Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 24 - HOLDING COMPANIES › Form F - ENTERPRISE RISK REPORT

Current through June 17, 2024
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
Neb.Rev.Stat.
§
										44-2121(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:
a) Any material developments regarding
				strategy, internal audit findings, compliance or risk management affecting the
				insurance holding company system;
b) Acquisition or disposal of insurance
				entities and reallocating of existing financial or insurance entities within
				the insurance holding company system;
c) Any changes of shareholders of the
				insurance holding company system exceeding ten percent (10%) or more of voting
				securities;
d) Developments in
				various investigations, regulatory activities or litigation that may have a
				significant bearing or impact on the insurance holding company
				system;
e) Business plan of the
				insurance holding company system and summarized strategies for next 12 months;
f) Identification of material
				concerns of the insurance holding company system raised by supervisory college,
				if any, in last year;
g)
				Identification of insurance holding company system capital resources and
				material distribution patterns;
h)
				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);
i) Information on
				corporate or parental guarantees throughout the holding company and the
				expected source of liquidity should such guarantees be called upon; and
j) 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.