-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, DrX4qK7HwevvBzVIeYoIGZ/rJyoVfhfCwj5bnmdUrKjUWiFzlLTrus38BfzJuhJY 5TucX1MyFzhrV/12Qc58Gw== 0001005477-01-002862.txt : 20010424 0001005477-01-002862.hdr.sgml : 20010424 ACCESSION NUMBER: 0001005477-01-002862 CONFORMED SUBMISSION TYPE: NSAR-U PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010423 FILER: COMPANY DATA: COMPANY CONFORMED NAME: SERVUS LIFE INSURANCE CO CENTRAL INDEX KEY: 0001071296 STANDARD INDUSTRIAL CLASSIFICATION: [] IRS NUMBER: 136150240 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: NSAR-U SEC ACT: SEC FILE NUMBER: 811-09031 FILM NUMBER: 1608929 BUSINESS ADDRESS: STREET 1: HARTFORD LIFE INSURANCE CO STREET 2: 200 HOPMEADOW ST CITY: SIMSBURY STATE: CT ZIP: 06089 BUSINESS PHONE: 8608436320 MAIL ADDRESS: STREET 1: HARTFORD LIFE INSURANCE CO STREET 2: 200 HOPMEADOW ST CITY: SIMSBURY STATE: CT ZIP: 06089 FORMER COMPANY: FORMER CONFORMED NAME: ROYAL LIFE INSURANCE CO OF AMERICA SEPARATE ACCOUNT ONE DATE OF NAME CHANGE: 19980929 NSAR-U 1 0001.txt FORM N-SAR FORM N-SAR ANNUAL REPORT FOR REGISTERED INVESTMENT COMPANIES Report as of the end of annual period: 12/31/00 (a) or fiscal year: / / (b) Is this a transition report? (Y or N): N Is this an amendment to a previous filing? (Y or N): N 1.A) Registrant Name: Servus Life Insurance Company Separate Account One B) File Number: 811-09031 C) Telephone Number: 860-843-3911 2.A) Street: PO Box 2999 B) City: Hartford C) State: CT D) Zip Code: 06104 Zip Ext.: 2999 E) Foreign Country: Foreign Postal Code: 3. Is this the first filing on this form by the Registrant? (Y or N) ---N--- 4. Is this the last filing on this form by the Registrant? (Y or N) ---N--- 5. Is Registrant a small business investment company (SBIC)?(Y or N) ---N--- 6. Is Registrant a unit investment trust (UIT)?(Y or N) -------------Y------ 111. A) Depositor Name (if any): Servus Life Insurance Company B) File Number: C) City: Hartford State: CT Zip Code: 06104 Zip Ext.:2999 Foreign Country: Foreign Postal Code: 112. A) Sponsor Name (if any): Servus Life Insurance Company B) File Number: C) City: Hartford State: CT Zip Code: 06104 Zip Ext.:2999 Foreign Country: Foreign Postal Code: PRINCIPAL UNDERWRITER 114. A) Underwriter Name (if any): Hartford Securities Distribution Company, Inc. B) File Number: 8-48097 C) City: Hartford State: CT Zip Code: 06104 Zip Ext.: 2999 Foreign Country: Foreign Postal Code: INDEPENDENT PUBLIC ACCOUNTANT 115. A) Accountant Name: Arthur Andersen & Company B) City: Hartford State: CT Zip Code: 06103 Zip Ext.: Foreign Country: Foreign Postal Code: 116. Family of investment companies information: A) Is Registrant part of a family of investment companies? (Y or N) N B) If 'Y' (Yes), state the number of registered management investment companies in the family: (NOTE: Count as a separate company each series of a series company and each portfolio of a multiple portfolio company; exclude all series of unit investment trusts from this number.) 117. a) Is Registrant a separate account of an insurance company (Y or N) Y If answer is Yes, are any of the following types of contracts funded by the registrant?: b) Variable annuity contracts? (Y/N) Y c) Scheduled premium variable life contracts? (Y/N) N d) Flexible premium variable life contracts? (Y/N) N e) Other types of insurance products registered under the Securities Act of 1933? (Y/N) N 118. State the number of series existing at the end of the period that had securities registered under the Securities Act of 1933. 1 119. State the number of new series for which registration statements under the Securities Act of 1933 became effective during the period. 0 120. State the total value of the portfolio securities on the date of deposit for the new series included in item 119 ($000's) $0 121. State the number of series for which a current prospectus was in existence at the end of the period 1 122. State the number of existing series for which additional units were registered under the Securities Act of 1933 during the current period 0 123. State the total value of the additional units considered in answering item 122 ($000,s omitted) $0 124. State the total value of units of prior series that were placed in the portfolios of a subsequent series during the current period (the value of the units is to be measured on the date they were placed in the subsequent series) ($000's omitted) $0 125. State the total amount of sales loads collected (before re-allowances to other brokers or dealers) by Registrant's principal underwriter and any underwriter which is an affiliated person of the principal underwriter during the current period solely from the sale of units of all series of registrant (000,s omitted) $0 126. Of the amount shown in Item 125, state the total dollar amount of sales loads collected from secondary market operations in registrant's units (include the sales loads, if any, collected on units of a prior series placed in the portfolio of a subsequent series.) ($000's omitted) $0 127. List opposite the appropriate description below the number of series whose portfolios are invested primarily (Based upon a percentage of NAV)in each type of security shown, the aggregate total assets at market value as of a date at or near the end of the current period of each such group of series and the total income distributions made by each such group of series during the current period (excluding distribution of realized gains, if any):
Number of Total Assets Total Income Series ($000's Distributions Investing omitted) ($000'somitted) --------- -------- --------------- A. U.S. Treasury direct issue ----- ----- ----- B. U.S. Government agency ----- ----- ----- C. State and municipal tax-free ----- ----- ----- D. Public utility debt ----- ----- ----- E. Brokers or dealers debt or debt of brokers' or dealers parent ----- ----- ----- F. All other corporate interned & long term debt ----- ----- ----- G. All other corporate short-term debt ----- ----- ----- H. Equity securities of brokers or dealers or parents of brokers or dealers ----- ----- ----- I. Investment company equity securities ----- ----- ----- J. All other equity securities ----- $0 $0 K. Other securities ----- ----- ----- L. Total assets of all series of registrant ----- $0 $0
128. Is the timely payment of principal and interest on any of the portfolio securities held by any of the Registrant's series at the end of the current period insured or guaranteed by an entity other than the issuer? (Y or N) --------------------------------------------N 131. Total expenses incurred by all series of Registrant during the current reporting period ($000,s omitted) $0 -----END PRIVACY-ENHANCED MESSAGE-----