Financial Analysis
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| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| FIN111 |
Health Entities Checklist Filing requirements |
English | |
| FIN117 |
TDI Instructions for Filing CPA Audited Financial Reports |
English | |
| FIN119 |
Life, Accident and Health Insurers Filing requirements |
English | |
| FIN122 |
Property & Casualty Insurers Filing Requirements Checklist Filing requirements |
English | |
| FIN127 |
Title Checklist Filing requirements |
English | |
| FIN128 |
Annual Statement Blank - Farm Mutual Companies |
EXCEL | English |
| FIN128 |
Annual Statement Blank - Farm Mutual Companies |
English | |
| FIN138 |
Texas Supplemental A for County Mutuals Form Texas Supplemental "A" for County Mutuals Form |
English | |
| FIN145 |
Notice of intent to relocate books and records outside of Texas Form TDI BR-93 |
English | |
| FIN244 |
CPA Audited Financial Report - Intent Form Register a CPA to file an audited financial report |
English | |
| FIN246 |
Affidavit for Exemption from Filing CPA Audited Financial Report CPA Exemption Form |
English | |
| FIN251 |
Annual Statement Blank - Mutual Assessments, Burials, LMAs |
EXCEL | English |
| FIN251 |
Annual Statement Blank - Mutual Assessments, Burials, LMAs |
English | |
| FIN383 |
CCRC 2 - Continuing care provider CCRC 2 - Application for Approval by the Commissioner for Release of Loan Reserve Fund Escrow Account Amounts |
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 |
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 |
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 |
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 |
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 |
English | |
| FIN394 |
CCRC 11 - Notice by Provider of Repayment of Previously Released Funds to Escrow Account |
English | |
| FIN395 |
CCRC 12 - Affidavit of Repayment of Previously Released Funds to the Reserve Fund Escrow Account |
English | |
| FIN396 |
CCRC 13 - Notice of Lien |
English | |
| FIN397 |
CCRC 14 - Calculations Concerning Conditions |
English | |
| FIN403 |
CCRC Release Escrow Checklist |
English | |
| FIN584 |
Form D Application - Prior Notice of Transaction |
English | |
| FIN585 |
Service Agreement Checklist Management, Service, Cost Sharing, Tax Allocation, Rental, Lease Agreement Checklist |
English | |
| FIN586 |
MGA Contract Review Checklist Managing General Agency Contract Review Checklist |
English | |
| FIN587 |
TPA Contract Review Checklist Third Party Administrator Contract Review Checklist |
English | |
| FIN588 |
Custodial Agreement Review Checklist |
English | |
| FIN590 |
Financial Analysis Fee Transmittal Form for MEWAs and CCRCs |
English | |
| FIN599 |
Cybersecurity Checklist |
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 |
English | |
| FIN609 |
Annual Verification of Fidelity Bond Coverage (HMO Employee) |
English | |
| FIN610 |
Annual Verification of Fidelity Bond Coverage (management contractor employees) |
English |
For more information, contact: FinancialAnalysis@tdi.texas.gov