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