West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-35 - Insurance Holding Company Systems › Appendix F

Current through Register Vol. XLI, No. 28, July 12, 2024
FORM F
ENTERPRISE RISK REPORT
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 W. Va. Code
				  33-27-2(d),
				  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:
* 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 ten percent (10%) 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 such 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 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 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.