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Texas Department of Insurance
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Financial Analysis

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TDI Form Number Description File Format Language
FIN111

Health Entities Checklist

Filing requirements

PDF English
FIN117

TDI Instructions for Filing CPA Audited Financial Reports

PDF English
FIN119

Life, Accident and Health Insurers

Filing requirements

PDF English
FIN122

Property & Casualty Insurers Filing Requirements Checklist

Filing requirements

PDF English
FIN127

Title Checklist

Filing requirements

PDF English
FIN128

Annual Statement Blank - Farm Mutual Companies

EXCEL English
FIN128

Annual Statement Blank - Farm Mutual Companies

PDF English
FIN138

Texas Supplemental A for County Mutuals Form

Texas Supplemental "A" for County Mutuals Form

PDF English
FIN145

Notice of intent to relocate books and records outside of Texas

Form TDI BR-93

PDF English
FIN244

CPA Audited Financial Report - Intent Form

Register a CPA to file an audited financial report

PDF English
FIN246

Affidavit for Exemption from Filing CPA Audited Financial Report

CPA Exemption Form

PDF English
FIN251

Annual Statement Blank - Mutual Assessments, Burials, LMAs

EXCEL English
FIN251

Annual Statement Blank - Mutual Assessments, Burials, LMAs

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
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
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
FIN403

CCRC Release Escrow Checklist

PDF English
FIN584

Form D Application - Prior Notice of Transaction

PDF English
FIN585

Service Agreement Checklist

Management, Service, Cost Sharing, Tax Allocation, Rental, Lease Agreement Checklist

PDF English
FIN586

MGA Contract Review Checklist

Managing General Agency Contract Review Checklist

PDF English
FIN587

TPA Contract Review Checklist

Third Party Administrator Contract Review Checklist

PDF English
FIN588

Custodial Agreement Review Checklist

PDF English
FIN590

Financial Analysis Fee Transmittal Form

for MEWAs and CCRCs

PDF English
FIN599

Cybersecurity Checklist

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
FIN609

Annual Verification of Fidelity Bond Coverage (HMO Employee)

PDF English
FIN610

Annual Verification of Fidelity Bond Coverage (management contractor employees)

PDF English

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