Ins 6.40(12)(b)(b) Dissenters’ rights of appraisal. Outline briefly the rights of appraisal or similar rights of dissenting stockholders with respect to any matter to be acted upon and indicate any statutory procedure required to be followed by such stockholders in order to perfect their rights. Where such 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 such date. Ins 6.40(12)(c)(c) Persons making solicitations not subject to s. Ins 6.40 (11). Ins 6.40(12)(c)1.1. 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 he or she intends to oppose any action intended to be taken by the management and indicate the action which he or she intends to oppose. Ins 6.40(12)(c)2.2. 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. Ins 6.40(12)(c)3.3. If the solicitation is to be made by specially engaged employees or paid solicitors, state: Ins 6.40(12)(c)3.a.a. The material features of any contract or arrangement for such solicitation and identify the parties, and Ins 6.40(12)(d)(d) Interest of certain persons in matters to be acted upon. Describe briefly any substantial interest, direct or indirect, by stockholdings or otherwise, of any director, nominee for election for 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. Ins 6.40(12)(e)1.1. State, as to class of voting stock 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. Ins 6.40(12)(e)2.2. Give the date as of which the record list of stockholders entitled to vote at the meeting will be determined. If the right to vote is not limited to stockholders of record on that date, indicate the conditions under which other stockholders may be entitled to vote. Ins 6.40(12)(f)(f) 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: Ins 6.40(12)(f)1.1. Name each such person, state when his or her term of office or the term of office for which he or she is a nominee will expire, and all other positions and offices with the insurer presently held by him or her, and indicate which persons are nominees for election as directors at the meeting. Ins 6.40(12)(f)2.2. State his or her present principal occupation or employment and give the name and principal business of any corporation or other organization in which such employment is carried on. Furnish similar information as to all of his or her principal occupations or employments during the last 5 years, unless he or she is now a director and was elected to his or her present term of office by a vote of stockholders at a meeting for which proxies were solicited under this regulation. Ins 6.40(12)(f)3.3. If he or she is or has previously been a director of the insurer, state the period or periods during which he or she has served as such. Ins 6.40(12)(f)4.4. State, as of the most recent practicable date, the approximate amount of each class of stock of the insurer or any of its parents, subsidiaries or affiliates other than directors’ qualifying shares, beneficially owned directly or indirectly by him or her. If he or she is not the beneficial owner of any such stocks make a statement to that effect. Ins 6.40(12)(g)(g) Remuneration and other transactions with management and others. Furnish the information reported or required in item 1. of Schedule SIS — Stockholder Information Supplement (s. Ins 7.02) under the heading “Information Regarding Management and Directors” if action is to be taken with respect to: 1) the election of directors, 2) any remuneration plan, contract or arrangement in which any director, nominee for election as a director, or officer of the insurer will participate, 3) any pension or retirement plan in which any such person will participate, or 4) the granting or extension to any such person of any options, warrants or rights to purchase any stocks, other than warrants or rights issued to stockholders, 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 aforesaid heading of Schedule SIS. Ins 6.40(12)(h)(h) 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: Ins 6.40(12)(h)1.1. A brief description of the material features of the plan, each class of persons who will participate therein, the approximate number of persons in each such class, and the basis of such participation. Ins 6.40(12)(h)2.2. The amounts which would have been distributable under the plan during the last calendar year to Ins 6.40(12)(h)3.3. If the plan to be acted upon may be amended (other than by a vote of stockholders) 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 subd. 2., the nature of such amendments should be specified. Ins 6.40(12)(i)(i) Pension and retirement plan. If action is to be taken with respect to any pension or retirement plan of the insurer, furnish the following information: Ins 6.40(12)(i)1.1. A brief description of the material features of the plan, each class of persons who will participate therein, the approximate number of persons in each such class, and the basis of such participation. Ins 6.40(12)(i)2.a.a. The approximate total amount necessary to fund the plan with respect to past services, the period over which such amount is to be paid, and the estimated annual payments necessary to pay the total amount over such period; Ins 6.40(12)(i)2.b.b. The estimated annual payment to be made with respect to current services; and Ins 6.40(12)(i)2.c.c. The amount of such annual payments to be made for the benefit of each person named in par. (g), directors and officers as a group, and employees as a group. Ins 6.40(12)(i)3.3. If the plan to be acted upon may be amended (other than by a vote of stockholders) 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 par. (h) 2. c., the nature of such amendments should be specified. Ins 6.40(12)(j)(j) 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 herein as “warrants”) to purchase stock of the insurer or any subsidiary or affiliate, other than warrants issued to all stockholders on a pro rata basis, furnish the following information: Ins 6.40(12)(j)1.1. The title and amount of stock 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 stock called for or to be called for by the warrants, as of the latest practicable date. Ins 6.40(12)(j)2.2. If known, state separately the amount of stock called for or to be called for by warrants received or to be received by the following persons, naming each such person: Ins 6.40(12)(j)2.b.b. Each other person who will be entitled to acquire 5% or more of the stock called for or to be called for by such warrants. Ins 6.40(12)(j)3.3. If known, state also the total amount of stock called for or to be called for by such warrants, received or to be received by all directors and officers of the company as a group and all employees, without naming them. Ins 6.40(12)(k)1.1. If action is to be taken with respect to the authorization or issuance of any stock of the insurer, furnish the title, amount and description of the stock to be authorized or issued. Ins 6.40(12)(k)2.2. If the shares of stock 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. Ins 6.40(12)(k)3.3. If the shares of stock to be authorized or issued are other than additional shares of common stock of a class outstanding, the commissioner may require financial statements comparable to those contained in the annual report. Ins 6.40(12)(L)(L) Mergers, consolidations, acquisitions and similar matters. Ins 6.40(12)(L)1.1. If action is to be taken with respect to a merger, consolidation, acquisition, or similar matter, furnish in brief outline the following information: Ins 6.40(12)(L)1.a.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 stockholders in order to perfect such rights. Ins 6.40(12)(L)1.c.c. The business done by the company to be acquired or whose assets are being acquired. Ins 6.40(12)(L)1.d.d. If available, the high and low sales prices for each quarterly period within 2 years. Ins 6.40(12)(L)1.e.e. The percentage of outstanding shares which must approve the transaction before it is consummated. Ins 6.40(12)(L)2.2. For each company involved in a merger, consolidation or acquisition, the following financial statements should be furnished: Ins 6.40(12)(L)2.b.b. A comparative statement of operating income and expenses for each of the last 2 fiscal years and, as a continuation of each statement, a statement of earning per share after related taxes and cash dividends paid per share. Ins 6.40(12)(L)2.c.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. Ins 6.40(12)(m)(m) Restatement of accounts. If action is to be taken with respect to the restatement of any asset, capital, or surplus of the insurer, furnish the following information: Ins 6.40(12)(m)1.1. State the nature of the restatement and the date as of which it is to be effective. Ins 6.40(12)(m)2.2. Outline briefly the reasons for the restatement and for the selection of the particular effective date. Ins 6.40(12)(m)3.3. State the name and amount of each account affected by the restatement and the effect of the restatement thereon. Ins 6.40(12)(n)(n) 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 stockholders, state the nature of such matter, the reason for submitting it to a vote of stockholders and what action is intended to be taken by the management in the event of a negative vote on the matter by the stockholders. Ins 6.40(12)(o)(o) Amendment of charter, by-laws, or other documents. If action is to be taken with respect to any amendment of the insurer’s charter, by-laws or other documents as to which information is not required above, state briefly the reasons for and general effect of such amendment and the vote needed for its approval. Ins 6.40(13)(13) Information to be included in statements filed by or on behalf of a participant (other than the insurer) in a proxy solicitation in an election contest. Ins 6.40(13)(b)1.b.b. 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. Ins 6.40(13)(b)2.b.b. Information as to all material occupations, positions, offices or employments during the last 10 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. Ins 6.40(13)(b)3.3. 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 10 years. If so, identify the principals, the subject matter and your relationship to the parties and the outcome. Ins 6.40(13)(b)4.4. State whether or not, during the past 10 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. Ins 6.40(13)(c)1.1. State the amount of each class of stock of the insurer which you own beneficially, directly or indirectly. Ins 6.40(13)(c)2.2. State the amount of each class of stock of the insurer which you own of record but not beneficially. Ins 6.40(13)(c)3.3. State with respect to the stock specified in subds. 1. and 2. the amounts acquired within the past 2 years and the dates of acquisition and the amounts acquired on each date. Ins 6.40(13)(c)4.4. If any part of the purchase price or market value of any of the stock specified in subd. 3. 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. Ins 6.40(13)(c)5.5. 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. Ins 6.40(13)(c)6.6. 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. Ins 6.40(13)(c)7.7. State the amount of each class of stock of any parent, subsidiary or affiliate of the insurer which you own beneficially, directly or indirectly. Ins 6.40(13)(d)1.1. 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. Ins 6.40(13)(d)2.2. 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. Ins 6.40(13)(d)3.3. State whether or not you or any of your associates have any arrangement or understanding with any person. Ins 6.40(13)(d)3.a.a. With respect to any future employment by the insurer or its subsidiaries or affiliates; or Ins 6.40(13)(d)3.b.b. 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. Ins 6.40(13)(e)(e) 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)
Ins 6.40 HistoryHistory: Cr. Register, November, 1965, No. 119, eff. 12-1-65; corrections in (4) (a) and (12) (g) made under s. 13.93 (2m) (b) 7., Stats., Register, January, 1999, No. 517; correction in (5) (b) made under s. 13.93 (2m) (b) 7., Stats., Register October 2006 No. 610. Ins 6.41Ins 6.41 Insider trading of equity securities of domestic stock insurers. Ins 6.41(1)(a)(a) “Insurer” means any domestic insurance company with an equity security subject to the provisions of s. 611.31, Stats., and not exempt thereunder.
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