Form IN-1942 "Risk Retention Group - Notice and Registration" - Tennessee

What Is Form IN-1942?

This is a legal form that was released by the Tennessee Department of Commerce and Insurance - a government authority operating within Tennessee. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 29, 2020;
  • The latest edition provided by the Tennessee Department of Commerce and Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form IN-1942 by clicking the link below or browse more documents and templates provided by the Tennessee Department of Commerce and Insurance.

ADVERTISEMENT
ADVERTISEMENT

Download Form IN-1942 "Risk Retention Group - Notice and Registration" - Tennessee

Download PDF

Fill PDF online

Rate (4.6 / 5) 18 votes
Page background image
 
 
 
 
 
 
 
 
 
 
 
RISK RETENTION GROUP
REGISTRATION PACKET
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ALL REGISTRATIONS AND FORMS CAN BE MAILED OR E-MAILED TO THE
FOLLOWING ADDRESS:
 
Tennessee Department of Commerce and Insurance
Financial Affairs Section
th
500 James Robertson Parkway, 10
Floor
Nashville, TN 37243
Foreign.RRG@tn.gov
For questions, call 615-741-1670
 
 
RRG Registration
Form IN-1942
RDA 2226
Rev. July 29, 2020
 
 
 
 
 
 
 
 
 
 
 
 
RISK RETENTION GROUP
REGISTRATION PACKET
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ALL REGISTRATIONS AND FORMS CAN BE MAILED OR E-MAILED TO THE
FOLLOWING ADDRESS:
 
Tennessee Department of Commerce and Insurance
Financial Affairs Section
th
500 James Robertson Parkway, 10
Floor
Nashville, TN 37243
Foreign.RRG@tn.gov
For questions, call 615-741-1670
 
 
RRG Registration
Form IN-1942
RDA 2226
Rev. July 29, 2020
 
 
FOREIGN RISK RETENTION GROUP NOTICE & REGISTRATION INSTRUCTIONS
This registration form is being filed by a Risk Retention Group (RRG) operating in accordance with the Federal
Liability Risk Retention Act of 1986 (LRRA), 15 United States Code 3901-3906, chartered or licensed to write only
liability insurance by the state of domicile listed in #1e of this application. The registration form and supplemental
documents are provided in accordance with §3902(d)(2) of the LRRA. Under §3902 of the LRRA, with the exception
of the domiciliary state, RRGs are exempt from any state laws, rules, regulations, or orders that would make unlawful,
or would regulate, directly or indirectly, the operation of an RRG, except that any state may require an RRG to comply
with those laws specified in §3902(a)1(A),(B),(C), and (G) of the LRRA. The domiciliary state regulates the formation
and operation of the RRG.
The LRRA, codified in Tennessee at Tennessee Code Annotated §§56-45-101 et seq. (“the Risk Retention Act”), allows
insurers authorized in one state to write liability insurance on commercial risks without being authorized or eligible in
each state in which they do business. The following explains the requirements for a risk retention group to operate in
Tennessee under the Act.
FOREIGN INSURER REQUIREMENTS: Before it may become registered in Tennessee, each insurer intending
to write in Tennessee under the Risk Retention Act must:
1. Submit the attached registration application form completed, pursuant to Tenn. Code Ann. § 56-45-104(a)(1)(A);
and
2. Submit a copy of its plan of operation or feasibility study, pursuant to Tenn. Code Ann. § 56-45-104(a)(1)(B)
If available, the following items should also be submitted with the registration application:
A copy of the group's certified financial statement, pursuant to Tenn. Code Ann. § 56-45-104(b)(1); and
A copy of each examination, pursuant to Tenn. Code Ann. § 56-45-104(b)(2).
If the registration application will be submitted electronically, please submit this completed registration application
form along with the other required and/or available documentation to: Foreign.RRG@tn.gov.
Informational note regarding premium taxes: Each risk retention group is liable for the payment of premium taxes and
taxes on premiums of direct business for risks resident or located within this state, and shall report to the commissioner
the net premiums written for risks resident or located within this state. The risk retention group is subject to taxation,
and any applicable fines and penalties related to the taxation, on the same basis as a foreign admitted insurer.
The Insurance Division of the Tennessee Department of Commerce and Insurance has implemented rules requiring
insurance companies to submit their premium tax returns and payments electronically though OPTins (Online Premium
Tax for Insurance). Contact OPTins for details at http://www.optins.org. All taxes shall be reported and payable in
OPTins on a quarterly basis with payments due on or before June 1; August 20; December 1; and March 1 as prescribed
by Tenn. Code Ann. § 56-4-205.
Page 1 of 10
STATE OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE
Form IN-1942
RRG Registration
500 James Robertson Parkway, 10
th
Fl, Nashville, TN 37243-1132
RDA 2226
Insurance Division, Financial Affairs Section
Rev. July 29, 2020
615-741-1670
 
STATE OF TENNESSEE
RISK RETENTION GROUP - NOTICE AND REGISTRATION 
(All Information Should Be Typed)
PART A 
1a.
Name of the Risk Retention Group as it appears on its Certificate of Authority:
1b.
Address of the Risk Retention Group:
____________________________________________________________________________________
____________________________________________________________________________________
1c.
NAIC Company Code:
1d.
FEIN:
1e.
State of domicile, date licensed and date chartered:
1f.
Primary contact person for state of domicile to whom questions regarding the Risk Retention
Group should be addressed (include name, phone number, and email address):
 
2.
List any other name(s) by which the Risk Retention Group is known or may be doing business
in this State or any other state:
3.
The Risk Retention Group is authorized to engage in the following lines and/or classifications
of liability insurance under the laws of its chartering State:
Page 2 of 10
STATE OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE
Form IN-1942
RRG Registration
500 James Robertson Parkway, 10
th
Fl, Nashville, TN 37243-1132
RDA 2226
Insurance Division, Financial Affairs Section
Rev. July 29, 2020
615-741-1670
 
4.
Give a general description of the liability insurance coverages the Risk Retention Group plans to
write in the state it is registering to do business in.
5.
Has the Risk Retention Group’s domiciliary state approved the Risk Retention Group to register
and expand its writings in the state in which it is seeking to become registered?
6.
Ownership of the Risk Retention Group consists of one of the following (check one):
a)
the owners of the Group are only persons who comprise the membership of the
Group and who are provided insurance by the Group.
b)
the sole owner of the Group is:
(Name and Address of Organization)
an organization which has as its members only persons who comprise the membership of
the Group and which has as its owners only persons who comprise the membership of the
Group and who are provided insurance by the Group.
7.
The Risk Retention Group members are engaged in businesses or activities similar or related with
respect to the liability to which such members are exposed by virtue of any related, similar or
common business (whether profit or nonprofit), trade, product, services (including professional
services), premises or operations. Give a general description of businesses or activities engaged
in by the Group’s members:
8.
(a) List the name, position with the Risk Retention Group, and address of each officer and
director of the Risk Retention Group: (Attach additional pages, if necessary.)
Page 3 of 10
STATE OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE
Form IN-1942
RRG Registration
500 James Robertson Parkway, 10
th
Fl, Nashville, TN 37243-1132
RDA 2226
Insurance Division, Financial Affairs Section
Rev. July 29, 2020
615-741-1670
 
(b) Identify and give the telephone number of the officer or director of the Risk Retention Group
who can be contacted for any information regarding the management of the insurance activities
of the Group:
Name:
Telephone #:
9.
List the name, address, and telephone number of the company responsible for managing the
insurance operations of the Risk Retention Group and the company contact person’s name,
telephone number, and email. (If none, answer none.)
Contact Person:
Telephone #
Email:
10.
List the name(s) NPR#, and address(es) of the licensed insurance agent(s) or broker(s) who will
be responsible for marketing the Risk Retention Group’s insurance policies in the State of
Tennessee and the current licensing status in the State of Tennessee: (If none, answer none.
Attach additional pages, if necessary.)
Name
NPR#
Address
License Status in State
Registering
11.
In accordance with the Liability Risk Retention Act, we verify the following:
A.
The Risk Retention Group is a corporation or other limited liability association whose
primary activity consists of assuming and spreading all, or any portion, of the liability
exposure of its members.
B.
The Risk Retention Group is organized for the primary purpose of conducting the activity
described under Item “A” above.
C.
The Risk Retention Group does not exclude any person from membership in the Group
solely to provide for members of the Group a competitive advantage over such a person.
Page 4 of 10
STATE OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE
Form IN-1942
RRG Registration
500 James Robertson Parkway, 10
th
Fl, Nashville, TN 37243-1132
RDA 2226
Insurance Division, Financial Affairs Section
Rev. July 29, 2020
615-741-1670
Page of 10