A Form A must be certified. The information required for a Form A filing includes the following:
- (1) That set forth in SDCL 58-5A-4, 58-5A-5, and 58-5A-6;
- (2) A brief description of how control is to be acquired;
- (3) A chart indicating the interrelationships between the applicant and affiliates of the applicant; the percentage of voting securities of each person owned or controlled by the applicant or by any other person; the legal entity of the applicant or affiliate; the state of domicile of the applicant and each affiliate; and whether the applicant or affiliate is subject to delinquency or reorganization proceedings, what the proceedings are, the court of jurisdiction, and the date begun. If the control of an affiliate is maintained by other than voting securities, the applicant must indicate the basis of the control. No affiliate need be identified if its total assets are equal to less than one-half of one percent of the total assets of the ultimate controlling person affiliated with the applicant;
- (4) If the consideration used for acquisition is borrowed, a description of the relationship between the borrower and the lender; the amounts to be borrowed; copies of all agreements, promissory notes, and security arrangements; and an explanation of the criteria used in determining the nature and amount of the consideration;
- (5) A list of the financial statements and exhibits that are attached in an appendix;
- (6) Any proposed employment, consultation, advisory, lease, or management contracts concerning the insurer and annual reports to the stockholders of the insurer and the applicant for the last two years; and
(7) A description of any plans for declaring any extraordinary dividends, to liquidate the insurer, to sell its assets to or merge it with any person to make any material change in its business operations or corporate structure or management.
Note: A copy of Form A may be obtained from the Division of Insurance, 124 South Euclid Avenue, 2nd Floor, Pierre, South Dakota 57501, (605) 773-3563, free of charge.
Source: 20 SDR 36, effective September 19, 1993; 25 SDR 13, effective August 9, 1998; 42 SDR 83, effective December 3, 2015.
General Authority: SDCL 58-5A-70.
Law Implemented: SDCL 58-5A-4 , 58-5A-5 , 58-5A-6 , 58-5A-70.
Prior versions effective: 1998-08-09.