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Texas Department of Insurance
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Continuing Care Retirement Communities

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TDI Form Number Description File Format Language
FIN321 Company Licensing Fee Transmittal Form
Company Licensing and Registration Fee Transmittal Form to be submitted with filings.
PDF English
FIN381 CCRC Filing Requirements for Certificate of Authority
Instructions for an entity wishing to operate as a Continuing Care Retirement Community (CCRC) in Texas
PDF English
FIN382 CCRC 1 - Application for Certificate of Authority to do Business in Texas
Continuing Care Retirement Community (CCRC) application for Certificate of Authority to do business in Texas, CCRC From #1
PDF English
FIN383 CCRC 2 - Continuing care provider
CCRC 2 - Application for Approval by the Commissioner for Release of Loan Reserve Fund Escrow Account Amounts
PDF English
FIN384 CCRC 3 - Officers and Directors Page
Continuing Care Retirement Community (CCRC) listing of all associated officers and directors, CCRC Form #3
PDF English
FIN385 CCRC 4 - Biographical Data Form for a For-Profit CCRC
Continuing Care Retirement Community (CCRC) biographical data form to be completed by any person serving as a board member for a for-profit CCRC, CCRC Form #4
PDF English
FIN386 CCRC 4A - CCRC Biographical Affidavit for a Not-For-Profit CCRC
Continuing Care Retirement Community (CCRC) biographical data form to be completed by any person serving as a board member for a Not-for-Profit CCRC, CCRC Form #4a
PDF English
FIN387 CCRC 5 - Acknowledgement of Delivery of Disclosure Statement
Continuing Care Retirement Community (CCRC) resident's acknowledgement of delivery of Disclosure Statement, CCRC Form #5
PDF English
FIN388 CCRC 6 - Format for Disclosure Statement
Continuing Care Retirement Community (CCRC) detailed instructions and format for submitting Disclosure Statement, CCRC Form #6
WORD English
FIN389 CCRC Form #6A - CCRC Instructions for Preparation of Disclosure Statement
Continuing Care Retirement Community (CCRC) instructions for preparing Disclosure Statement filing, CCRC Form #6a
PDF English
FIN390 CCRC 7 - Change of Control Statement
PDF English
FIN391 CCRC 8 - Certification of Changes to Disclosure Statement
Continuing Care Retirement Community (CCRC) certification of changes made to the Disclosure Statement, CCRC Form #8
PDF English
FIN392 CCRC 9 - Notice of Request to Release Entrance Fee Escrow Funds
Continuing Care Retirement Community (CCRC) written notice of request to release entrance fee escrow funds, CCRC Form #9
PDF English
FIN393 CCRC 10 - Notice of Request to Release Funds from the Reserve Fund Escrow Account
Continuing Care Retirement Community (CCRC) written notice of request to release funds from the reserve funds escrow account, CCRC Form #10
PDF English
FIN394 CCRC 11 - Notice by Provider of Repayment of Previously Released Funds to Escrow Account
PDF English
FIN395 CCRC 12 - Affidavit of Repayment of Previously Released Funds to the Reserve Fund Escrow Account
PDF English
FIN396 CCRC 13 - Notice of Lien
PDF English
FIN397 CCRC 14 - Calculations Concerning Conditions
PDF English
FIN398 CCRC Name Change Checklist
Continuing Care Retirement Community (CCRC) charter amendment checklist to effect a name change
PDF English
FIN403 CCRC Release Escrow Checklist
PDF English
FIN590 Financial Analysis Fee Transmittal Form
for MEWAs and CCRCs
PDF English
FIN604 CCRC 1a - Application for authority to offer continuing care in residence services
PDF English
FIN605 CCRC 6B - Format for Disclosure Statement for Continuing Care in Residence
WORD English
FIN607 CCRC 14a - Provider request for release of continuing care residence entrance fee escrow funds
PDF English

For more information, contact: CompanyLicense@tdi.texas.gov