New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter IV - Financial Condition Of Insurer and Reports to Superintendent › Subchapter A - Rules of General Application › Part 80 - Controlled insurers › Subpart 80-1 - Holding companies › Section 80-1.2 - Registration of controlled insurers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer required to register or amend
					 its registration pursuant to Insurance Law section 1503(a) shall furnish the
					 required information on registration statement form HC 1, as specified in the
					 instructions made a part thereof (see subdivision [d] of this section). The
					 initial registration statement shall be accompanied by the information required
					 by subdivisions (e) and (f) of section
					 80-1.4  of
					 this Part. Thereafter, an insurer shall file an amendment to the registration
					 statement within 120 days following the end of its ultimate holding company's
					 fiscal year and within 120 days following the end of each succeeding fiscal
					 year, indicating changes, if any, during the preceding fiscal year in respect
					 to items 1, 2, 4, 7 and 8 of the registration statement.
(b) An insurer may request an extension of
					 the time in which to register or amend a registration. The superintendent may
					 grant the extension upon the insurer's showing that it is impractical to
					 register or amend within the period set forth.
(c) A registered insurer may request the
					 termination of its registration upon a showing, pursuant to section
					 80-1.3 
					 of this Part, that it is no longer a controlled insurer. Upon a favorable
					 determination by the superintendent, such registration shall terminate upon
					 such conditions as the superintendent deems necessary or appropriate.
(d)
Registration statement.
New York Department of Financial Services
New York, New York
Form HC 1
REGISTRATION STATEMENT
FILED PURSUANT TO SECTION 1503 OF
THE NEW YORK INSURANCE LAW
Name of Registrant
Name, Title and Address of Officer to Whom Notices
						and
Correspondence Concerning this Statement should be
						Addressed
________________________________________
Name
_________________________________________
Title
Address
INSTRUCTIONS
A.
Use and time of filing.
11 NYCRR Part 80-1 (Insurance Regulation 52) adopted pursuant to the provisions
					 of section 1503, prescribes the use of Registration Statement HC 1 for filing
					 by a controlled insurer.
B.
Formal requirements.
(a) A
					 registrant shall file electronically a registration statement and any amendment
					 thereto. The registration statement shall be signed in the name of the
					 registrant and shall be verified by the officer or agent executing the
					 same.
(b) The registrant shall
					 submit a registration statement and amendments thereto to the New York State
					 Department of Financial Services in New York City.
C.
Incorporation by
					 reference
.
(a) Except as otherwise
					 specifically provided, the provisions of Insurance Law section 1508 shall
					 govern incorporation by reference. Where any other controlled insurer within
					 the registrant's holding company system has filed a registration statement it
					 may be convenient and desirable for the registrant to refer to answers
					 contained in such statement. In such cases, the registrant may state that such
					 reference shall be deemed to refer to any and all amendments of such items or
					 exhibits thus referred to that may thereafter be filed by such controlled
					 insurer and, if such statement is made, it shall be deemed to include all
					 future amendments to the particular item or exhibit to which reference is made.
					 If such a statement is not made, the incorporation by reference shall be deemed
					 to refer only to the specific item or exhibit referred to as in effect at the
					 date the statement making such incorporation by reference is filed.
(b) The registrant shall file a definitive
					 exhibit and a complete statement in answer to any item if the superintendent
					 requires such a filing because the incorporation by reference of such exhibit,
					 or of all or part of the answer to such item, is not responsive to the item
					 requested.
D.
Availability of information.
If the information called for by
					 any item or exhibit of this form is not known to the registrant, it need give
					 only such information as can be procured without incurring unreasonable effort
					 or expense; provided, however, that in every case the answer shall:
(a) clearly and specifically indicate what
					 part of the information supplied is not definitely known to the registrant and
					 allege that the statements made represent the registrant's best information and
					 belief;
(b) adequately disclose the
					 sources from which the registrant has procured the information given;
					 and
(c)
(1) state specifically that unreasonable
					 effort or expense would be involved in procuring more accurate information and
					 provide reasons to support the assertion; or
(2) make a statement showing that the
					 required information is within the knowledge of another person, provided that
					 the statement shall also show that the registrant has made appropriate requests
					 to such person for the desired information and shall set forth the results of
					 such requests or efforts.
REQUIRED INFORMATION
Item 1. Specify exact name of
					 registrant.
Item 2. Specify address
					 and principal executive offices.
Item
					 3. Specify date on which registrant became a controlled insurer of
					 its ultimate holding company, and all methods by which control was acquired and
					 is maintained.
Item 4.
(a) Furnish a chart that clearly presents the
					 identities of and interrelationships among, the ultimate holding company and
					 all controlled persons and controlled insurers within registrant's holding
					 company system. Indicate in such chart the percentage of voting securities of
					 each such person that is owned or controlled by the ultimate holding company or
					 by any other controlled person or controlled insurer within the system. If
					 control of any person within the system is maintained other than by the
					 ownership or control of voting securities, then indicate the basis of such
					 control. As to each person specified in such chart indicate the type of
					 organization (e.g., corporation, trust, partnership) and the State or other
					 jurisdiction of domicile.
(b) If
					 court proceedings looking toward a reorganization or liquidation are pending
					 with respect to any such person, indicate which person, and set forth the title
					 of the court, nature of proceedings and the date when commenced.
Item 5. Principal
					 shareholders of persons within holding company system. As of a date not more
					 than six months prior to registration (indicating such date for each class),
					 give the following information with respect to each person who owns of record,
					 or is known by the registrant to own beneficially, ten percent or more of any
					 class of equity security of any person within the holding company system; any
					 such ownership reflected in answer to item 4 need not be restated:
(a) Class of security;
(b) Holder of record and address; and
					 beneficial owner (if not the holder of record) and address;
(c) Number of shares held of record or known
					 to be beneficially owned; and
(d)
					 Percentage of class so held or owned.
Item 6. Business activities. Describe briefly
					 the general character and principal locations of the business done by the
					 ultimate holding company and the persons identified under item 4 as being
					 within the holding company system.
Item
					 7. Officers and directors. Give the name and business address of
					 each director and executive officer of the ultimate holding company. For each
					 such individual give the title of every position held by him or her with
					 significant persons within the holding company system.
Item 8. Articles of incorporation. With
					 respect to the ultimate holding company, furnish a copy of the charter,
					 articles of incorporation, trust agreement, voting trust agreement, or other
					 fundamental document of organization, and a copy of its by-laws or other
					 instruments corresponding thereto. Each such document shall be in the amended
					 form effective at the date of filing the registration statement or shall be
					 accompanied by copies of any amendments to it then in effect.
Item 9. Submit a statement that the
					 registrant's board of directors, or a committee thereof, oversees corporate
					 governance and internal controls and that the registrant's officers or senior
					 management have approved or devised, implemented, and continue to maintain and
					 monitor corporate governance and internal control procedures.
This registration statement comprises:
(a) Pages numbered ____ to ____,
					 consecutively.
(b) The following
					 Exhibits:
SIGNATURE
Pursuant to the requirements of New York Insurance Law
						section 1503 and 11 NYCRR Part 80-1 (Insurance Regulation 52) the registrant
						has caused this registration statement to be duly signed on its behalf in the
						City of _and State of_, on the_day of _, 20
By (Name) (Title)
Attest:
(Signature of Officer)
(Title)
CERTIFICATION
The undersigned deposes and says that she/he has duly
						executed the attached registration statement dated_, 20_, for and on behalf of
						(Name of Company); that she/he is the(Title of Officer) of
such company; and that all action by directors and other
						bodies necessary to authorize deponent to execute and file such instrument has
						been taken. Deponent further says that she/he is familiar with such instrument
						and that the facts therein set forth are true to the best of her/his knowledge,
						information and belief.
Dated: