Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69O - OIR - Insurance Regulation
Chapter 69O-143 - DOMESTIC INSURERS
Section 69O-143.037 - Information to Be Filed by or on Behalf of a Participant (Other Than the Insurer) in a Proxy Solicitation in an Election Contest
Universal Citation: FL Admin Code R 69O-143.037
Current through Reg. 50, No. 187; September 24, 2024
(1) Insurer. State the name and address of the insurer.
(2) Identity and Background.
(a) State the following:
1. Your name and business address.
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.
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 such 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 subparagraph need not be
included in the proxy statement or other proxy soliciting
material.
(3) Interest in Stock of the Insurer.
(a) State the amount of
each class of stock of the insurer which you own beneficially, directly or
indirectly.
(b) State the amount of
each class of stock of the insurer which you own of record but not
beneficially.
(c) State with
respect to the stock specified in paragraphs (3)(a) and (b), the amounts
acquired within the past two years, the dates of acquisition and the amounts
acquired on each date.
(d) If any
part of the purchase price or market value of any of the stock specified in
paragraph (3)(c), is represented by funds borrowed or otherwise obtained for
the purpose of acquiring or holding such stock, so state and indicate the
amount of the indebtedness as of the latest practicable date. If such funds
were borrowed or obtained otherwise than pursuant to a margin account or 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 stock of the insurer, including but not limited to joint ventures, loan or
option arrangements, puts or calls, guarantees against loss 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 stock 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 stock
of any parent, subsidiary or affiliate of the insurer which you own
beneficially, directly or indirectly.
(4) Further Matters to Be Furnished.
(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 thereto.
(5) Signature. The statement required in this section 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)
Rulemaking Authority 624.308 FS. Law Implemented 624.307(1), 628.152 FS.
New 3-18-65, Repromulgated 12-24-74, Formerly 4-17.12, 4-17.012, 4-143.037.
Disclaimer: These regulations may not be the most recent version. Florida may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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