Conn. Agencies Regs. § 38a-124-24
Any transaction which has been or shall be exempted by the commissioner from the requirements of section 38a-118 of the 1965 supplement to the general statutes shall, insofar as it is otherwise subject to the provisions of section 38a-119 of said supplement, be likewise exempted from said section 38a-119.
SCHEDULE A
CONNECTICUT INSURANCE DEPARTMENT
Hartford, Connecticut
CONNECTICUT
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed Pursuant to Section 38a-118 of the Connecticut General StatutesClick here to view imageClick here to view image
SCHEDULE A
CONNECTICUT INSURANCE DEPARTMENT
Hartford, Connecticut
CONNECTICUT
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed Pursuant to Section 38a-118 of the Connecticut General Statutes
INSTRUCTIONS
A statement on this form is required to be filed by every person who on December 31, 1965, (i) is directly or indirectly the beneficial owner of more than 10 per cent of any class of any equity security of a Connecticut domiciled stock insurance company, or (ii) is an officer, as defined by the Connecticut Insurance Commissioner, or a director of the company which is the issuer of such securities; and every person who thereafter becomes such a beneficial owner, director or officer. However, such reporting requirements shall not apply with respect to any equity securities of a domestic stock insurance company if (i) any class of its equity securities shall be registered, or shall be required to be registered, pursuant to Section 12 of the Securities Exchange Act of 1934, as amended, or (ii) such domestic stock insurance company shall not have any class of its equity securities held of record by one hundred or more persons on the last business day of the year next preceding the year in which equity securities of the company would be subject to the provisions of Sections 38a-118, 38a-119 and 38a-120 except for the provisions of subdivision (ii) of Section 38a-123.
Persons who hold any of the relationships specified in Instruction 1 on December 31, 1965, are required to file a statement within 10 days after December 31, 1965. Persons who subsequently assume any of the specified relationships are required to file a statement within 10 days after assuming such relationship.
Statements are not deemed to have been filed with the Commissioner until they have actually been received by the Commissioner.
One signed copy of each statement shall be filed with the Connecticut Insurance Commissioner, State Office Building, Hartford, Connecticut.
A separate statement shall be filed with respect to the securities of each company.
Indicate clearly the relationship of the reporting person to the company, for example, "Director," "Director and Vice President," "Beneficial owner of more than 10 per cent of the company's common stock," etc.
The information as to beneficial ownership of securities shall be given as of the date on which the event occurred which requires the filing of a statement on this form; for example, when the person whose ownership is reported became a director or officer of the company.
Persons specified in Instruction 1 above shall include information as to their beneficial ownership of all classes of equity securities of the domestic stock insurance company.
The statement of the title of a security shall be such as clearly to identify the security even though there may be only one class, for example, "Class A Common Stock," "$6 Convertible Preferred Stock," "5% Debentures Due 1965," etc.
Under "Nature of ownership," state whether ownership of the securities is "direct" or "indirect." If the ownership is indirect, i.e., through a partnership, corporation, trust or other entity, indicate, in a footnote or other appropriate manner, the name or identity of the medium through which the securities are indirectly owned. The fact that securities are held in the name of a broker or other nominee does not, of itself, constitute indirect ownership. Securities owned indirectly shall be reported on separate lines from those owned directly and also from those owned through a different type of indirect ownership.
In stating the amount of securities beneficially owned, give the face amount of debt securities or the number of shares or other units of other securities. In the case of securities owned indirectly, the entire amount of securities owned by the partnership, corporation, trust or other entity, shall be stated. The person whose ownership is reported may, if he so desires, also indicate, in a footnote or other appropriate manner, the extent of his interest in the partnership, corporation, trust or other entity.
A statement may include any additional information or explanation deemed relevant by the person filing the statement.
If the statement is filed for a corporation, partnership, trust, etc., the name of the organization shall appear over the signature of the officer or other person authorized to sign the statement. If the statement is filed for an individual, it shall be signed by him or specifically on his behalf by a person authorized to sign for him.
SCHEDULE B
CONNECTICUT INSURANCE DEPARTMENT
Hartford, Connecticut
CONNECTICUT
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
Filed Pursuant to Section 38a-118 of the Connecticut General Statutes
SCHEDULE B
CONNECTICUT INSURANCE DEPARTMENT
Hartford, Connecticut
CONNECTICUT
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
Filed Pursuant to Section 38a-118 of the Connecticut General Statutes
INSTRUCTIONS
Statements on this form are required to be filed by every person who at any time during any calendar month was (i) directly or indirectly the beneficial owner of more than 10 per cent of any class of equity securities of a Connecticut domiciled stock insurance company, or (ii) an officer, as defined by the Connecticut Insurance Commissioner, or a director of the company which is the issuer of such securities, and who during such month had any change in his beneficial ownership of any class of equity securities of such company. However, such reporting requirements shall not apply with respect to any equity securities of a domestic stock insurance company if (i) any class of its equity securities shall be registered, or shall be required to be registered, pursuant to Section 12 of the Securities Exchange Act of 1934, as amended, or (ii) such domestic stock insurance company shall not have any class of its equity securities held of record by one hundred or more persons on the last business day of the year next preceding the year in which equity securities of the company would be subject to the provisions of Section 38a-118, 38a-119 and 38a-120, except for the provisions of subdivision (ii) of Section 38a-123.
Statements are required to be filed on or before the 10th day after the end of each month in which any change in beneficial ownership has occurred. Statements are not deemed to have been filed with the Commissioner until they have actually been received by the Commissioner.
One signed copy of each statement shall be filed with the Connecticut Insurance Commissioner, State Office Building, Hartford, Connecticut.
A separate statement shall be filed with respect to the securities of each company.
Indicate clearly the relationship of the reporting person to the company; for example, "Director," "Director and Vice President," "Beneficial owner of more than 10 per cent of the company's common stock," etc.
Persons required to file statements on this form shall include in their statements all changes during the month in their beneficial ownership, and their beneficial ownership at the end of the month, of all classes of equity securities of the company.
Every transaction shall be reported even though purchases and sales during the month are equal or the change involves only the nature of ownership, for example, from direct to indirect ownership. Beneficial ownership at the end of the month of all classes of securities required to be reported shall be shown even though there has been no change during the month in the ownership of securities of one or more classes.
The statement of the title of the security shall be such as clearly to identify the security even though there may be only one class, for example, "Class A Common Stock," "$6 Convertible Preferred Stock," "5% Debentures Due 1965," etc.
The exact date (month, day and year) of each transaction shall be stated opposite the amount involved in the transaction.
In stating the amount of securities acquired, disposed of, or beneficially owned, give the face amount of debt securities or the number of shares or other units of other securities. In the case of securities owned indirectly, i.e., through a partnership, corporation, trust or other entity, the entire amount of securities involved in the transaction or owned by the partnership, corporation, trust or other entity shall be stated. The person whose ownership is reported may, if he so desires, also indicate, in a footnote or other appropriate manner, the extent of his interest in the transactions or holdings of the partnership, corporation, trust or other entity.
Under "Nature of ownership," state whether ownership of the securities is "direct" or "indirect." If the ownership is indirect, i.e., through a partnership, corporation, trust or other entity, indicate, in a footnote or other appropriate manner, the name or identity of the medium through which the securities are indirectly owned. The fact that securities are held in the name of a broker or other nominee does not, of itself, constitute indirect ownership. Securities owned indirectly shall be reported on separate lines from those owned directly and from those owned through a different type of indirect ownership.
If the transaction was with the issuer of the securities, so state. If it involved the purchase of securities through the exercise of options, so state and give the exercise price per share. If any other purchase or sale was effected otherwise than in the open market, that fact shall be indicated. If the transaction was not a purchase or sale, indicate its character; for example, gift, 5% stock dividend, etc., as the case may be. The foregoing information may be appropriately set forth in the table or under "Remarks" at the end of the table.
Statements may contain any additional information or explanation deemed relevant by the person filing the statement.
If the statement is filed for a corporation, partnership, trust, etc., the name of the organization shall appear over the signature of the officer or other person authorized to sign the statement. If the statement is filed for an individual, it shall be signed by him or specifically on his behalf by a person authorized to sign for him.
Conn. Agencies Regs. § 38a-124-24