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Filing Forms A, B & D, Including Ordinary/Extraordinary Dividends and Distributions
Form A – Mergers or Acquisitions of Domestic Insurance Companies
 
Guidance:

Ohio Administrative Code 3901-3-01, which clarifies Ohio Revised Code section 3901.321.
 
Additional Forms Required to Support Filing:
 
Exceptions to T​hird-Party Verifications: Third-party verifications are not required if the acquiring party already has within its holding company system an insurance company domiciled in Ohio. Additional exceptions may be granted based upon facts and circumstances. Please contact the Office of Risk Assessment at (614) 728-1704 with related questions.
 
Filing Format:
 
  • File two signed hardcopies of each Form A filing with the department.
  • File one additional copy with the department electronically on CD ROM or diskette in portable      document format (PDF), labeled appropriately.
Note: In the event the filing of past annual statements is required, the requirement may be met by reference to the NAIC database.
 
Additional Resources:
 
Please refer to Material Transactions Review Criteria for additional information and review criteria forms designed to streamline the review process. ​
 
 
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Form B - Registration and Subsequent Filings by Insurers Under an Insurance Holding Company:
 
Guidance:

Ohio Administrative Code 3901-3-02, which clarifies ORC sections 3901.33. Also refer to ORC section 3901.37(A).
 
Additional Forms Required to Support Filing:
 
When applicable under the Administrative Code, some Form B filings require:
 
  • Biographical Affidavits on NAIC UCAA Form 11, which can be found under "Forms" at www.naic.org/industry_ucaa.htm with the following exclusions:
    • Do NOT submit UCAA Form 11 Supplemental Information exhibits with any Form B filing. They are not required.
    • Do NOT submit third-party verification of biographical information with any Form B filing. They are not required.
    • Do NOT submit "Disclosure and Authorization Concerning Background Reports" with any Form B Biographical Affidavits.  They are not required.
See Ohio Administrative Code 3901-3-02 for additional information.
 
Filing Format:
 
  • File one signed hardcopy of each Form B statement with the department.
  • File one additional copy with the department electronically on CD ROM or diskette in portable document format (PDF), labeled appropriately.
Additional Resources:
Please refer to Material Transactions Review Criteria for additional information and review criteria forms designed to streamline the review process.
 
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Ordinary/Extraordinary Dividends or Distributions:
Guidance:
ORC sections 3901.33, 3901.34(C), 3901.37(B), and see form INS7239.

Filing Format:
File one signed hardcopy with the department.

Additional Resources:
Please refer to Material Transactions Review Criteria for additional information and review criteria forms designed to streamline the review process.
 
_______________________________________________________________________________​
 
Form D - Transactions Between Affilitates:
Guidance:

Ohio Administrative Code 3901-3-03, which clarifies ORC section 3901.341. Also refer to ORC sections 3901.33, 3901.34 and 3901.37(A).​

 

Filing Format:

  • File one signed hardcopy with the Department.
  • ​File all electronic attachments as required by Ohio Administrative Code 3901-3-03(D)(2) on CD ROM or diskette in portable document format (PDF), labeled appropriately.

Additional Resources:

 

Please refer to Material Transactions Review Criteria for additional information and review criteria forms designed to streamline the review process.​

 
 
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The State of Ohio is an Equal Opportunity Employer

Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, Ohio  43215
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John Kasich, Governor | Jillian Froment, Director
General Info: 614-644-2658 | Consumer Hotline: 800-686-1526
Fraud Hotline: 800-686-1527 | OSHIIP Hotline: 800-686-1578