Proxies, Consents, Authorizations and Disclosure Requirements

PURPOSE: This rule provides for the regulation of proxies, consents and authorizations of domestic stock insurance companies in Missouri in order to maintain state regulation of insurance. Domestic stock insurance companies are exempt from Securities and Exchange Commission regulations on condition that—a) they file annual statements with their domiciliary insurance department, b) statutory regulation of insider trading activities be enacted in each state and c) proxy rules substantially similar to those of the Securities and Exchange Commission be adopted. The provisions of this rule are substantially similar to those rules. This rule was adopted pursuant to the provisions of section 374.045, RSMo, implementing and effectuating section 375.191, RSMo. (1) Application of Rule. This rule is applicable to each domestic stock insurer which has any class of equity security held by record by one hundred (100) or more persons; provided, however, that this rule shall not apply to any insurer if ninety-five percent (95%) or more of its equity securities are owned or controlled by a parent or an affiliated insurer and the remaining securities are held of record by fewer than five hundred (500) persons. A domestic stock insurer which files with the Securities and Exchange Commission (SEC) forms of proxies, consents and authorizations complying with the requirements of the Securities Exchange Act of 1934 and the applicable regulations promulgated shall be exempt from the provisions of this rule with respect to any class of securities subject to SEC jurisdiction. (2) Proxies, Consents and Authorizations. No domestic stock insurer or any director, officer or employee of the insurer subject to section (1) or any other person shall solicit or permit the use of his/her name to solicit by mail or otherwise, any proxy, consent or authorization in respect to any class of equity security of the insurer held of record by one hundred (100) or more persons in contravention of this rule and Schedules A and B annexed and made a part of this rule. (3) Disclosure of Equivalent Information. (A) Unless proxies, consents or authorizations in respect to any class of equity security of a domestic insurer subject to section (1) are solicited by or on behalf of the management of the insurer from the holders of record of the security in accordance with this rule and the schedules in this rule prior to any annual or other meeting of the security holders, the insurer, in accordance with this rule, shall file with the director and transmit to all security holders of record information substantially equivalent to the information which would be required to be transmitted if a solicitation were made. The insurer shall transmit a written information statement containing the information specified in subsection (5)(D) to every security holder who is entitled to vote in regard to any matter to be acted upon at the meeting and from whom a proxy is not solicited on behalf of the management of the insurer; provided, that in the case of a class of securities in unregistered or bearer form, the statement need be transmitted only to those security holders whose names and addresses are known to the insurer. (4) Definitions. (A) The definitions and instructions set out in Schedule SIS, as promulgated by the National Association of Insurance Commissioners and as furnished annually by the Department of Commerce and Insurance to insurers, shall be applicable for purposes of this rule. (B) For purposes of this rule, the terms solicit and solicitation shall include: 1. Any request for a proxy, whether or not accompanied by or included in a form of proxy; 2. Any request to execute, not to execute or to revoke a proxy; or 3. The furnishing of a form of proxy or other communication to security holders under circumstances reasonably calculated to result in the procurement, withholding or revocation of a proxy. (C) The terms solicit and solicitation shall not include: 1. Any solicitation by a person in respect to securities of which s/he is the beneficial owner; 2. Action by a broker or other person in respect to securities carried in his/her name or in the name of his/her nominee in forwarding to the beneficial owner of the securities soliciting material received from the insurer or impartially instructing the beneficial owner to forward a proxy to the person, if any, to whom the beneficial owner desires to give a proxy or impartially requesting instructions from the beneficial owner with respect to the authority to be conferred by the proxy and stating that a proxy will be given if the instructions are received by a certain date; and 3. The furnishing of a form of proxy to the security holder upon the unsolicited request of the security holder or the performance by any person of ministerial acts on behalf of a person soliciting a proxy. (5) Information to be Furnished to Security Holders. (A) No solicitation subject to this rule shall be made unless each person solicited is concurrently furnished or previously has been furnished with a written proxy statement containing the information specified in Schedule A. (B) If the solicitation is made on behalf of the management of the insurer and relates to an annual meeting of security holders at which directors are to be elected, each proxy statement furnished pursuant to subsection (5)(A) shall be accompanied or preceded by an annual report (in preliminary or final form) to the security holders containing the financial statements for the last fiscal year as are referred to in Schedule SIS under the heading—“Financial Reporting to Stockholders.” Subject to the previously mentioned requirements with respect to financial statements, the annual report to security holders may be in any form deemed suitable by the management. (C) Two (2) copies of each report sent to the security holders pursuant to this section shall be mailed to the director not later than the date on which the report is first sent or given to security holders or the date on which preliminary copies of solicitation material are filed with the director pursuant to subsection (5)(A), whichever date is later. (D) If no solicitation is being made by management of the insurer with respect to any annual or other meeting, the insurer shall mail to every current security holder of record, to arrive at least twenty (20) days prior to the meeting date, an information statement as required by section (3), containing the information called for by all of the items of Schedule A, other than 1, 3 and 4, which would be applicable to any matter to be acted upon at the meeting if proxies were to be solicited in connection with the meeting. If the information statement relates to an annual meeting at which directors are to be elected, it shall be accompanied by an annual report to the security holders in the form provided in subsection (5)(B). (6) Requirements as to Proxy and Information Statement. (A) The form of proxy shall indicate in bold-face type whether or not the proxy is solicited on behalf of the management, shall provide a specifically designated blank space for dating the proxy and shall identify clearly and impartially each matter or group of related matters intended to be acted upon, whether proposed by the management or security holders. No reference need be made to proposals as to which discretionary authority is conferred pursuant to subsection (6)(C). (B) Means shall be provided in the proxy or the person solicited to specify by ballot a choice between approval or disapproval of each matter or group of related matters referred to other than elections to office. A proxy may confer discretionary authority with respect to matters as to which a choice is not so specified if the form of proxy states in bold-face type how it is intended to vote the shares or authorization represented by the proxy in each case. 1. A form of proxy which provides both for elections to office and for action on other specified matters shall be prepared so as to clearly provide, by box or otherwise, means by which the security holder may withhold authority to vote for elections to office. 2. Any form of proxy which is executed by the security holder in a manner as not to withhold authority to vote for elections to office shall be deemed to grant that authority, provided the form of proxy so states in boldface type. (C) A proxy may confer discretionary authority with respect to other matters which may come before the meeting, provided the persons on whose behalf the solicitation is made are not aware a reasonable time prior to the time the solicitation is made that any other matters are to be presented for action at the meeting and provided further that a specified statement to that effect is made in the proxy statement or in the form of proxy. (D) No proxy shall confer authority to vote for the election of any person to any office for which a bona fide nominee is not named in the proxy statement or to vote; at any annual meeting other than the next annual meeting (or any adjournment) to be held after the date on which the proxy statement and form of proxy are first sent or given to security holders. (E) The proxy statement or form of proxy shall provide, subject to reasonable specified conditions, that the proxy will be voted and that where the person solicited specifies, by means of the ballot provided pursuant to subsection (6)(B), a choice with respect to any matter to be acted upon, the vote will be in accordance with the specifications so made. (F) The information included in the proxy statement or information statement shall be clearly presented and the statements made shall be divided into groups according to subject matter, with appropriate headings. All printed proxy statements or information statements shall be clearly and legibly presented. (7) Material Required to be Filed. (A) Two (2) preliminary copies of the information statement or proxy statement and form of proxy and any other soliciting material to be furnished to security holders concurrently shall be filed with the director at least ten (10) days prior to the date definitive copies of the material are first sent or given to security holders or the shorter period prior to that date as the director may authorize upon a showing of good cause. (B) Two (2) preliminary copies of any additional soliciting material relating to the same meeting or subject matter to be furnished to security holders subsequent to the proxy statements shall be filed with the director at least two (2) days (exclusive of Saturdays, Sundays or holidays) prior to the date copies of this material are first sent or given to security holders or a shorter period Company Regulation prior to the date as the director may authorize upon a showing of good cause. (C) Two (2) definitive copies of the information statement or the proxy statement, form of proxy and all other soliciting material, in the form in which this material is furnished to security holders, shall be filed with or mailed for filing to, the director not later than the date material is first sent or given to the security holders. (D) Where any information statement or proxy statement, form of proxy or other material filed pursuant to this rule is amended or revised, two (2) of the copies shall be marked to clearly show these changes. (E) Copies of replies to inquiries from security holders requesting further information and copies of communications which do no more than request that forms of proxy solicited be signed and returned need not be filed pursuant to this section. (F) Notwithstanding the provisions of subsections (7)(A) and (B) and (10)(E), copies of soliciting material in the form of speeches, press releases and radio or television scripts may be filed, but need not, with the director prior to use or publication. Definitive copies, however, shall be filed with or mailed for filing to the director as required by subsection (7)(C) not later than the date that material is used or published. The provisions of subsections (7)(A) and (B) and (10)(E) shall apply, however, to any reprints or reproductions of all or any part of that material. (8) False or Misleading Statements. No proxy statement, form of proxy, notice of meeting information statement or other communication, written or oral, subject to this rule, shall contain any statement which, at the time and in the light of the circumstances under which it is made, is false or misleading with respect to any material fact or which omits to state any material fact necessary in order to make the statements not false or misleading or necessary to correct any statement in any earlier communication with respect to the same meeting or subject matter which has become false or misleading. (9) Prohibition of Certain Solicitations. No person making a solicitation which is subject to this rule shall solicit any undated or postdated proxy or any proxy which provides that it shall be deemed to be dated as of any date subsequent to the date on which it is signed by the security holder. (10) Special Provisions Applicable to Election Contest. (A) Applicability. This section shall apply to any solicitation subject to this rule by any person or group for the purpose of opposing a solicitation subject to this rule by any other person or group with respect to the election or removal of directors at any annual or special meeting of security holders. (B) Participant or Participant in a Solicitation. 1. For purposes of this section, the terms participant and participants in a solicitation include: the insurer; any director of the insurer and any nominee for whose election as a director proxies are solicited; or any other person, acting alone or with one (1) or more other persons, committees or groups, in organizing, directing or financing the solicitation. 2. For the purposes of this section, the terms participant and participant in a solicitation do not include: a bank, broker or dealer who, in the ordinary course of business, lends money or executes orders for the purchase or sale of securities and who is not otherwise a participant; any person or organization retained or employed by a participant to solicit security holders or any person who merely transmits proxy soliciting material or performs ministerial or clerical duties; any person employed in the capacity of attorney, accountant or advertising, public relations or financial adviser and whose activities are limited to the performance of his/her duties in the course of the employment; any person regularly employed as an officer or employee of the insurer or any of its subsidiaries or affiliates who is not otherwise a participant; or any officer or director of or any person regularly employed by any other participant, if the officer, director or employee is not otherwise a participant. (C) Filing of Information Required by Schedule B. 1. No solicitation subject to this section shall be made by any person other than the management of an insurer unless, at least five (5) business days prior to the solicitation or a shorter period as the director may authorize upon a showing of good cause, there has been filed, with the director by or on behalf of each participant in the solicitation, a statement in duplicate containing the information specified by Schedule B and a copy of any material proposed to be distributed to security holders in furtherance of that solicitation. Where preliminary copies of any materials are filed, distribution to security holders should be deferred until the director’s comments have been received and complied with. 2. Within five (5) business days after a solicitation subject to this section is made by the management of an insurer or a longer period as the director may authorize upon a showing of good cause, there shall be filed with the director by or on behalf of each participant in that solicitation, other than the insurer and by or on behalf of each management nominee for director, a statement in duplicate containing the information specified by Schedule B. 3. If any solicitation on behalf of management or any other person has been made or if proxy material is ready for distribution, prior to a solicitation subject to this section in opposition thereto, a statement in duplicate containing the information specified in Schedule B shall be filed with the director, by or on behalf of each participant in the prior solicitation, other than the insurer, as soon as reasonably practicable after the commencement of the solicitation in opposition thereto. 4. If, subsequent to the filing of the statements required by paragraphs (10)(C)1.– 3., additional persons become participants in a solicitation subject to this section, there shall be filed with the director, by or on behalf of each person, a statement in duplicate containing the information specified by Schedule B within three (3) business days after the person becomes a participant or a longer period as the director may authorize upon a showing of good cause. 5. If any material change occurs in the facts reported in any statement filed by or on behalf of any participant, an appropriate amendment in the statement shall be filed promptly with the director. 6. Each statement and amendment filed pursuant to this subsection shall be part of the public files of the director. (D) Solicitations Prior to Furnishing Required Proxy Statement. Notwithstanding the provisions of subsection (5)(A), a solicitation subject to this section may be made prior to furnishing security holders a written proxy statement containing the information specified in Schedule A with respect to the solicitation; provided, that— 1. The statement required by subsection (10)(C) is filed by or on behalf of each participant in the solicitation; 2. No form of proxy is furnished to security holders prior to the time the written proxy statement required by subsection (5)(A) is furnished to those persons. Provided, however, that paragraph (10)(D)2. shall not apply where a proxy statement then meeting the requirements of Schedule A has been furnished to security holders; 3. At least the information specified in paragraphs (10)(C)2. and 3. to be filed by each participant or an appropriate summary are included in each communication sent or given to security holders in connection with the solicitation; and 4. A written proxy statement containing Company Regulation the information specified in Schedule A with respect to a solicitation is sent or given security holders at the earliest practicable date. (E) Solicitations Prior to Furnishing Required Written Proxy Statement—Filing Requirements. Two (2) copies of any soliciting material proposed to be sent or given to security holders prior to the furnishing of the written proxy statement required by subsection (5)(A) shall be filed with the director in preliminary form at least five (5) business days prior to the date definitive copies of the material are first sent or given to those persons or a shorter period as the director may authorize upon a showing of good cause. (F) Application of This Section to Annual Report. Notwithstanding the provisions of subsections (5)(B) and (C), two (2) copies of any portion of the annual report referred to in subsection (5)(B) which comments upon or refers to any solicitation subject to section (10) or to any participant in any this solicitation, other than the solicitation by the management, shall be filed with the director, as proxy material subject to regulation. That portion of the report shall be filed with the director, in preliminary form, at least five (5) business days prior to the date copies of the report are first sent or given to security holders. AUTHORITY: sections 374.045 and 375.191, RSMo 1986.* This rule was previously filed as 4 CSR 190-10.020. This version of rule filed Dec. 8, 1965, effective Dec. 31, 1965. Amended: Filed Dec. 5, 1969, effective Dec. 15, 1969. Amended: Filed Aug. 5, 1974, effective Aug. 15, 1974. Non-substantive change filed Sept. 11, 2019, published Oct. 31, 2019. *Original authority: 374.045, RSMo 1967 and 375.191, RSMo 1939, amended 1967. Schedule A Information Required in Proxy Statement or Information Statement Item 1. Revocability of Proxy. State whether or not the person giving the proxy has the power to revoke it. If the right of revocation before the proxy is exercised, is limited or is subject to compliance with any formal procedure, briefly describe the limitation or procedure. Item 2. Dissenter’s Rights of Appraisal. Outline briefly the rights of appraisal or similar rights of dissenting security holders with respect to any matter to be acted upon and indicate any statutory procedure required to be followed by the security holders in order to perfect their rights. Where the rights may be exercised only within a limited time after the date of the adoption of a proposal, the filing of a charter amendment or other similar act, state whether the person solicited will be notified of that date. Item 3. Persons Making Solicitations Not Subject to Section 10. (a) If the solicitation is made by the management of the insurer, so state. Give the name of any director of the insurer who has informed the management in writing that s/he intends to oppose any action intended to be taken by the management and indicate the action which s/he intends to oppose. (b) If the solicitation is made otherwise than by the management of the insurer, state the names and addresses of the persons by whom and on whose behalf it is made and the names and addresses of the persons by whom the cost of solicitation has been or will be borne, directly or indirectly. (c) If the solicitation is to be made by specially engaged employees or paid solicitors, state the material features of any contract or arrangement for this solicitation and identify the parties and the cost or anticipated cost of the solicitation. Item 4. Interest of Certain Persons in Matters to be Acted Upon. Describe briefly any substantial interest, direct or indirect, by security holdings or otherwise, of any director, nominee for election as director, officer and, if the solicitation is made otherwise than on behalf of management, each person on whose behalf the solicitation is made, in any matter to be acted upon, other than elections to office. Item 5. Voting Securities. (a) State, as to each class of voting securities of the insurer entitled to be voted at the meeting, the number of shares outstanding and the number of votes to which each class is entitled. (b) Give the date as of which the record list of security holders entitled to vote at the meeting will be determined. If the right to vote is not limited to security holders of record on that date, indicate the conditions under which other security holders may be entitled to vote. (c) If action is to be taken with respect to the election of directors and if the persons solicited have cumulative voting rights, make a statement that they have the rights and state briefly the conditions precedent to the exercise of the rights. Item 6. Nominees and Directors. If action is to be taken with respect to the election of directors, furnish the following information, in tabular form to the extent practicable, with respect to each person nominated for election as a director and each other person whose term of office as a director will continue after the meeting: (a) Name each such person, state when his/her term of office or the term of office for which s/he is nominee will expire and all other positions and offices with the insurer presently held by him/her and indicate which persons are nominees for election as directors at the meeting. (b) State his/her present principal occupation or employment and give the name and principal business of any corporation or other organization in which this employment is carried on. Furnish similar information as to all of his/her principal occupations or employments during the last five (5) years, unless s/he is now a director and was elected to his/her present term of office by a vote of security holders at a meeting for which proxies were solicited under this rule. (c) If s/he is or has previously been a director of the insurer, state the period or periods during which s/he has served as such. (d) State, as of the most recent practicable date, the approximate amount of each class of equity securities of the insurer or any of its parents, subsidiaries or affiliates other than directors’ qualifying shares, beneficially owned directly or indirectly by him/her. If s/he is not the beneficial owner of any such securities, make a statement to that effect. Item 7. Remuneration and Other Transactions With Management and Others. Furnish the information reported or required in Item 1. of Schedule SIS under the heading—Information Regarding Management and Directors if action is to be taken with respect to—a) the election of directors, b) any remuneration plan, contract or arrangement in which any director, nominee for election as a director or officer of the insurer will participate, c) any pension or retirement plan in which any such person will participate or d) the granting or extension to any such person of any options, warrants or rights to purchase any securities, other than warrants or rights issued to security holders, as such, on a pro rata basis. If the solicitation is made on behalf of persons other than the management, information shall be furnished only as to Item 1.A of the previously mentioned heading of Schedule SIS. Item 8. Bonus, Profit-Sharing and Other Remuneration Plans. If action is to be taken with respect to any bonus, profit-sharing or other remuneration plan, of the insurer, furnish the following information: (a) A brief description of the material features of the plan, each class of person who will participate, the approximate number of persons in each such class and the basis of participation; (b) The amounts which would have been distributable under the plan during the last calendar year to— (1) Each person named in Item 7. of this schedule; (2) Directors and officers as a group; and (3) All other employees as a group, if the plan had been in effect; and (c) If the plan to be acted upon may be amended (other than by a vote of security holders) in a manner which would materially increase the cost of the plan to the insurer or to materially alter the allocation of the benefits as between the groups specified in paragraph (b) of this item, the nature of the amendments should be specified. Item 9. Pension and Retirement Plans. If action is to be taken with respect to any pension or retirement plan of the insurer, furnish the following information: (a) A brief description of the material features of the plan, each class of persons who will participate, the approximate number of persons in each such class and the basis of such participation; (b) State—1) the approximate total amount necessary to fund the plan with respect to past services, the period over which the amount is to be paid and the estimated annual payments necessary to pay the total amount over the period, 2) the estimated annual payments to be made with respect to current services and 3) the amount of the annual payments to be made for the benefit of—i) each person named in Item 7. of this schedule, ii) directors and officers as a group and iii) employees as a group; and (c) If the plan to be acted upon may be amended (other than by a vote of security holders) in a manner which would materially increase the cost thereof to the insurer or to materially alter the allocation of the benefits as between the groups specified in subparagraph (b)(3) of this item, the nature of the amendments should be specified. Item 10. Options, Warrants or Rights. If action is to be taken with respect to the granting or extension of any options, warrants or rights (all referred to in this as warrants) to purchase securities of the insurer or any subsidiary or affiliate, other than warrants issued to all security holders on a pro rata basis, furnish the following information: (a) The title and amount of securities called for or to be called for, the prices, expiration dates and other material conditions upon which the warrants may be exercised, the consideration received or to be received by the insurer, subsidiary or affiliate for the granting or extension of the warrants and the market value of the securities called for or to be called for by the warrants, as of the latest practicable date; (b) If known, state separately the total amount of securities called for or to be called for by warrants received or to be received by the following persons, naming each person: 1) each person named in Item 7. of this schedule and 2) each other person who will be entitled to acquire five percent (5%) or more of the securities called for or to be called for by the warrants; and (c) If known, state also the total amount of securities called for or to be called for by the warrants, received or to be received by all directors and officers of the company as a group and all employees, without naming them. Item 11. Authorization or Issuance of Securities. 1. If action is to be taken with respect to the authorization or issuance of any securities of the insurer, furnish the title, amount and description of the securities to be authorized or issued. 2. If the securities are other than additional shares of common stock of a class outstanding, furnish a brief summary of the following, if applicable: dividend, voting, liquidation, preemptive and conversion rights, redemption and sinking fund provisions, interest rate and date of maturity. 3. If the securities to be authorized or issued are other than additional shares of common stock of a class outstanding, the director may require financial statements comparable to those contained in the annual report. Item 12. Mergers, Consolidations, Acquisitions and Similar Matters. 1. If action is to be taken with respect to a merger, consolidation, acquisition or similar matter, furnish in brief outline the following information: (a) The rights of appraisal or similar rights of dissenters with respect to any matters to be acted upon. Indicate any procedure required to be followed by dissenting security holders in order to perfect the rights; (b) The material features of the plan or agreement; (c) The business done by the company to be acquired or whose assets are being acquired; (d) If available, the high and low sales prices for each quarterly period within two (2) years; and (e) The percentage of outstanding shares which must be voted for the transaction before it is consummated. 2. For each company involved in a merger, consolidation or acquisition, the following financial statements should be furnished: (a) A comparative balance sheet as of the close of the last two (2) fiscal years; (b) A comparative statement of operating income and expenses for each of the last two (2) fiscal years and as a continuation of each statement, a statement of earnings per share after related taxes and cash dividends paid per share; and (c) A pro forma combined balance sheet and income and expenses statement for the last fiscal year giving effect to the necessary adjustments with respect to the resulting company. Item 13. Restatement of Accounts. If action is to be taken with respect to the restatement of an asset, capital or surplus account of the insurer, furnish the following information: (a) State the nature of the restatement and the date as of which it is to be effective; (b) Outline briefly the reasons for the restatement and for the selection of the particular effective date; and (c) State the name and amount of each account affected by the restatement and the effect of the restatement thereon. Item 14. Matters Not Required to be Submitted. If action is to be taken with respect to any matter which is not required to be submitted to a vote of security holders, state the nature of the matter, the reason for submitting it to a vote of security holders and what action is intended to be taken by the management in the event of a negative vote on the matter by the security holders. Item 15. Amendment of Charter, Bylaws or Other Documents. If action is to be taken with respect to any amendment of the insurer’s charter, bylaws or other documents as to which information is not required in previous items 1.–14., state briefly the reasons for and general effect of the amendment and the vote needed for its approval. Schedule B Information to be Included in Statements Filed by or on Behalf of a Participant (Other Than the Insurer) in a Proxy Solicitation or in an Election Contest Item 1. Insurer. State the name and address of the insurer. Item 2. Identity and Background. (a) State the following: (1) Your name and business address; and (2) Your present principal occupation or employment and the name, principal business and address of any corporation or other organization in which such employment is carried on. (b) State the following: (1) Your residence address; and (2) Information as to all material occupations, positions, offices or employments during the last ten years, giving starting and ending dates of each and the name, principal business and address of any business corporation or other business organization in which each occupation, position, office or employment was carried on. (c) State whether or not you are or have been a participant in any other proxy contest involving this company or other companies within the past ten years. If so, identify the principals, the subject matter and your relationship to the parties and the outcome. (d) State whether or not, during the past ten years, you have been convicted in a criminal proceeding (excluding traffic violations or similar misdemeanors) and, if so, give dates, nature of conviction, name and location of court and penalty imposed or other disposition of the case. A negative answer to this subitem need not be included in the proxy statement or other proxy soliciting material. Item 3. Interest in Securities of the Insurer. (a) State the amount of each class of securities of the insurer which you own beneficially, directly or indirectly. (b) State the amount of each class of securities of the insurer which you own of record but not beneficially. (c) State with respect to all securities of the insurer purchased or sold within the past two years, the dates on which they were purchased or sold and the amount purchased or sold on that date. (d) If any part of the purchase price or market value of any of the securities specified in subitem (c) is represented by funds borrowed or otherwise obtained for the purpose of acquiring or holding these securities, so state and indicate the amount of the indebtedness as of the latest practicable date. If these funds were borrowed or obtained otherwise than pursuant to a margin account or a bank loan in the regular course of business of a bank, broker or dealer, briefly describe the transaction and state the names of the parties. (e) State whether or not you are a party to any contracts, arrangements or understandings with any person with respect to any securities of the insurer, including, but not limited to, joint ventures, loan or option arrangements, puts or calls, guarantees against losses or guarantees of profits, division of losses or profits or the giving or withholding of proxies. If so, name the persons with whom such contracts, arrangements or understandings exist and give the details thereof. (f) State the amount of securities of the insurer owned beneficially, directly or indirectly, by each of your associates and the name and address of each such associate. (g) State the amount of each class of securities of any parent, subsidiary or affiliate of the insurer which you own beneficially, directly or indirectly. Item 4. General Information. (a) Describe the time and circumstances under which you became a participant in the solicitation and state the nature and extent of your activities or proposed activities as a participant. (b) Describe briefly and where practicable, state the approximate amount of any material interest, direct or indirect, of yourself and of each of your associates in any material transactions since the beginning of the company’s last fiscal year or in any material proposed transactions, to which the company or any of its subsidiaries or affiliates was or is to be a party. (c) State whether or not you or any of your associates have any arrangement or understanding with any person— (1) With respect to any future employment by the insurer or its subsidiaries or affiliates; or (2) With respect to any future transactions to which the insurer or any of its subsidiaries or affiliates will or may be a party. If so, describe such arrangement or understanding and state the names of the parties to the transactions. Item 5. Signature. The statement shall be dated and signed in the following manner: I certify that the statements made in this statement are true, complete, and correct, to the best of my knowledge and belief. ____________________________________ (Date) ____________________________________ (Signature of participant or authorized representative)