IS HEREBY NOTIFIED THAT THE SELLER OF
THE SECURITIES MAY BE RELYING ON THE EXEMPTION FROM THE PROVISIONS OF SECTION 5
OF THE SECURITIES ACT PROVIDED BY RULE 144A UNDER THE SECURITIES ACT.

 

THE
HOLDER OF THE SECURITIES REPRESENTED BY THIS CERTIFICATE AGREES FOR THE BENEFIT
OF THE COMPANY THAT (A) SUCH SECURITIES MAY BE OFFERED, RESOLD OR
OTHERWISE TRANSFERRED ONLY (I) TO THE COMPANY, (II) TO A PERSON WHOM THE SELLER
REASONABLY BELIEVES IS A “QUALIFIED INSTITUTIONAL BUYER” (AS DEFINED IN RULE
144A UNDER THE SECURITIES ACT) IN A TRANSACTION MEETING THE REQUIREMENTS OF
RULE 144A, (III) TO AN INSTITUTIONAL “ACCREDITED INVESTOR” WITHIN THE MEANING
OF SUBPARAGRAPH (a) (1), (2), (3) OR (7) OF RULE 501 UNDER THE
SECURITIES ACT THAT IS ACQUIRING THE SECURITY FOR ITS OWN ACCOUNT, OR FOR THE
ACCOUNT OF AN “ACCREDITED INVESTOR,” FOR INVESTMENT PURPOSES AND NOT WITH A
VIEW TO, OR FOR OFFER OR SALE IN CONNECTION WITH, ANY DISTRIBUTION IN VIOLATION
OF THE SECURITIES ACT, (IV) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT
UNDER THE SECURITIES ACT OR (V) PURSUANT TO AN EXEMPTION FROM THE SECURITIES
ACT, IN EACH CASE IN ACCORDANCE WITH ANY APPLICABLE SECURITIES LAWS OF ANY
STATE OF THE UNITED STATES OR ANY OTHER APPLICABLE JURISDICTION AND, IN THE
CASE OF (III) OR (V), SUBJECT TO THE RIGHT OF THE COMPANY TO REQUIRE AN OPINION
OF COUNSEL AND OTHER INFORMATION SATISFACTORY TO IT AND (B) THE HOLDER
WILL NOTIFY ANY PURCHASER OF ANY SECURITIES FROM IT OF THE RESALE RESTRICTIONS
REFERRED TO IN (A) ABOVE.

 

THE SECURITIES WILL BE ISSUED AND MAY BE TRANSFERRED ONLY IN
BLOCKS HAVING AN AGGREGATE PRINCIPAL AMOUNT OF NOT LESS THAN $100,000. TO THE
FULLEST EXTENT PERMITTED BY LAW, ANY ATTEMPTED TRANSFER OF SECURITIES, OR ANY
INTEREST THEREIN, IN A BLOCK HAVING AN AGGREGATE PRINCIPAL AMOUNT OF LESS THAN
$100,000 AND MULTIPLES OF $1,000 IN EXCESS THEREOF SHALL BE DEEMED TO BE VOID
AND OF NO LEGAL EFFECT WHATSOEVER. TO THE FULLEST EXTENT PERMITTED BY LAW, ANY
SUCH PURPORTED TRANSFEREE SHALL BE DEEMED NOT TO BE THE HOLDER OF SUCH
SECURITIES FOR ANY PURPOSE, INCLUDING, BUT NOT LIMITED TO, THE RECEIPT OF
PRINCIPAL OF OR INTEREST ON SUCH SECURITIES, OR ANY INTEREST THEREIN, AND SUCH

 

 

PURPORTED TRANSFEREE SHALL BE DEEMED TO HAVE NO INTEREST WHATSOEVER IN
SUCH SECURITIES.

 

THE
HOLDER OF THIS SECURITY, OR ANY INTEREST THEREIN, BY ITS ACCEPTANCE HEREOF OR
THEREOF ALSO AGREES, REPRESENTS AND WARRANTS THAT IT IS NOT AN EMPLOYEE
BENEFIT, INDIVIDUAL RETIREMENT ACCOUNT OR OTHER PLAN OR ARRANGEMENT SUBJECT TO
TITLE I OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED (“ERISA”), OR SECTION 4975 OF THE
INTERNAL REVENUE CODE OF 1986, AS AMENDED (THE “CODE”)
(EACH A “PLAN”), OR AN ENTITY
WHOSE UNDERLYING ASSETS INCLUDE “PLAN ASSETS” BY REASON OF ANY PLAN’S
INVESTMENT IN THE ENTITY, AND NO PERSON INVESTING “PLAN ASSETS” OF ANY PLAN MAY ACQUIRE
OR HOLD THIS SECURITY OR ANY INTEREST THEREIN. ANY PURCHASER OR HOLDER OF THE
SECURITIES OR ANY INTEREST THEREIN WILL BE DEEMED TO HAVE REPRESENTED BY ITS
PURCHASE AND HOLDING THEREOF THAT IT IS NOT AN EMPLOYEE BENEFIT PLAN WITHIN THE
MEANING OF SECTION 3(3) OF ERISA, OR A PLAN TO WHICH SECTION 4975
OF THE CODE IS APPLICABLE, A TRUSTEE OR OTHER PERSON ACTING ON BEHALF OF AN
EMPLOYEE BENEFIT PLAN OR PLAN, OR ANY OTHER PERSON OR ENTITY USING THE ASSETS
OF ANY EMPLOYEE BENEFIT PLAN OR PLAN TO FINANCE SUCH PURCHASE.

 

 

AmCOMP Preferred Insurance Company

 

Surplus Note due 2034

 

	
  No. 1

  	
  $ 10,000,000

  

 

AmCOMP Preferred Insurance Company, a stock insurance
company organized and existing under the laws of Florida (hereinafter called the “Company,” which
term includes any successor Person under the Indenture hereinafter referred
to), for value received, hereby promises to pay to Sigler & Co., or
registered assigns, the principal sum of Ten Million Dollars ($10,000,000) or
such other principal amount represented hereby as may be set forth in the records
of the Securities Registrar hereinafter referred to in accordance with the
Indenture on December 15, 2034.  The
Company further promises to pay interest on said principal sum from September 14,
2004, or from the most recent Interest Payment Date to which interest has been
paid or duly provided for, quarterly in arrears on March 15, June 15,
September 15, and December 15 of each year, commencing December15,
2004, or if any such day is not a Business Day, on the next succeeding Business
Day (and no interest shall accrue in respect of the amounts whose payment is so
delayed for the period from and after such Interest Payment Date until such
next succeeding Business Day), except that, if such Business Day falls in the
next succeeding calendar year, such payment shall be made on the immediately
preceding Business Day, in each case, with the same force and effect as if made
on the Interest Payment Date, at a variable rate equal to LIBOR plus 4.05% per annum, until the principal hereof is paid or duly
provided for or made available for payment; provided,
that the Company shall have received the prior approval of the
Applicable Insurance Regulatory Authority therefor if then required; provided,
further, that any overdue
principal, premium, if any, and any overdue installment of interest shall bear
Additional Interest at a variable rate equal to LIBOR plus 4.05% per annum (to the extent that the payment of such
interest shall be legally enforceable), compounded quarterly, from the latter
of (a) the dates such amounts are due and (b) the dates such amounts
are approved by the Applicable Insurance Regulatory Authority until they are
paid or made available for payment, and such interest shall be payable on
demand.  Notwithstanding the foregoing or
anything to the contrary herein contained or implied, principal of and premium,
if any, and interest on the Securities shall be (i) payable solely from
and to the extent, if any, of Available Surplus, (ii) subject to the prior
approval of the Applicable Insurance Regulatory Authority therefor and (iii) subject
to any other restrictions set forth under Applicable Insurance Laws (the
foregoing, collectively, the “Payment Restrictions”).  If not so approved or if there is
insufficient Available Surplus therefor, such principal, premium, if any, or
interest shall not be due and payable.

 

The amount of interest payable shall be computed on
the basis of a 360-day year and the actual number of days elapsed in the
relevant interest period.  The interest
so payable, and punctually paid or duly provided for out of the Available
Surplus, on any Interest Payment Date shall, as provided in the Indenture, be
paid to the Person in whose name this Security (or one or more Predecessor
Securities) is registered at the close of business on the Regular Record Date
for such interest installment; provided, that
the Company shall have received the prior approval of the Applicable Insurance
Regulatory Authority therefor if then required. 
Any such interest not so punctually paid or duly provided for on the
Interest Payment Date shall forthwith cease to be payable to the Holder on such
Regular Record Date and may either be paid to the Person in whose name this
Security (or one or more Predecessor Securities) is registered at the close of

 

 

business on a Special
Record Date for the payment of such Defaulted Interest to be fixed by the
Trustee, notice whereof shall be given to Holders of Securities not less than
ten (10) days prior to such Special Record Date, or be paid at any time in
any other lawful manner not inconsistent with the requirements of any
securities exchange on which the Securities may be listed, and upon such notice
as may be required by such exchange, all as more fully provided in the
Indenture.

 

Payment of principal of, premium, if any, and
interest on this Security shall be made in such coin or currency of the United
States of America as at the time of payment is legal tender for payment of
public and private debts.  Payments of
principal, premium, if any, and interest due at the Maturity of this Security
shall be made at the Place of
Payment upon surrender of such Securities to the Paying
Agent, and payments of interest shall be made, subject to such surrender where
applicable, by wire transfer at such place and to such account at a banking
institution in the United States as may be designated in writing to the Paying
Agent at least ten (10) Business Days prior to the date for payment by the
Person entitled thereto unless proper written transfer instructions have not
been received by the relevant record date, in which case such payments shall be
made by check mailed to the address of such Person as such address shall appear
in the Security Register.

 

The indebtedness evidenced by this Security
is, to the extent provided in the Indenture, subordinate and junior in right of
payment to the prior payment in full of all Senior Obligations, and this
Security is issued subject to the provisions of the Indenture with respect
thereto. Each Holder of this Security, by accepting the same, (a) agrees to
and shall be bound by such provisions, (b) authorizes and directs the
Trustee on his or her behalf to take such actions as may be necessary or
appropriate to effectuate the subordination so provided and (c) appoints
the Trustee his or her attorney-in-fact for any and all such purposes. Each
Holder hereof, by his or her acceptance hereof, waives all notice of the
acceptance of the subordination provisions contained herein and in the
Indenture by each holder of Senior Obligations, whether now outstanding or
hereafter incurred, and waives reliance by each such holder upon said
provisions.

 

Unless the certificate of authentication hereon has
been executed by the Trustee by manual signature, this Security shall not be
entitled to any benefit under the Indenture or be valid or obligatory for any
purpose.

 

 

IN WITNESS WHEREOF, the Company has duly
executed this certificate on this 14th day of September, 2004.

 

 

	
   

  	
  AMCOMP PREFERRED INSURANCE COMPANY

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Debra C. Ruedisili

  	
   

  
	
   

  	
   

  	
  Name:

  	
  Debra Cerre-Ruedisili

  
	
   

  	
   

  	
  Title:

  	
  President

  
					

 

 

This is one of the Securities referred to in
the within mentioned Indenture.

 

 

Dated: September 14, 2004

 

	
   

  	
  JPMORGAN CHASE BANK,

  
	
   

  	
  not in its
  individual capacity, but solely as Trustee

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Maria D. Calzado

  	
   

  
	
   

  	
   

  	
  Authorized Signatory

  

 

 

[REVERSE
OF SECURITY]

 

This Security is one of a duly authorized issue of
securities of the Company (the “Securities”)
issued under the Indenture, dated as of September 14, 2004 (the “Indenture”),
between the Company and JPMorgan Chase Bank, as Trustee (in such capacity, the “Trustee,”
which term includes any successor trustee under the Indenture), to which
Indenture and all indentures supplemental thereto reference is hereby made for
a statement of the respective rights, limitations of rights, duties and
immunities thereunder of the Company, the Trustee, the holders of Senior
Obligations and the Holders of the Securities and of the terms upon which the
Securities are, and are to be, authenticated and delivered.

 

All terms used in this Security that are defined in
the Indenture shall have the meanings assigned to them in the Indenture.

 

The Company may, on any
Interest Payment Date, at its option, upon not less than thirty (30) days’ nor
more than sixty (60) days’ written notice to the Holders of the Securities
(unless a shorter notice period shall be satisfactory to the Trustee) on or
after December 15, 2009 and subject to the terms and conditions of Article XI
of the Indenture, redeem this Security in whole at any time or in part from
time to time at a Redemption Price equal to one hundred percent (100%) of the
principal amount hereof, together, in the case of any such redemption, with
accrued interest, including any Additional Interest, to but excluding the date
fixed for redemption; subject to there being no, or the satisfaction of any,
Payment Restrictions.

 

In the event of redemption of this Security in part
only, a new Security or Securities for the unredeemed portion hereof will be
issued in the name of the Holder hereof upon the cancellation hereof.  If less than all the Securities are to be
redeemed, the particular Securities to be redeemed shall be selected not more
than sixty (60) days prior to the Redemption Date by the Trustee from the Outstanding
Securities not previously called for redemption, by such method as the Trustee
shall deem fair and appropriate and which may provide for the selection for
redemption of a portion of the principal amount of any Security.

 

The Indenture permits, with certain exceptions as
therein provided, the Company and the Trustee at any time to enter into a
supplemental indenture or indentures for the purpose of modifying in any manner
the rights and obligations of the Company and of the Holders of the Securities,
with the consent of the Holders of not less than a majority in principal amount
of the Outstanding Securities. The Indenture also contains provisions
permitting Holders of specified percentages in principal amount of the
Securities, on behalf of the Holders of all Securities, to waive compliance by
the Company with certain provisions of the Indenture and certain past defaults
under the Indenture and their consequences. Any such consent or waiver by the
Holder of this Security shall be conclusive and binding upon such Holder and
upon all future Holders of this Security and of any Security issued upon the
registration of transfer hereof or in exchange herefor or in lieu hereof,
whether or not notation of such consent or waiver is made upon this Security.

 

No reference herein to the Indenture nor any provision
of this Security or of the Indenture shall alter or impair the obligation of
the Company, which is absolute and unconditional, to pay the principal of and
any premium, if any, and interest, including any Additional Interest (to the

 

 

extent legally
enforceable), on this Security at the times, place and rate and in the coin or
currency herein prescribed.

 

As provided in the Indenture and subject to certain
limitations therein set forth, the transfer of this Security is registrable in
the Securities Register upon surrender of this Security for registration of
transfer at the office or agency of the Company maintained for such purpose,
duly endorsed by, or accompanied by a written instrument of transfer in form
satisfactory to the Company and the Securities Registrar and duly executed by,
the Holder hereof or such Holder’s attorney duly authorized in writing and,
thereupon, one or more new Securities of like tenor of authorized denominations
and for the same aggregate principal amount will be issued to the designated
transferee or transferees.

 

The Securities are issuable only in registered form
without coupons in minimum denominations of $100,000 and any integral multiples
of $1,000 in excess thereof.  As provided
in the Indenture and subject to certain limitations therein set forth,
Securities are exchangeable for a like aggregate principal amount of Securities
and of like tenor of a different authorized denomination as requested by the
Holder surrendering the same.

 

No service charge shall be made for any such
registration of transfer or exchange, but the Company may require payment of a
sum sufficient to cover any tax or other governmental charge payable in
connection therewith.

 

The Company, the Trustee and any agent of the Company
or the Trustee may treat the Person in whose name this Security is registered
as the owner hereof for all purposes, whether or not this Security be overdue,
and neither the Company, the Trustee nor any such agent shall be affected by
notice to the contrary.

 

The Company and, by its acceptance of this Security or
a beneficial interest herein, the Holder of, and any Person that acquires a
beneficial interest in, this Security agree that, for United States federal,
state and local tax purposes, it is intended that this Security constitute
indebtedness.

 

This Security shall be construed and enforced in
accordance with and governed by the laws of the State of New York, without
reference to its conflict of laws provisions (other than Section 5-1401 of
the General Obligations Law).Exhibit 10.26

 

AMENDED

TAX ALLOCATION AGREEMENT

 

This Agreement is entered into this 1st day of January, 1998, by and
among AmCOMP Incorporated (“Parent”), and AmCOMP Preferred Insurance Company,
AmCOMP Assurance Corporation, Pinnacle Administrative Company and Pinnacle
Benefits, Inc. (collectively referred to as “Subsidiaries”).

 

RECITALS

 

A.                                   AmCOMP Incorporated is a Delaware corporation
authorized to serve as a holding company for AmCOMP Preferred Insurance
Company, AmCOMP Assurance Corporation, Pinnacle Administrative Company and
Pinnacle Benefits, Inc.;

 

B.                                     AmCOMP Preferred Insurance Company, formerly
Pinnacle Assurance Corporation, is a Florida corporation operating under a
certificate of authority from the Florida Department of Insurance as a domestic
stock insurance company;

 

C.                                     AmCOMP Assurance Corporation, formerly Thomas
Jefferson Insurance Company, is a Florida corporation operating under a
certificate of authority from the Florida Department of Insurance as a domestic
stock insurance company;

 

D.                                    Pinnacle Administrative Company, formerly
Florida Administrators, Inc., is a Florida corporation authorized to act
as a management company;

 

E.                                      Pinnacle Benefits, Inc., formerly
Compensation Benefits, Inc., is a Florida corporation authorized to act as
a service company;

 

F.                                      AmCOMP Incorporated, AmCOMP Preferred
Insurance Company, AmCOMP Assurance Corporation, Pinnacle Administrative
Company and Pinnacle Benefits, Inc. are members of an affiliated group (“Group”)
within the meaning of Section 1504(a) of the Internal Revenue Code of
1986, as amended (the “Code”).  The
parties will be filing their federal income tax returns on a consolidated
basis, as required by Section 1502 of the Code and the regulations
thereunder, and wish to provide in a written agreement a method for allocating
among themselves the federal income tax liability of Group;

 

NOW, THEREFORE, in consideration of the mutual covenants and agreements
set forth herein, which the parties hereby acknowledge as sufficient, the
parties hereby agree as follows:

 

Section 1

Obligations of Subsidiaries

 

1.1           Separate
Recording.  Subsidiaries shall record
on their books tax calculations based upon separate return calculations where
required.

 

1.2           Estimated Tax
Payments.  On or before the
prescribed due date for each estimated payment of federal income tax each
Subsidiary shall compute the estimated payment that would be required to be made
by that Subsidiary if it filed a separate return subject to the provisions of Section 3
hereof, and pay such amount to Parent or inform Parent in writing that no
estimated payment is owed under this provision.

 

 

1.3           Taxes Due on Return.  On or before the prescribed due date (without
extension) of the federal consolidated income tax return for Group, each
Subsidiary shall compute the amount of federal income tax the Subsidiary would
be required to pay for the immediately preceding fiscal year if the Subsidiary
had filed a separate return, subject to the provisions of Section 3.2
hereof.  Each Subsidiary shall pay such
amount to Parent, minus the amounts previously paid as estimated tax payments
under Section 1.2 hereof, with respect to such fiscal year, or shall
inform Parent in writing that no payment is owed by Subsidiary or that such
Subsidiary has overpaid and that an amount is owed by Parent to each
Subsidiary.

 

1.4           Documentation. 
Each Subsidiary shall provide to Parent documentation supporting its computation
of the amounts due under this Agreement. 
In the event Parent disagrees with a Subsidiary’s computation, the parties
shall make a good faith effort to resolve their differences within ninety (90)
days after the documentation is provided to Parent.  In the event the parties cannot agree, they
shall submit the issue to the certified public accounting firm then utilized by
Parent for federal income tax matters for a final and binding determination, to
be made within ninety (90) days after submission.

 

Section 2

Obligations of Parent

 

2.1           Generally.  Parent
shall file in a consolidated form all federal tax returns required of itself and
Subsidiaries.

 

2.2           Refunds to Subsidiaries.  In the event Parent owes an amount to
Subsidiary pursuant to Section 1.3, Parent shall pay such amount to
Subsidiary within a reasonable time after filing of the consolidated federal
income tax return of Group, including proper extensions.  Such payment may be made, in Parent’s sole
discretion, in the form of surplus notes or other notes, debt obligations or
securities created or issued by Parent in favor of such Subsidiary.

 

2.3           Adjustments. 
In the event of any adjustment of the tax liability shown on the
consolidated federal income tax return of Group, by reason of an amended
return, claim for refund, audit by the Internal Revenue Service or otherwise,
the separate return tax liability of each Subsidiary under Section 1 shall
be recomputed to give effect to any portion of such adjustment applicable to
such Subsidiary as if it had been made a part of the original computation of
tax liability hereunder.  Such
recomputation and any adjusting payment required as a result shall be made
within a reasonable time after final administrative or judicial determination
of such adjustment.

 

Section 3

Computation of Amounts

 

3.1           Application of Federal Tax Laws.  In the computation of amounts to be paid under
the foregoing sections, all applicable rules of the federal income tax law
shall be applied as though each Subsidiary filed a separate return.

 

3.2           Benefit of Losses and Credits.  Each Subsidiary shall be entitled to utilize
its net operating losses and tax credits (including carrybacks) to the same
extent and in the same manner as it would if it had filed a separate tax
return.

 

2

 

3.3           Consistent
Application.  The applicable rules of
the federal income tax law, including the Internal Revenue Code and any
applicable IRS Regulations or decisions, as well as the provisions of paragraph
3.2 above, shall be applied on a consistent basis from one period to the next.  If a Subsidiary wishes to change the basis on
which it applies any applicable rule of federal income tax law such change
must be approved by the Parent before it is implemented, with any appropriate
adjustments required by Parent.

 

Section 4

Separate Returns

 

In the event any Subsidiary is entitled or required under the Internal
Revenue Code or applicable IRS Regulations to file an amended income tax return
for any prior year in which it filed a return separately from Group, any refund
or additional tax liability shown on such separate return shall be paid
directly to or by the corporation filing the return.

 

Section 5

Termination

 

5.1           Termination of
Affiliated Group.  This Agreement
shall cease to apply to all tax years beginning on or after the date the
parties cease to be members of the same affiliated group filing a consolidated
federal income tax return.

 

5.2           Other
Circumstances.  This Agreement shall
not be terminated under any other circumstances except pursuant to the written
agreement of the parties.

 

Section 6

Miscellaneous

 

6.1           Entire Agreement.  This Agreement contains the entire agreement
of the parties and may not be modified or amended except by an agreement in
writing signed by the parties.

 

6.2           Succession and Assignability.  The
rights and obligations of the parties hereunder shall be binding upon and inure
to the benefit of the parties and their respective successors and assigns.

 

6.3           Amendment.  This Agreement may be amended upon written
approval of all of the parties hereto.

 

6.4           Severability.  If any term, provision or condition contained
in this Agreement shall, to any extent, be held invalid or unenforceable, the
remainder of this Agreement shall not be affected thereby, and each term,
provision and condition of this Agreement not affected shall be valid and
enforceable to the fullest extent permitted by law.

 

3

 

IN WITNESS WHEREOF, the
parties hereto have caused this Agreement to be duly executed as of the day and
year first above written.

 

 

	
  AmCOMP
  Incorporated

  	
  AmCOMP
  Preferred Insurance Company

  
	
   

  	
   

  
	
   

  	
  /s/ Don Johnson

  	
   

  	
   

  	
  /s/ Don Johnson

  	
   

  
	
  By:

  	
  Don
  Johnson

  	
   

  	
  By:

  	
  Don
  Johnson

  	
   

  
	
   

  	
  Chief
  Financial Officer

  	
   

  	
   

  	
  Chief
  Financial Officer

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Pinnacle
  Administrative Company

  	
  AmCOMP
  Assurance Corporation

  
	
   

  	
   

  
	
   

  	
  /s/ Don Johnson

  	
   

  	
   

  	
  /s/ Don Johnson

  	
   

  
	
  By:

  	
  Don
  Johnson

  	
   

  	
  By:

  	
  Don
  Johnson

  	
   

  
	
   

  	
  Chief
  Financial Officer

  	
   

  	
   

  	
  Chief
  Financial Officer

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Pinnacle
  Benefits, Inc.

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  /s/ Don Johnson

  	
   

  	
   

  	
   

  	
   

  
	
  By:

  	
  Don
  Johnson

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  Chief
  Financial Officer

  	
   

  	
   

  	
   

  	
   

  

 

4

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