Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter B - INSURANCE HOLDING COMPANY SYSTEMS › Section 7.213 - Form C

Current through Reg. 49, No. 28; July 12, 2024
(a) Notice of
				  Ordinary and Extraordinary Dividends and Other Distributions. Complete
				  subsections (a) and (b) of this section for an Ordinary Dividend under §
										7.203(o)
				  of this title (relating to Registration of Insurers) and complete subsections
				  (a) - (c) of this section for an Extraordinary Dividend under §
										7.204(d)
				  of this title (relating to Transactions Subject to Prior Notice).
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(b)
				  Dividend or distribution.
(1) Name of
				  insurer.
(2) Address of
				  insurer.
(3) Declaration of
				  dividend:
(A) Amount of declared dividend or
				  distribution: $
(B) Recipient of
				  declared dividend or distribution.
(C) Declaration date.
(D) Proposed payment date.
(4) The dividend or distribution
				  is in compliance with the Act and is indicated in subparagraphs (A) and (B) of
				  this paragraph:
(A) Calculation.
(i) Amount of current dividend or
				  distribution: $
(ii) Dividends or
				  distributions paid during preceding 12 months, excluding current dividend or
				  distribution but including declaration date, payment date, type of dividend or
				  distribution, and amount: $
(iii)
				  Total of (i) and (ii): $
(iv)
				  Surplus as regards policyholders (net worth for HMO) as of preceding December
				  31: $
(I) 10 percent of (iv) for Life,
				  P&C, and HMO: $
(II) 20 percent
				  of (iv) for Title: $
(v)
				  Operating income:
(I) Net gain from operations
				  before realized capital gains as of preceding December 31 for Life, Title and
				  HMO: $
(II) Net income as of
				  preceding December 31 for P&C: $
(vi) Greater of calculated surplus from (iv)
				  or the operating income from (v): $
(B) If the amount from (iii) exceeds the
				  amount from (vi), then provide the information required by subsection (c)
				  relating to extraordinary dividend and distribution.
(5) Earned surplus, defined as the unassigned
				  funds (surplus), must be greater than the current dividend or distribution
				  amount stated in (4)(A)(i) of this subsection. Earned surplus must be
				  calculated as of the most recent financial information available.
(6) Supporting documentation of the balance
				  sheet, summary of operations including capital and surplus account, and cash
				  flow statement of the most recently filed monthly, quarterly, or annual
				  statement, together with documentation to support the standards specified in
				  Insurance Code §
											823.008.
(7) Additional requirements are as follows:
(A) Identify property, including bank
				  accounts, to be used to pay the dividend or distribution or to be converted to
				  pay the dividend or distribution.
(B) Provide insurer's ratio of net written
				  premium to capital and surplus for 12 months as of the end of the last calendar
				  year. In addition, provide the same ratio after deducting the total amount of
				  the present dividend or distribution.
(C) Identify and describe any reason (other
				  than general business trends) that earnings are expected to decrease.
(D) Identify any investment or contribution
				  by the insurer to subsidiaries made since the last calendar year or to be made
				  in the immediate future.
(E) Give a
				  brief statement as to the effect upon the insurer's capital and surplus or
				  HMO's net worth and the reasonableness of remaining capital and surplus or net
				  worth after payment of dividend or distribution in relation to the insurer's
				  outstanding liabilities and the adequacy of capital and surplus or net worth
				  relative to the insurer's financial needs.
(8) Certification that there has been no
				  material adverse change in the financial condition of the insurer since the
				  date of the most recent financial statement filed with the department and the
				  payment of the dividend or distribution does not adversely affect the interest
				  of policyholders.
(9) Certification
				  that the declaration or payment of the dividend or distribution does not
				  violate any of the provisions of Insurance Code Chapter 403 or §841.253,
				  as applicable, and that the amount of the dividend or distribution declared was
				  calculated based on the amount of cash and the current fair market value of any
				  other property to be paid or distributed.
(10) Signature.
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