Pennsylvania Code › Title 31 - INSURANCE › Part I - General Provisions › Subpart B - Securities and Stock Transactions › Chapter 25 - RULES AND PROCEDURAL REQUIREMENTS FOR INSURANCE HOLDING COMPANY SYSTEMS › Appendix A › Form F - ENTERPRISE RISK REPORT

Current through Register Vol. 54, No. 28, July 13, 2024
Filed with the Insurance Department 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 section 1401 of the act (40 P. S. §
												991.1401) 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 a 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.
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.
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.
Item 3: Signature and
						Certification
SIGNATURE AND CERTIFICATION
Signature and certification required as follows:
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