N.Y. Comp. Codes R. & Regs. tit. 11, Appendices, app 22
(cf. Subpart 81-2)
(cf. Subpart 81-2)
13. What is the admitted asset value of the subsidiary as a percentage of the parent corporation's total admitted assets as of the thirty-first day of December next preceding this report? ____________.
14. What investments that must comply with article 17 of the New York Insurance Law have been made in this subsidiary during the calendar year ending the thirty-first day of December next preceding this report? ____________.
15. Attach as Exhibit B a description of any changes, other than changes already provided for questions 8, 9, 10, 12, and 13 of the Information Report, with respect to information or material supplied in connection with the Preliminary Information Report required by section 81-2.3 of Regulation 115 or the previously filed Information Report. If a Preliminary Information Report has never been filed for this subsidiary, furnish the answer that would have been provided for question 12 of that report. A description of any change should reference the question number affected.
16. Attach as Exhibit C a chart showing as of the day of the last day of the fiscal year covered by this report the parent corporation and all of its subsidiaries indicating the percentage of voting securities owned directly or indirectly by the parent corporation and by each subsidiary listed. If ownership is through other than voting securities provide details.
17. Attach as Exhibit D as of the last day of the fiscal year covered by this report, the identities of any officer or director of the subsidiary, and the identity of any person, to the parent corporation's knowledge, who owns or owned, directly or indirectly, more than five percent of the voting securities of the securities, who owns or owned, directly or indirectly, more than a five-percent ownership interest in the subsidiary.
18. Attach as Exhibit E financial projections, for three full years and provide the identities of the persons making such projections.
19. Attach as Exhibit F financial statements of the subsidiary for the most recent fiscal year accompanied by the certificate of an independent certified public accountant to the effect that such financials present fairly the subsidiary's financial position and the results of its operations for the year then ended, in conformity with generally accepted accounting principles or with requirements of insurance or other accounting principles prescribed or permitted under the laws of the jurisdiction in which such subsidiary is organized. The first Information Report filed for the subsidiary shall contain financial statements for the three most recent years if they are available.
20. Attach as Exhibit G a copy of the most recent Annual Statement filed with the state of domicile if filling is for an insurance subsidiary not authorized to do an insurance business in this State.
21. Attach as Exhibit H a brief description of all transactions entered into during the subsidiary's next preceding fiscal year by the subsidiary with the parent corporation, or its parent, subsidiaries or affilliates (other than any transactions otherwise reported to or approved by the Superintendent under any provision of the Insurance Law) inclusive of arrangements for common management or cooperative or joint use of personnel, property or services. Transactions not deemed material, transactions in series, or numerous similar transactions, may be reported in the aggregate provided that they are reasonably described. The issuance of contracts of insurance issued in the normal course of business other than contracts of reinsurance shall not be deemed transactions hereunder. Descriptions of transactions, other than those reported in the aggregate shall include at least the following: the nature and purpose of the transaction the nature and amounts of any payments or transactions the nature and amounts of any payments or transfers of assets between the parties the identities of all parties to such transactions and whether any officers or directors of a party are pecuniarily interested therein, and copies of any contracts, agreements or memoranda of understanding (not previously filed) between the parties relating to the transaction.
22. Attach as Exhibit I a copy of the latest annual report, if any, to shareholders of the subsidiary.
23. Attach as Exhibit J a statement as to whether the investment in or acquisition of the subsidiary complies with the individual and aggregate investment limitations set forth in Article 17. Supply statistics in support thereof.
24. Are there any plans to materially change the principal business activity of the subsidiary? ____________ Yes ________ No ________.
25. Are there any plans to dispose of any significant assets of the subsidiary? ____________ Yes ________ No ________.
26. Attach as Exhibit K any additional information necessary to prevent this report from being misleading or incomplete, including events subsequent to the subsidiary's fiscal year.
27. Do you wish to except any part or parts of this filing from disclosure pursuant to paragraph (d) of section 87.2 of the Public Officers Law or Section 1709 of the Insurance Law all as permitted by section 81-2.9 of Regulation 115? ____________ Yes ________ No ________.
If answer is yes, indicate which part or parts as Exhibit L.
28. Name, title, signature and telephone number of officer responsible for preparing this report.
Name
Title
Signature
Telephone Number
FORM IR-85
N.Y. Comp. Codes R. & Regs. tit. 11, Appendices, app 22