Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 14 - INSURANCE HOLDING COMPANY › Appendix F - FORM F ENTERPRISE RISK REPORT

Current through Register Vol. 30, No. 28, July 12, 2024
Filed with the Arizona Department of Insurance
___________________________________________________
Name of Registrant/Applicant
On Behalf of/Related to Following Insurance Companies
Name Address
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Date: , 20
Name, Title, Address and telephone number of Individual to
				  Whom Notices and Correspondence Concerning This Statement Should be
Addressed:
ITEM 1. ENTERPRISE RISK
[The Registrant/Applicant, to the best of its knowledge and
				  belief, shall provide information regarding the following areas that could
				  produce enterprise risk as defined in A.R.S. §
									20-481(4),
				  provided such information is not disclosed in the Insurance Holding Company
				  System Annual Registration Statement filed on behalf of itself or another
				  insurer for which it is the ultimate controlling person:
Any material developments regarding strategy, internal audit
				  findings, compliance or risk management affecting the insurance holding company
				  system;
Acquisition or disposal of insurance entities and
				  reallocating of existing financial or insurance entities with the insurance
				  holding company system;
Any changes of shareholders of the insurance holding company
				  system exceeding ten percent (10%) or more of voting securities;
Developments in various investigations, regulatory activities
				  or litigation that may have a significant bearing or impact on the insurance
				  holding company system'
Business plan of the insurance holding company system and
				  summarized strategies for next 12 months;
Identification of material concerns of the insurance holding
				  company system raised by supervisory college, if any, in last year;
Identification of insurance holding company system capital
				  resources and material distribution patterns;
Identification of any negative movement, or discussions with
				  rating agencies which may have caused, or may cause, potential negative
				  movement in the credit ratings and individual insurer financial strength
				  ratings assessment of the insurance holding company system (include both the
				  rating score and outlook);
Information on corporate or parental guarantees throughout
				  the holding company and the expected source of liquidity should such guarantees
				  be called upon; and
Identification of any material activity or development of the
				  insurance holding company system that, in the opinion of senior management,
				  could adversely affect the insurance holding company system.
[The Registrant/Applicant may attach the appropriate form
				  most recently filed with the U.S. Securities and Exchange Commission, provided
				  the Registrant/Applicant includes specific references to those areas listed in
				  Item 1 for which the form provides responsive information. If the
				  Registrant/Applicant is not domiciled in the U.S., it may attach its most
				  recent public audited financial statement filed in its country of domicile,
				  provided the Registrant/Applicant includes specific references to those areas
				  listed in Item 1 for which the financial statement provides responsive
				  information.]
ITEM 2. OBLIGATION TO REPORT
[If the Registrant/Applicant has not disclosed any
				  information pursuant to Item 1, the Registrant/Applicant shall include a
				  statement affirming that, to the best of its knowledge and belief, it has not
				  identified enterprise risk subject to disclosure pursuant to Item 1.]