Ohio Miscellaneous Regulatory Material DEPARTMENT OF INSURANCE BULLETINS Bulletin 94-5 Dividend/distribution reporting requirement	Effective Date April 12, 1994

Effective October 1, 1993, Section 3901.34 of the Ohio Revised Code has been amended to require any insurer subject to registration under Section 3901.33 of the Ohio Revised Code to notify the Superintendent of Insurance prior to paying any dividend or distribution. This informational notice must be made within five business days following an insurer's declaration of any dividend or distribution to its shareholders and at least ten calendar days prior to payment of such dividend or distribution. The ten calendar day period is measured from the date that the Superintendent actually receives the notice and not the date of postmark. If the tenth day is a Saturday, Sunday, or holiday, the next business day is deemed to be the tenth day.

If an insurer files a Notice of the declaration of a dividend or distribution which is incomplete, the Notice will be returned to the insurer. The ten calendar day period does not begin to run when an incomplete Notice is returned to the insurer.

Section 3901.34 of the Ohio Revised Code was also amended to provide that whenever an extraordinary dividend or distribution is paid in knowing violation of the prior notice and approval requirements of the section, the Superintendent may, subject to Chapter 119 of the Revised Code, cause an insurer to pay a civil forfeiture of not more than $250,000.00. The statute also provides that each payment of an extraordinary dividend or distribution made in violation of the reporting and approval requirements may be considered a separate offense.

In addition to any civil penalty, an insurer may be required to recapture any dividend or distribution paid if proper notice was not given to the Department, prior to the insurer refiling for approval of the dividend or distribution.

Attached as Exhibit A to this Bulletin is the format for the information an insurer should use to give notice of an ordinary or an extraordinary dividend or distribution.

Harold T. Duryee
Director of Insurance

EXHIBIT A

Ohio Department of Insurance
2100 Stella Court
Columbus, Ohio 43266- 0566
Attn: Office of Financial Regulation Services

DIVIDEND/DISTRIBUTION NOTIFICATION FILING

O.R.C. 3901.33, 3901.34(C), 3901.37(B)

Company Name ___________________________________________________________
Amount of Dividend/Distribution to be Paid $ ___________________________
Ordinary Portion $ ______________ Extraordinary Portion* $ _____________

Date Dividend/Distribution declared by Board of Directors ______________
Date Dividend/Distribution to be paid __________________________________

Describe the form** in which the dividend/distribution is to be paid
(e.g. cash, securities, etc.):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Describe the entity(ies) to receive payment: ___________________________
________________________________________________________________________

Complete Part A if the dividend/distribution is solely allocated as an ordinary dividend/distribution.

Complete Part B if any part of the dividend/distribution is allocated as an extraordinary dividend/distribution.

* A distribution (return of capital) paid from other than earned surplus shall be considered an extraordinary distribution. Earned surplus means an amount equal to an insurer's unassigned funds as set forth in its most recent annual statement submitted to the Department.

** If payment to be other than cash, provide the cost, current book value and fair market value of the asset(s) forming the payment. Provide an explanation of the basis for valuation, if other than cash.

I hereby certify that the information contained and attached herein is accurate and complete to the best of my knowledge and belief.
Name _____________
Title _____________
State of _____________
County of _____________

Subscribed and sworn to before me this ___ day of ____ , 199_ .

_____________
Notary
Public
(Seal)

My Commission Expires ________ , ___

PART A -- INFORMATIONAL FILING FOR ORDINARY DIVIDEND/DISTRIBUTION

1. Narrative as to the effect of the proposed payment upon the company's surplus and the reasonableness of the remaining surplus in relation to the company's outstanding liabilities, obligations, business writings, contingencies, and overall financial position.

2. A statutory balance sheet (use the most recently filed quarterly financial statement) showing the effect of the dividend payment.

3. A calculation* illustrating all dividends and distribution payments made during the twelve month period preceding the date that the dividend/distribution is to be paid and clearly demonstrating, using the statutory formula, the allocation of the proposed payment to the proper ordinary/extraordinary classifications.

PART B -- INFORMATIONAL FILING FOR EXTRAORDINARY DIVIDEND/DISTRIBUTION

1. Complete Part A, Part 1 and 3.

2. A pro forma statutory statement of financial position and operations for the calendar year to date period ending at the month end immediately preceding the date the dividend/distribution was declared by the Board of Directors.

* The amount representing surplus as regards policyholders is found on page 3, line 37, for life insurers and page 3, line 25 for property/casualty insurers, of their respective annual statements.

CROSS REFERENCE 3901.33; 3901.34; 3901.37

DATE NEW 1994

SUBJECT CATEGORY 360 - Filing and reporting requirements
520 - Acquisition of control
560 - Finance and investments

INDEX
Affiliated insurers and Corporate distributions and
Reporting requirements
Dividends and Affiliated insurers and Reporting requirements
Forms (documents) and Affiliated insurers and Corporate distributions
Insurance holding company systems and Corporate distributions and
Reporting requirements
Extraordinary distributions and Reporting requirements and
Affiliated insurers