*12825202120100100*

PROPERTY AND CASUALTY COMPANIES-ASSOCIATION EDITION

ANNUAL STATEMENT

For the Year Ended December 31, 2021

OF THE CONDITION AND AFFAIRS OF THE

First Acceptance Insurance Company of Tennessee, Inc.

NAIC Group Code

3362

,

3362

NAIC Company Code

12825

Employer's ID Number

20-5135088

(Current Period)

(Prior Period)

Organized under the Laws of

Tennessee

, State of Domicile or Port of Entry

Tennessee

Country of Domicile

United States

Incorporated/Organized

06/30/2006

Commenced Business

01/01/2007

Statutory Home Office

3813 Green Hills Village Drive

,

Nashville, TN, US 37215

(Street and Number)

(City or Town, State, Country and Zip Code)

Main Administrative Office

3813 Green Hills Village Drive

Nashville, TN, US 37215

615-327-4888

(Street and Number)

(City or Town, State, Country and Zip Code)

(Area Code)

(Telephone Number)

Mail Address

3813 Green Hills Village Drive

,

Nashville, TN, US 37215

(Street and Number or P.O. Box)

(City or Town, State, Country and Zip Code)

Primary Location of Books and Records

3813 Green Hills Village Drive

Nashville, TN, US 37215

615-327-4888

(Street and Number)

(City or Town, State, Country and Zip Code)

(Area Code) (Telephone Number)

Internet Web Site Address

N/A

Statutory Statement Contact

Michael John Bodayle

615-844-2907

mbodayle@acceptanceinsurance.com

(Name)

(Area Code) (Telephone Number) (Extension)

615-844-2806

(E-Mail Address)

(Fax Number)

OFFICERS

Name

Title

Name

Title

Larry Emmett Willeford

,

President

Michael John Bodayle

,

Treasurer

Michael John Bodayle

,

Secretary

,

,

OTHER OFFICERS

,

DIRECTORS OR TRUSTEES

Larry Emmett Willeford

Michael John Bodayle

State of

Tennessee

ss

County of

Davidson

The officers of this reporting entity, being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures manual except to the extent that: (1) state law may differ; or, (2) that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement.

Larry Emmett Willeford

Michael John Bodayle

Michael John Bodayle

President

Treasurer

a. Is this an original filing?

Secretary

Yes [ X ] No [ ]

Subscribed and sworn to before me

b. If no:

this

day of

February, 2022

1.

State the amendment number

2.

Date filed

3. Number of pages attached

Jennifer L. Johnson, Director-Operations Services

March 7, 2023

ANNUAL STATEMENT FOR THE YEAR 2021 OF THE First Acceptance Insurance Company of Tennessee, Inc.

ASSETS

Current Year

Prior Year

1

2

3

4

Net Admitted Assets

Net Admitted

Assets

Nonadmitted Assets

(Cols. 1 - 2)

Assets

1.

Bonds (Schedule D)

14,781,702

14,781,702

13,929,209

2.

Stocks (Schedule D):

2.1

Preferred stocks

0

0

0

2.2

Common stocks

0

0

0

3. Mortgage loans on real estate (Schedule B):

3.1

First liens

0

0

3.2

Other than first liens

0

0

4. Real estate (Schedule A):

4.1 Properties occupied by the company (less

$

encumbrances)

0

0

4.2 Properties held for the production of income

(less $

encumbrances)

0

0

4.3 Properties held for sale (less

$

encumbrances)

0

0

5.

Cash ($

5,920,273 , Schedule E-Part 1), cash equivalents

($

8,827,574 , Schedule E-Part 2) and short-term

investments ($

0

, Schedule DA)

14,747,847

14,747,847

14,949,938

6.

Contract loans (including $

premium notes)

0

0

7.

Derivatives (Schedule DB)

0

0

0

8.

Other invested assets (Schedule BA)

0

0

0

9.

Receivables for securities

0

0

10.

Securities lending reinvested collateral assets (Schedule DL)

0

0

11.

Aggregate write-ins for invested assets

0

0

0

0

12.

Subtotals, cash and invested assets (Lines 1 to 11)

29,529,548

0

29,529,548

28,879,147

13.

Title plants less $

charged off (for Title insurers

only)

0

0

14.

Investment income due and accrued

98,403

98,403

91,534

15. Premiums and considerations:

15.1 Uncollected premiums and agents' balances in the course of

collection

601,781

601,781

511,086

15.2

Deferred premiums, agents' balances and installments booked but

deferred and not yet due (including $

earned

but unbilled premiums)

4,639,141

4,639,141

4,821,418

15.3 Accrued retrospective premiums ($

) and

contracts subject to redetermination ($

)

0

0

16.

Reinsurance:

16.1

Amounts recoverable from reinsurers

1,292,586

1,292,586

1,213,759

16.2

Funds held by or deposited with reinsured companies

0

0

16.3

Other amounts receivable under reinsurance contracts

0

0

17.

Amounts receivable relating to uninsured plans

0

0

18.1

Current federal and foreign income tax recoverable and interest thereon

0

0

18.2

Net deferred tax asset

706,504

321,911

384,593

539,102

19.

Guaranty funds receivable or on deposit

0

0

20.

Electronic data processing equipment and software

0

0

21. Furniture and equipment, including health care delivery assets

($

)

0

0

22.

Net adjustment in assets and liabilities due to foreign exchange rates

0

0

23.

Receivables from parent, subsidiaries and affiliates

249,698

249,698

1,202,170

24.

Health care ($

) and other amounts receivable

0

0

25.

Aggregate write-ins for other-than-invested assets

95,867

95,867

0

0

26. Total assets excluding Separate Accounts, Segregated Accounts and

Protected Cell Accounts (Lines 12 to 25)

37,213,528

417,778

36,795,750

37,258,216

27. From Separate Accounts, Segregated Accounts and Protected

Cell Accounts

0

0

28.

Total (Lines 26 and 27)

37,213,528

417,778

36,795,750

37,258,216

DETAILS OF WRITE-INS

1101.

0

0

1102.

0

0

1103.

0

0

1198.

Summary of remaining write-ins for Line 11 from overflow page

0

0

0

0

1199.

Totals (Lines 1101 through 1103 plus 1198) (Line 11 above)

0

0

0

0

2501.

Prepaid Expenses

95,106

95,106

0

0

2502.

Due From Vendors

761

761

0

0

2503.

Miscellaneous Receivables

0

0

0

0

2598.

Summary of remaining write-ins for Line 25 from overflow page

0

0

0

0

2599.

Totals (Lines 2501 through 2503 plus 2598) (Line 25 above)

95,867

95,867

0

0

2

ANNUAL STATEMENT FOR THE YEAR 2021 OF THE First Acceptance Insurance Company of Tennessee, Inc.

LIABILITIES, SURPLUS AND OTHER FUNDS

1

2

Current Year

Prior Year

1.

Losses (Part 2A, Line 35, Column 8)

9,657,807

9,679,643

2.

Reinsurance payable on paid losses and loss adjustment expenses (Schedule F, Part 1, Column 6)

1,903,494

1,582,089

3.

Loss adjustment expenses (Part 2A, Line 35, Column 9)

2,448,045

2,217,677

4.

Commissions payable, contingent commissions and other similar charges

33,632

27,326

5.

Other expenses (excluding taxes, licenses and fees)

39,493

83,047

6.

Taxes, licenses and fees (excluding federal and foreign income taxes)

7,686

25,233

7.1

Current federal and foreign income taxes (including $

on realized capital gains (losses))

0

7.2

Net deferred tax liability

0

8.

Borrowed money $

and interest thereon $

0

9.

Unearned premiums (Part 1A, Line 38, Column 5) (after deducting unearned premiums for ceded reinsurance of

$

5,646,261

and including warranty reserves of $

and accrued accident and

health experience rating refunds including $

for medical loss ratio rebate per the Public Health

Service Act)

8,226,707

8,368,742

10.

Advance premium

36,306

38,265

11.

Dividends declared and unpaid:

11.1 Stockholders

0

11.2 Policyholders

0

12.

Ceded reinsurance premiums payable (net of ceding commissions)

0

13.

Funds held by company under reinsurance treaties (Schedule F, Part 3, Column 20)

0

14.

Amounts withheld or retained by company for account of others

0

15.

Remittances and items not allocated

0

16.

Provision for reinsurance (including $

certified) (Schedule F, Part 3, Column 78)

0

17.

Net adjustments in assets and liabilities due to foreign exchange rates

0

18.

Drafts outstanding

0

19.

Payable to parent, subsidiaries and affiliates

476,269

461,168

20.

Derivatives

0

0

21.

Payable for securities

0

22.

Payable for securities lending

0

23.

Liability for amounts held

under uninsured plans

0

24.

Capital notes $

and interest thereon $

0

25.

Aggregate write-ins for liabilities

82,695

39,552

26.

Total liabilities excluding protected cell liabilities (Lines 1 through 25)

22,912,134

22,522,742

27.

Protected cell liabilities

0

28.

Total liabilities (Lines 26 and 27)

22,912,134

22,522,742

29.

Aggregate write-ins for special surplus funds

0

0

30.

Common capital stock

1,500,000

1,500,000

31.

Preferred capital stock

0

32.

Aggregate write-ins for other-than-special surplus funds

0

0

33.

Surplus notes

0

34.

Gross paid in and contributed surplus

12,500,000

12,500,000

35.

Unassigned funds (surplus)

(116,384)

735,474

36.

Less treasury stock, at cost:

36.1

shares common (value included in Line 30

$

)

0

36.2

shares preferred (value included in Line 31

$

)

0

37.

Surplus as regards policyholders (Lines 29 to 35, less 36) (Page 4, Line 39)

13,883,616

14,735,474

38.

Totals (Page 2, Line 28, Col. 3)

36,795,750

37,258,216

DETAILS OF WRITE-INS

2501.

Unclaimed Checks

82,695

39,552

2502.

Rounding

0

2503.

0

2598.

Summary of remaining write-ins for Line 25 from overflow page

0

0

2599.

Totals (Lines 2501 through 2503 plus 2598) (Line 25 above)

82,695

39,552

2901.

0

2902.

0

2903.

0

2998.

Summary of remaining write-ins for Line 29 from overflow page

0

0

2999.

Totals (Lines 2901 through 2903 plus 2998) (Line 29 above)

0

0

3201.

0

3202.

0

3203.

0

3298.

Summary of remaining write-ins for Line 32 from overflow page

0

0

3299.

Totals (Lines 3201 through 3203 plus 3298) (Line 32 above)

0

0

3

ANNUAL STATEMENT FOR THE YEAR 2021 OF THE First Acceptance Insurance Company of Tennessee, Inc.

STATEMENT OF INCOME

1

2

Current Year

Prior Year

1.

UNDERWRITING INCOME

Premiums earned (Part 1, Line 35, Column 4)

27,123,702

26,843,655

DEDUCTIONS:

2.

Losses incurred (Part 2, Line 35, Column 7)

16,356,984

13,464,192

3.

Loss adjustment expenses incurred (Part 3, Line 25, Column 1)

3,766,450

3,920,688

4.

Other underwriting expenses incurred (Part 3, Line 25, Column 2)

9,671,738

9,659,297

5.

Aggregate write-ins for underwriting deductions

0

2

6.

Total underwriting deductions (Lines 2 through 5)

29,795,172

27,044,179

7.

Net income of protected cells

0

8.

Net underwriting gain (loss) (Line 1 minus Line 6 plus Line 7)

(2,671,470)

(200,524)

INVESTMENT INCOME

9.

Net investment income earned (Exhibit of Net Investment Income, Line 17)

292,414

354,618

10.

Net realized capital gains (losses) less capital gains tax of $

(Exhibit of Capital Gains (Losses))

0

11.

Net investment gain (loss) (Lines 9 + 10)

292,414

354,618

OTHER INCOME

12.

Net gain (loss) from agents' or premium balances charged off (amount recovered $

amount

charged off $

)

0

13.

Finance and service charges not included in premiums

1,737,449

1,706,024

14.

Aggregate write-ins for miscellaneous income

0

0

15.

Total other income (Lines 12 through 14)

1,737,449

1,706,024

16.

Net income before dividends to policyholders, after capital gains tax and before all other federal and foreign income taxes

(Lines 8 + 11 + 15)

(641,607)

1,860,118

17.

Dividends to policyholders

0

18.

Net income, after dividends to policyholders, after capital gains tax and before all other federal and foreign income taxes

(Line 16 minus Line 17)

(641,607)

1,860,118

19.

Federal and foreign income taxes incurred

0

20.

Net income (Line 18 minus Line 19) (to Line 22)

(641,607)

1,860,118

CAPITAL AND SURPLUS ACCOUNT

21.

Surplus as regards policyholders, December 31 prior year (Page 4, Line 39, Column 2)

14,735,474

12,328,651

22.

Net income (from Line 20)

(641,607)

1,860,118

23.

Net transfers (to) from Protected Cell accounts

0

24.

Change in net unrealized capital gains or (losses) less capital gains tax of $

0

25.

Change in net unrealized foreign exchange capital gain (loss)

0

26.

Change in net deferred income tax

167,402

(368,780)

27.

Change in nonadmitted assets (Exhibit of Nonadmitted Assets, Line 28, Col. 3)

(377,654)

615,485

28.

Change in provision for reinsurance (Page 3, Line 16, Column 2 minus Column 1)

0

0

29.

Change in surplus notes

0

30.

Surplus (contributed to) withdrawn from protected cells

0

31.

Cumulative effect of changes in accounting principles

0

32.

Capital changes:

32.1 Paid in

300,000

32.2 Transferred from surplus (Stock Dividend)

0

32.3 Transferred to surplus

0

33.

Surplus adjustments:

33.1 Paid in

0

33.2 Transferred to capital (Stock Dividend)

0

33.3 Transferred from capital

0

34.

Net remittances from or (to) Home Office

0

35.

Dividends to stockholders

0

36.

Change in treasury stock (Page 3, Lines 36.1 and 36.2, Column 2 minus Column 1)

0

0

37.

Aggregate write-ins for gains and losses in surplus

0

0

38.

Change in surplus as regards policyholders for the year (Lines 22 through 37)

(851,859)

2,406,823

39.

Surplus as regards policyholders, December 31 current year (Line 21 plus Line 38) (Page 3, Line 37)

13,883,616

14,735,474

DETAILS OF WRITE-INS

0501.

Rounding

2

0502.

0

0503.

0

0598.

Summary of remaining write-ins for Line 5 from overflow page

0

0

0599.

Totals (Lines 0501 through 0503 plus 0598) (Line 5 above)

0

2

1401.

Rounding

0

1402.

0

1403.

0

1498.

Summary of remaining write-ins for Line 14 from overflow page

0

0

1499.

Totals (Lines 1401 through 1403 plus 1498) (Line 14 above)

0

0

3701.

Rounding

0

3702.

0

3703.

0

3798.

Summary of remaining write-ins for Line 37 from overflow page

0

0

3799.

Totals (Lines 3701 through 3703 plus 3798) (Line 37 above)

0

0

4

ANNUAL STATEMENT FOR THE YEAR 2021 OF THE First Acceptance Insurance Company of Tennessee, Inc.

CASH FLOW

1

2

Current Year

Prior Year

1.

Cash from Operations

Premiums collected net of reinsurance

27,071,290

27,893,494

2.

Net investment income

429,282

574,789

3.

Miscellaneous income

1,737,449

1,706,024

4.

Total (Lines 1 through 3)

29,238,021

30,174,307

5.

Benefit and loss related payments

16,136,242

14,090,775

6.

Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts

0

0

7.

Commissions, expenses paid and aggregate write-ins for deductions

13,262,615

13,051,325

8.

Dividends paid to policyholders

0

0

9.

Federal and foreign income taxes paid (recovered) net of $

tax on capital gains (losses)

0

0

10.

Total (Lines 5 through 9)

29,398,857

27,142,100

11.

Net cash from operations (Line 4 minus Line 10)

(160,836)

3,032,207

12.

Cash from Investments

Proceeds from investments sold, matured or repaid:

12.1

Bonds

3,757,948

2,073,633

12.2

Stocks

0

0

12.3

Mortgage loans

0

0

12.4

Real estate

0

0

12.5

Other invested assets

0

0

12.6

Net gains or (losses) on cash, cash equivalents and short-term investments

0

0

12.7

Miscellaneous proceeds

0

0

13.

12.8

Total investment proceeds (Lines 12.1 to 12.7)

3,757,948

2,073,633

Cost of investments acquired (long-term only):

13.1

Bonds

4,754,176

0

13.2

Stocks

0

0

13.3

Mortgage loans

0

0

13.4

Real estate

0

0

13.5

Other invested assets

0

0

13.6

Miscellaneous applications

0

0

14.

13.7

Total investments acquired (Lines 13.1 to 13.6)

4,754,176

0

Net increase (decrease) in contract loans and premium notes

0

0

15.

Net cash from investments (Line 12.8 minus Line 13.7 minus Line 14)

(996,229)

2,073,633

16.

Cash from Financing and Miscellaneous Sources

Cash provided (applied):

16.1

Surplus notes, capital notes

0

0

16.2

Capital and paid in surplus, less treasury stock

0

300,000

16.3

Borrowed funds

0

0

16.4

Net deposits on deposit-type contracts and other insurance liabilities

0

16.5

Dividends to stockholders

0

0

17.

16.6

Other cash provided (applied)

954,973

1,000,008

Net cash from financing and miscellaneous sources (Lines 16.1 to 16.4 minus Line 16.5 plus Line 16.6)

954,973

1,300,008

18.

RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS

Net change in cash, cash equivalents and short-term investments (Line 11, plus Lines 15 and 17)

(202,092)

6,405,848

19.

Cash, cash equivalents and short-term investments:

19.1

Beginning of year

14,949,938

8,544,090

19.2

End of year (Line 18 plus Line 19.1)

14,747,847

14,949,938

5

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First Acceptance Corporation published this content on 01 March 2022 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 01 March 2022 22:58:25 UTC.