Mississippi Administrative Code › Title 19 - Department of Insurance › Part 1 - General › Chapter 20 - Insurance Holding Company Regulation with Reporting Forms and Instructions › Rule 19-1-20.30 - Form F - Enterprise Risk Report

Current through June 25, 2024
FORM F
ENTERPRISE RISK REPORT
Filed with the Insurance Department of the State of
				  _________________________
By
____________________________________
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
Miss. Code Ann.
§
									83-6-5(5),
				  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 within 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 (including 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.
Miss. Code Ann. §
										83-6-5
				  (Supp. 2013)