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Holding Company System Filing Instructions & Forms

Holding Company System

Filing Instructions & Forms

(IC 27-1-23 et al)



Form A - Statement Regarding the Acquisition of Control of or Merger with a Domestic Insurer

Form B - Insurance Holding Company System Annual Registration Statement

Form C - Summary of Changes to Registration Statement

Form D - Prior Notice of a Transaction

Form E - Pre-Acquisition Notification Form

Form F - Enterprise Risk Report



The information requested in the preceding should be delivered to the following:

Chief Financial Examiner
Indiana Department of Insurance
311 West Washington Street, Suite 103
Indianapolis, Indiana 46204-2787


Any questions may be directed to:


Life & Health, Fraternal, HMO & LSHMO

Amanda Denton


(317) 232-1369


P & C and Title

Pam Walters


(317) 232-5331