North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-03 - Regulation of Insurance Companies › Chapter 45-03-05 - Insurance Holding Company System Model Regulation With Reporting Forms and Instructions › Form F - ENTERPRISE RISK REPORT

Current through Supplement No. 393, July, 2024
Filed with the Insurance Department of the State of
				  ___________________
BY
___________________________________________
Name of Registrant/Applicant
On Behalf of the 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 subsection 3 of North Dakota Century Code
				  Section 26.1-10-01, provided the 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 10 percent 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 the 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 United States 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 United States, 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.