Domestic Change of Control (Form A)
Domestic Change of Control (Form A)
The chart below identifies the requirements for each Domestic Uniform State regarding a Form A filing.
Last Update: 07/17/2024
Updates to the information will be noted with a "*" next to the state name and edits will be italicized and bolded.
| State | Requirements - Mergers | Requirements - Acquisitions | Requirements - Change of Control |
|---|---|---|---|
| AL | ALA Code Section 27-29-3- Notification and Hearing Certified Articles of Merger or Merger Agreement Original Certificate of Authority or Form 15 – Affidavit of Lost Certificate of Authority Returned for the non-surviving company |
No Requirement if Domestic Insurer is Acquiring Another Party other than Notification via a Form B | Ala Code Section 27-29-3- Form A Notification and Hearing |
| AK | Contact State | Contact State | Contact State |
| AR | Ark. Code Ann. §§ 23-63-506–513 | Ark. Code Ann. §§ 23-63-506–513 | Ark. Code Ann. §§ 23-63-506–513 |
| AZ | The statement, including exhibits and all other documents filed as a part thereof, shall be filed with the Department electronically. Send to: financialfilings@difi.az.gov. Instructions are located at https://difi.az.gov/insurers/licensingregistration/acquisition-holding-…. | The statement, including exhibits and all other documents filed as a part thereof, shall be filed with the Department electronically. Send to: financialfilings@difi.az.gov. Instructions are located at https://difi.az.gov/insurers/licensingregistration/acquisition-holding-…. | The statement, including exhibits and all other documents filed as a part thereof, shall be filed with the Department electronically. Send to: financialfilings@difi.az.gov. Instructions are located at https://difi.az.gov/insurers/licensingregistration/acquisition-holding-…. |
| CA | Merger (ca.gov) | Holding Company Act (ca.gov) | Pre-notification. Insurers are required to submit new Biographical Affidavits and fingerprint cards and may also be required to file Form 700(c). |
| CO | See Colorado Regulation 3-4-1 (same for all three scenarios) | See Colorado Regulation 3-4-1 (same for all three scenarios) | See Colorado Regulation 3-4-1 (same for all three scenarios) |
| CT | Form A Application | Form A Application | Form A Application |
| DE | Send email to BERG@Delaware.gov referencing the request | Send email to BERG@Delaware.gov referencing the request | Send email to BERG@Delaware.gov referencing the request |
| DC | DC Code § 31-703, 704 and 737. | DC Code § 31-703, 704 and 737. | DC Code § 31-703, 704 and 737. |
| *FL | Sections 628.451 and 628.461, Florida Statutes | Section 628.461, Florida Statutes | Section 628.461, Florida Statutes |
| GA | Follows the Form A filing requirements; $5,000 fee | Follows the Form A filing requirements; $5,000 fee | Follows the Form A filing requirements; $5,000 fee |
| HI | Contact state for requirements. | Contact state for requirements. | Contact state for requirements. |
| ID | Yes | Yes | Yes |
| IL | Article X of the Illinois Insurance Code | Article VIII 1/2 of the Illinois Insurance Code | Article VIII 1/2 of the Illinois Insurance Code |
| IN | IC 27-1-9 | IC 27-1-23 | IC 27-1-23 |
| IA | IA Code Chapter 521A | IA Code Chapter 521A | IA Code Chapter 521A |
| KS | A person required to file a statement pursuant to K.S.A. 40-3304, and amendments thereto, shall furnish the required information on Form A in accordance with the Department's Policy and Procedure Providing Insurance Holding Company System Reporting Forms and Instructions, dated September 15, 2020, as adopted by K.A.R. 40-1-28. Such person shall also furnish the required information on Form E. | A person required to file a statement pursuant to K.S.A. 40-3304, and amendments thereto, shall furnish the required information on Form A in accordance with the Department's Policy and Procedure Providing Insurance Holding Company System Reporting Forms and Instructions, dated September 15, 2020, as adopted by K.A.R. 40-1-28. Such person shall also furnish the required information on Form E. | A person required to file a statement pursuant to K.S.A. 40-3304, and amendments thereto, shall furnish the required information on Form A in accordance with the Department's Policy and Procedure Providing Insurance Holding Company System Reporting Forms and Instructions, dated September 15, 2020, as adopted by K.A.R. 40-1-28. Such person shall also furnish the required information on Form E. |
| KY | Contact state for requirements. | Contact state for requirements. | Contact state for requirements. |
| LA | Form A Application (www.ldi.la.gov) | Form A Application (www.ldi.la.gov) | Form A Application (www.ldi.la.gov) |
| ME | Contact state for requirements. | Contact state for requirements. | Contact state for requirements. |
| MD | A Form A statement must be filed 60 days before a transaction is proposed to become effective. Pre-acquisition notice (Form E) must be filed 30 days before the transaction is proposed to become effective. | A Form A statement must be filed 60 days before a transaction is proposed to become effective. Pre-acquisition notice (Form E) must be filed 30 days before the transaction is proposed to become effective. | A Form A statement must be filed 60 days before a transaction is proposed to become effective. Pre-acquisition notice (Form E) must be filed 30 days before the transaction is proposed to become effective. |
| MA | Contact state for requirements. | Contact state for requirements. | Contact state for requirements. |
| MI | Petition to merge must be filed pursuant § 500.7604 of the Michigan Insurance Code. | Form A Statement must be filed pursuant to § 500.1311 of the Michigan Insurance Code. | Form A Statement must be filed pursuant to § 500.1311 of the Michigan Insurance Code. |
| MN | Approval required of domestic insurer. Contact state department for requirements at insurance.commerce@state.us. | Approval required of domestic insurer. Contact state department for requirements at insurance.commerce@state.us. | Approval required of domestic insurer. Contact state department for requirements at insurance.commerce@state.us. |
| MS |
See Mississippi Insurance Department Regulation |
See Mississippi Insurance Department Regulation |
See Mississippi Insurance Department Regulation |
| MO | See sections 382.040-382.060, RSMo and 20 CSR 200-11.101 | See sections 382.040-382.060, RSMo and 20 CSR 200-11.101 | See sections 382.040-382.060, RSMo and 20 CSR 200-11.101 |
| MT | Contact Montana CSI (406) 444-2040 | Contact Montana CSI (406) 444-2040 | Contact Montana CSI (406) 444-2040 |
| NE | Notification of all acquisitions and mergers is required pursuant Neb. Rev. Stat. §44-224.04 and/or Neb. Rev. Stat. §44-2120 to 44-2153. Contact Lindsay Crawford for additional information about filing requirements: Lindsay.crawford@nebraska.gov | Notification of all acquisitions and mergers is required pursuant Neb. Rev. Stat. §44-224.04 and/or Neb. Rev. Stat. §44-2120 to 44-2153. Contact Lindsay Crawford for additional information about filing requirements: Lindsay.crawford@nebraska.gov | Notification of all acquisitions and mergers is required pursuant Neb. Rev. Stat. §44-224.04 and/or Neb. Rev. Stat. §44-2120 to 44-2153. Contact Lindsay Crawford for additional information about filing requirements: Lindsay.crawford@nebraska.gov |
| NV | Contact state for requirements. | Contact state for requirements. | Contact state for requirements. |
| NH | RSA 401B:3 Acquisition of Control of or Merger With Domestic Insurer | RSA 401B:3 Acquisition of Control of or Merger With Domestic Insurer | RSA 401B:3 Acquisition of Control of or Merger With Domestic Insurer |
| NJ |
The New Jersey Insurance Holding Company Systems Act, N.J.S.A. 17:27A–1 et seq., and implementing rules, N.J.A.C. 11:1–35 et seq., set forth the standards and requirements for the acquisition of control of a New Jersey domestic insurer and the operations of insurance holding company systems. Submit inquiries pertaining to the filing of a Form A to: NJFormAfilings@dobi.nj.gov Guidelines for the filing of a Form A Statement: https://www.nj.gov/dobi/division_insurance/finexam.htm |
Also N.J.S.A. 17:27A–1 et seq., and implementing rules, N.J.A.C. 11:1–35 et seq. | Also N.J.S.A. 17:27A–1 et seq., and implementing rules, N.J.A.C. 11:1–35 et seq. |
| NM |
Office of Superintendent of Insurance Or overnight delivery to: |
Victoria A. Baca Ursula Almada |
|
| NY | https://myportal.dfs.ny.gov/web/guest-applications/acq-merger | https://myportal.dfs.ny.gov/web/guest-applications/acq-merger | The application for acquisition of control must comply with section 1506 of the Insurance law and Regulation 52 Subpart 52 80-1. The application for acquisition of control shall be in the form specified in section 80-1.6 of regulation 52 and include all the required information/documents specified in that section. For financial statements, the Department requires submission of the following: audited financial statements of the ultimate controlling person(s) for the preceding five years and unaudited financial information regarding the earnings and financial condition of the ultimate controlling person(s) as of a date not earlier than 90 days prior to the filing of the application for acquisition of control. The department also requires the submission of an acquisition commitment letter. The company should not submit biographical affidavits and IdentiGo pre-enrollment forms with the application. The company should not print out the pre-enrollment forms until instructed by the department. The department will notify the company when and how to submit these documents after the application is received. The Department reserves the right to request hard copies of the documents submitted with the application. If the change in control is within a group and the ultimate controlling person remains the same, an exemption may be requested. Notice of change of control is subject to Section 1506(e) of the NYIL. All copies should be submitted to the appropriate NYDFS portal which should be indicated on the NYDFS website. https://myportal.dfs.ny.gov/web/guest-applications/acq-merger. |
| NC | Contact state for requirements. | Contact state for requirements. | Contact state for requirements. |
| ND |
File Form A in accordance with N.D.C.C. § 26.1-10-03 Contact Chief Examiner Matt Fischer for additional information. |
File Form A in accordance with N.D.C.C. § 26.1-10-03 Contact Chief Examiner Matt Fischer for additional information. |
File Form A in accordance with N.D.C.C. § 26.1-10-03 Contact Chief Examiner Matt Fischer for additional information. |
| OH | Filing required. | Filing required if acquisition exceeds 10% of the voting stock of the entity being acquired. | Filing required. |
| OK | Contact state for requirements. | Contact state for requirements. | Contact state for requirements. |
| OR | Contact state for requirements. | Contact state for requirements. | Contact state for requirements. |
| PA | $2,500 filing fee. It is highly recommended that applicants meet with PID personnel in advance of filing an application. | $2,500 filing fee. It is highly recommended that applicants meet with PID personnel in advance of filing an application. | $2,500 filing fee. It is highly recommended that applicants meet with PID personnel in advance of filing an application. |
| PR | Must comply with Chapter 44 and submit Form E and once approve Form A must be submitted for review and approval for the Department. | Must comply with Chapter 44 and submit Form E and once approve Form A must be submitted for review and approval for the Department. | Must comply with Chapter 44 and submit Form E and once approve Form A must be submitted for review and approval for the Department. |
| RI | Approval by RI Insurance Division Required. | Approval by RI Insurance Division Required. | Approval by RI Insurance Division Required. |
| SC | S.C. Code Regs. 69-14, Chapter 21 of Title 38 of the S.C. Code. | S.C. Code Regs. 69-14, Chapter 21 of Title 38 of the S.C. Code. | S.C. Code Regs. 69-14, Chapter 21 of Title 38 of the S.C. Code. |
| SD | Email johanna.nickelson@state.sd.us to discuss. | Email johanna.nickelson@state.sd.us to discuss. | Email johanna.nickelson@state.sd.us to discuss. |
| TN | See TCA § 56-10 for a stock insurance company. Otherwise, see TCA § 56-11. | See TCA § 56-11. | See TCA § 56-11. |
| TX | Merger Checklist Required Information - FIN341 found at https://www.tdi.texas.gov/forms/fincolicense/fin341dommerge.pdf per Texas Insurance Code Chapter 824 and Texas Business Org Code Chapter 10. | Acquisition Heading, Divestiture Heading, Signature and Certification, Cybersecurity Checklist - FIN599 found at https://www.tdi.texas.gov/forms/finanalysis/fin599cybersec.pdf. Fingerprint Requirements and Instructions found at https://www.tdi.texas.gov/agent/fingerprint-instructions.html. | Not Required. |
| UT | Provide documents for each of the 14 items listed on the Form A application. | Provide documents for each of the 14 items listed on the Form A application. | Provide documents for each of the 14 items listed on the Form A application. |
| VT | Form A required 8 V.S.A. §3683. | Form A required 8 V.S.A. §3683. | Form A required 8 V.S.A. §3683. |
| VA | Approval required of domestic insurer. | Approval required of domestic insurer. | Approval required of domestic insurer. |
| WA | Merger requirements found in RCW 48.31.010. | Acquisition requirements for domestic entities found in RCW 48.31B.015. | Acquisition requirements for foreign entities found in RCW 48.31B.020. |
| WV | Domestic companies must file the Form A and Form E before the transaction is completed. | ||
| WI | Chapters 185, 193, 611, 613, and 614, Wis. Stat., describes the information which must be filed with OCI for a change in a company's status. The following provides a link to the OCI website for Application for Change in Domestic Company Status: https://oci.wi.gov/Pages/Companies/ApplicationForChangeInDomesticCompan…. |
Chapters 185, 193, 611, 613, and 614, Wis. Stat., describes the information which must be filed with OCI for a change in a company's status. The following provides a link to the OCI website for Application for Change in Domestic Company Status: https://oci.wi.gov/Pages/Companies/ApplicationForChangeInDomesticCompan…. | Chapters 185, 193, 611, 613, and 614, Wis. Stat., describes the information which must be filed with OCI for a change in a company's status. The following provides a link to the OCI website for Application for Change in Domestic Company Status: https://oci.wi.gov/Pages/Companies/ApplicationForChangeInDomesticCompan…. |
| WY | W.S. 26-44-103; See also Chapter 45 of regulations. | W.S. 26-44-103; See also Chapter 45 of regulations. | W.S. 26-44-103; See also Chapter 45 of regulations. |