Instructions:
- Notarized affidavit must be returned with completed schedules no later than Nov. 16, 1998.
- Only Texas investments are to be included in this report.
- Time period covered is January 1, 1997 through December 31, 1997. Information included in Parts I and II will have been reported in the December 31, 1997 NAIC Annual Statement. Statement value should be used.
- Total Investment Schedules in Part I (Schedules A - 1, B - 1, C - 1, and D - 1) are mandatory. If you have no Texas investments in one or more of these sections, report "0" on the total line at the end of the Schedule. If you are unable to identify investments in the related Schedules A - 2, B - 2, C - 2, and D - 2, please check the "Unable to Identify" box. (Note: Computer generated reports may be used in place of the attached forms but the format, including totals for each schedule, should be followed.)
- Parts II and III (Schedules E - 1 through I - 2) are optional. If you choose not to provide information on one or more Schedules, please check the "Investments Not Reported" or "Unable to Identify" box.
- All Texas investments should be reported on the Total Investments Schedules, including any investments reported in the detailed Defined Regions Schedules.
- If you require more than one page for a Schedule, please copy the "Continuation Page" at the end of the data call and fill in the Schedule Number and Investment Type information. For example, the continuation page for Real Estate - Total Investments, should read: A-1 Real Estate - Total Investments. If more than one page submitted for a Schedule, do not provide totals for individual pages. Fill in only the Total Annual Statement Value line on the final page of the Schedule.
- If information is reported in the "Defined Region" Schedule, a detailed listing of each investment is to be included. This should include: a description of the investment; CUSIP, loan number, or other company-identifying factor; location of investment (address, city and ZIP code); and annual statement value. Investments included in Defined Regions should meet one of the three following criteria:
- a) Defined Regions Criteria: Any Texas ZIP code with a 1990 median household income of less than 75 percent of the county median income but not more than 75 percent of the state median income or any ZIP code with a median income of less than 50 percent of the state median income. A list of these ZIP codes is provided, see attached Defined Regions - ZIP Code List. An electronic copy of this table may be downloaded from the TDI website - http://www.tdi.state.tx.us - Company/Data Call page. If you do not have Internet access and would like the table on disk, please contact Karen Ranspot at 512/475-3022.)
- b) Targeted Areas Criteria: Investments in areas targeted by geo-political entities such as the federal government, Texas, a Texas county or municipality for economic development may be included in the "Defined Regions" column if the name of geo-political entity and the program are included in the investment description. Examples of targeted areas are: Houston Enhanced Enterprise Community (U.S. Department of Housing & Urban Development), Rio Grande Valley Empowerment Zone (Texas Department of Commerce) and The Union Plaza Redevelopment Program (City of El Paso).
- c) Other: Investments may be included if you provide a brief explanation of how it benefits economically disadvantaged areas or population.
Questions concerning this call should be directed to Karen Ranspot at the Texas Department of Insurance, Technical Analysis Division at 512-475-3022.
Mail the completed call form and affidavit to:
Texas Department of Insurance
Attn: Karen Ranspot (MC105-5G)
P. O. Box 149096
Austin, Texas 78714-9096
COMMUNITY INVESTMENT REPORT AFFIDAVIT
THE STATE OF
COUNTY OF
I, , the (position)
of the
being duly sworn, deposes and says that all of the information of the named Company contained herein, together with any necessary related exhibits, schedules and explanations contained, annexed or referred to are a full and true statement in accordance with the instructions provided according to the best of my information, knowledge and belief.
Signature
SUBSCRIBED AND SWORN TO BEFORE ME this the ___ day of ________________, 19___.
Notary Public
(Printed Name of Notary)
My Commission Expires:
Texas Community Investment Report Data Call
Check Appropriate Box
¨ Company Report: NAIC Co. No. _________ Co. Name _____________________
¨ Group Report: NAIC Group No. _______ Group Name_________________
(list individual company names and NAIC company numbers)
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Address: ____________________________________________
(Street)
______________________________________________
(City, State and ZIP Code)
Contact Person: _____________________________________
Telephone No. _______________________________________
Only Texas investments should be included in this report. For mortgage loans and other direct investments, this is based on the location of the property or the business, not the location of the borrower. For corporate investments, Texas companies are defined as those incorporated in or with principle place of business in Texas.
Please contact Karen Ranspot at 512-475-3022 if you have questions.
Return completed data calls with notarized affidavits by November 16, 1998 to:
Texas Department of Insurance
Karen Ranspot (MC 105-5G)
P. O. Box 149104
Austin, TX 78714-9104