DOCSLIB.ORG

PROASSURANCE CORP Form 8-K Current Event Report Filed 2021-08

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
PROASSURANCE CORP Form 8-K Current Event Report Filed 2021-08 SECURITIES AND EXCHANGE COMMISSION FORM 8-K Current report filing Filing Date: 2021-08-17 | Period of Report: 2021-08-17 SEC Accession No. 0001777343-21-000042 (HTML Version on secdatabase.com) FILER PROASSURANCE CORP Business Address 100 BROOKWOOD PLACE CIK:1127703| IRS No.: 631261433 | State of Incorp.:DE | Fiscal Year End: 1231 BIRMINGHAM AL 35209 Type: 8-K | Act: 34 | File No.: 001-16533 | Film No.: 211182992 2058774400 SIC: 6331 Fire, marine & casualty insurance Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 OR 15(d) of the Securities Exchange Act of 1934 Date of Report (Date of earliest event reported): August 17, 2021 ProAssurance Corporation (Exact name of registrant as specified in its charter) Delaware 001-16533 63-1261433 (State of Incorporation) (Commission File No.) (IRS Employer I.D. No.) 100 Brookwood Place, Birmingham, AL 35209 (Address of Principal Executive Office ) (Zip code) Registrant’s telephone number, including area code: (205) 877-4400 Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions: ☐ Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) ☐ Soliciting material pursuant to Rule 14a-12 under the Securities Act (17 CFR 240.14a-12) ☐ Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17CFR 240.14d-2(b)) ☐ Pre-commencement communications pursuant to Rule 13e-(c) under the Exchange Act (17CFR 240.13e-(c)) Securities registered pursuant to Section 12(b) of the Act: Title of each class Trading Symbol(s) Name of each exchange on which registered Common Stock, par value $0.01 per share PRA New York Stock Exchange Indicate by check mark whether the registrant is an emerging growth company as defined in as defined in Rule 405 of the Securities Act of 1933 (§230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§240.12b-2 of this chapter). Emerging growth company ☐ If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨ 1 Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document ITEM 7.01 REGULATION FID DISCLOSURES In this Current Report on Form 8-K we are furnishing materials from which we will begin using information during meetings and presentations starting on August 17, 2021. These materials are presented in Exhibit 99.1. ITEM 9.01 FINANCIAL STATEMENTS AND EXHIBITS 99.1 Materials which we will begin using during meetings and presentations starting August 17, 2021. We are furnishing Exhibit 99.1 to this Current Report on Form 8-K in accordance with Item 7.01, Regulation FD Disclosure. This exhibit shall not be deemed to be “filed” for the purposes of Section 18 of the Securities and Exchange Act of 1934 (the “Exchange Act”), or otherwise subject to the liability of such section, nor shall such information be deemed incorporated by reference in any filing under the Securities Act of 1933 or the Exchange Act, regardless of the general incorporation language of such filing, except as shall be expressly set forth by specific reference in such filing. SIGNATURE Pursuant to the requirements of the Securities Exchange act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized. Date: August 17, 2021 PROASSURANCE CORPORATION by: /s/ Jeffrey P. Lisenby ----------------------------------- ------------------ Jeffrey P. Lisenby General Counsel 2 Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document Second Quarter 2021 August Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document ProAssurance Overview Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document ProAssurance Investor Briefing | August 2021 3 Mission, Vision, & Values The ProAssurance Mission We exist to Protect Others. Our Shared Vision We will be the best in the world at understanding and providing solutions for the risks our customers encounter as healers, innovators, employers, and professionals. Through an integrated family of companies, products, and services, we will be a trusted partner enabling those we serve to focus on their vital work. As the employer of choice, we embrace every day as a singular opportunity to reach for extraordinary outcomes, build and deepen superior relationships, and accomplish our mission with infectious enthusiasm and unbending integrity. Corporate Values Integrity | Leadership | Relationships | Enthusiasm Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document 4ProAssurance Investor Briefing | August 2021 At a Glance All data as of 6/30/21. Office locations and employee counts include NORCAL. Business Unit Principal Offices Employees Lines of Business HCPL 11 608 Healthcare Professional Liability Medmarc 1 27 Medical Technology Liability Innovative Specialty Team 1 101 Professional Liability for Podiatrists, Chiropractors, & Dentists, and LawyerCare Eastern 9 234 Workers’ Compensation & Captive Facilities (all lines) PRA Corporate 1 117 Corporate functions (Accounting, Legal, etc.) • Healthcare-centric specialty insurance writer ◦ Specialty Property & Casualty ▪ Healthcare Professional Liability (HCPL) ▪ Life Sciences and Medical Technology Liability ▪ Innovative Specialty Team ◦ Workers' Compensation Insurance ◦ Segregated Portfolio Cell (SPC) Reinsurance ◦ Lloyd's of London Syndicates (1729 & 6131) • Total Assets: $6.4 billion • Shareholders' Equity: $1.4 billion • Claims-Paying Ratings ◦ A.M. Best: “A” (Excellent) ◦ Fitch: “A-” (Strong) • 21 locations, with operations in three countries ◦ 1,087 employees • Writing in 50 states & DC Corporate Headquarters Claims Offices Claims/Underwriting Offices Underwriting Offices Cayman Islands Lloyds Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document ProAssurance Investor Briefing | August 2021 5 ProAssurance Executive Leadership Ned Rand - President & Chief Executive Officer Mr. Rand, who assumed this position at ProAssurance on July 1, 2019, was formerly Chief Operating Officer, and has served as Chief Financial Officer, Executive Vice President, and Senior Vice President of Finance since joining ProAssurance in November of 2004. Prior to joining ProAssurance, Mr. Rand was Chief Accounting Officer and Head of Corporate Finance for PartnerRe Ltd. from 2000 - 2004. He also served as the Chief Financial Officer of Atlantic American Corporation from 1996 - 2000 and Controller of United Capitol Insurance Company from 1992 - 1996. Prior to that time, Mr. Rand was employed by Coopers & Lybrand (now PriceWaterhouseCoopers) for four years. Mr. Rand is a certified public accountant and is a graduate of Davidson College where he majored in Economics. Mike Boguski President Specialty P&C Noreen Dishart Executive Vice President & Chief Human Resources Officer Dana Hendricks Executive Vice President & Chief Financial Officer Jeff Lisenby Executive Vice President & General Counsel Kevin Shook President Workers’ Compensation & Segregated Portfolio Cell Reinsurance Executive Team bios available on our website at Investor.ProAssurance.com/OD Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document ProAssurance Investor Briefing | August 2021 6 ProAssurance Board of Directors Director bios available on our website at Investor.ProAssurance.com/OD Maye Head Frei C M. James Gorrie N/C Ziad R. Haydar, MD C Edward L. Rand, Jr E Frank A. Spinosa, DPM N/C Katisha T. Vance, MD N/C A ‐ Audit Committee C ‐ Compensation Committee E ‐ Executive Committee N/C ‐ Nominating/Corporate Governance Committee Underlined ‐ Chair Scott C. Syphax C Samuel A. Di Piazza, Jr A Fabiola Cobarrubias, MD A Bruce D. Angiolillo A, C Kedrick D. Adkins, Jr A Thomas A.S. Wilson, Jr, MD Lead Director E, N/C W. Stancil Starnes Executive Chairman E Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document ProAssurance Investor Briefing | August 2021 7 ProAssurance Brand Profile Specialty P&C Healthcare Professional Liability Workers’ Comp Alternative Risk Transfer Medical Technology & Life Sciences Products Liability Legal Professional Liability Copyright © 2021 www.secdatabase.com. All Rights Reserved. Please Consider the Environment Before Printing This Document ProAssurance Investor Briefing | August 2021 8 ProAssurance Specialty Property & Casualty Specialty P&C is comprised of three major divisions. Healthcare Professional Liability (HCPL) offers coverage to healthcare providers and facilities. Excess and surplus coverage and alternative risk solutions (including reinsurance and loss portfolio transfers) are also included in HCPL. The Innovative
Load more

Recommended publications
  • F: \ Word \ Deborah\ 12 00 AL
    National Healthcare Medical Professional Liability Insurance Application ProAssurance Casualty Company/ProAssurance Indemnity Company, Inc. PO Box 150 • Okemos, MI 48805-0150 • 800.282.6242 • Fax 608.828.1100 With your fully completed, signed and dated application, please submit the following information: 1. Current insurance policy declaration page. 2. Loss runs from prior insurance companies or explanation as to why they are not available. Note: Submission of a completed application confers no obligation upon the Company to bind coverage. 1. Organization Information Name of Insured/Policyholder: Federal Tax ID (FEIN): ______-______________________ Primary Business Address: Mailing Address (if different from above): ____________________________________________________________ ____________________ City: County: State: ZIP: Office Phone: Office Fax: Website: Contact Name/Representative for Insurance Matters: Title: Phone: Email: A. Type of Corporation Corporation – Not for Profit Solo Corporation Partnership Multi-shareholder Corporation Limited Liability Corporation Other: B. For-profit Non-profit C. How long in operation? D. Does the policyholder, or any entity for which coverage is requested, practice under any dba/fka names? Yes No If yes, please list the names (attach a separate sheet if necessary): E. Please list (attach a separate sheet if necessary) all wholly owned or majority owned (51% or more) entities for which coverage is requested. Please include FEIN and retro dates: F. If requesting coverage for partially owned (under 50%) or affiliated entities, please list (attach a separate sheet if necessary) and explain why: 2. Coverage Information A. Requested Effective Date: / / MONTH DAY YEAR B. Primary Limits: i. Organizations: Per Claim: $_________ ___ Annual Aggregate: $_________ ____ Shared Separate ii. Physicians: Per Claim: $_________ ___ Annual Aggregate: $_________ ____ Shared Separate (Non-physician employees will automatically share in the limits available to the entity.
    [Show full text]
  • *38954201520100102* Quarterly Statement
    *38954201520100102* PROPERTY AND CASUALTY COMPANIES—ASSOCIATION EDITION QUARTERLY STATEMENT AS OF JUNE 30, 2015 OF THE CONDITION AND AFFAIRS OF THE PROASSURANCE CASUALTY COMPANY NAIC Group Code 2698 , 2698 NAIC Company Code 38954 Employer’s ID Number 38-2317569 (Current Period) (Prior Period) Organized under the Laws of Michigan , State of Domicile or Port of Entry Michigan Country of Domicile United States Incorporated/Organized 06/27/1980 Commenced Business 06/27/1980 Statutory Home Office 2600 PROFESSIONALS DRIVE , OKEMOS, MI, US 48864 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 100 BROOKWOOD PLACE BIRMINGHAM, AL, US 35209 205-877-4400 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address PO BOX 590009 , BIRMINGHAM, AL, US 35259-0009 (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 100 BROOKWOOD PLACE BIRMINGHAM, AL, US 35209 205-877-4400 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Web Site Address www.proassurance.com Statutory Statement Contact ELLEN MARCHMAN CHANDLER 205-445-2638 (Name) (Area Code) (Telephone Number) (Extension) [email protected] 205-868-4015 (E-Mail Address) (Fax Number) OFFICERS Name Title Name Title PRESIDENT, CHIEF CLAIMS DARRYL KEITH THOMAS , OFFICER KATHRYN ANNE NEVILLE , SECRETARY EDWARD LEWIS RAND, JR. , TREASURER, VICE PRESIDENT WILLIAM STANCIL STARNES , CHAIRMAN OTHER
    [Show full text]
  • AT&T Inc.; Rule 14A-8 No-Action Letter
    January 3, 2020 Via email: [email protected] Office of Chief Counsel Division of Corporation Finance U.S. Securities and Exchange Commission 100 F Street, NE Washington, DC 20549 RE: Stockholder Proposal of the National Center for Public Policy Research, Securities Exchange Act of 1934 – Rule 14a-8 Dear Sir or Madam, This correspondence is in response to the letter of Wayne Wirtz on behalf of AT&T, Inc. (the “Company”), dated December 12, 2019, requesting that your office (the “Commission” or “Staff”) take no action if the Company omits our Shareholder Proposal (the “Proposal”) from its 2020 proxy materials for its 2020 annual shareholder meeting. RESPONSE TO AT&T’S CLAIMS Our Proposal asks the Company’s Board of Directors to adopt a policy to disclose to shareholders the following: 1. A description of the specific minimum qualifications that the Board’s nominating committee believes must be met by a nominee to be on the board of directors; and 2. Each nominee’s skills, ideological perspectives, and experience presented in a chart or matrix form. Office of the Chief Counsel Division of Corporation Finance January 3, 2020 Page 2 of 7 The disclosure shall be presented to the shareholders through the annual proxy statement and the Company’s website within six (6) months of the date of the annual meeting and updated on an annual basis. TRUE DIVERSITY BOARD POLICY (our Proposal, attached to Company’s No-Action Request Letter, at Appendix A). The Company has argued that our Proposal may be excluded first because the Company has already substantially implemented the Proposal, and second because the proposal is too vague to be implemented.
    [Show full text]
  • Taking Fraud by Storm
    TAKING FRAUD BY STORM 2 017 Annual Report 2 President’s Letter: It’s Raining Solutions at NICB CONTENTS 4 Data Analytics: Faster Storm Chasing 6 Investigations: Shooting For (and From) the Sky 8 Training: Steady in any Weather Photo: Tornado damage in Texas 10 Legislative Advocacy: Stealing Fraud’s Thunder 12 Public Awareness: A Flood of Vital Information 14 Membership: New Ports in the Storm 15 Membership Listings 22 Financial Statements 24 Board of Governors 26 Advisors to the Board 27 NICB Senior Leadership Team Harvey, Irma, Maria. solution proving its mettle before, during and after vastly expanding our members’ abilities to quickly struck and wreaked their havoc, our teams instantly PRESIDENT’S natural disasters in assisting NICB members, first uncover potentially fraudulent claims, support their mobilized. Every department got involved, with In 2017, this trio of names was indelibly etched into responders and law enforcement agencies. investigations and streamline workflow efficiencies. team members working day and night to support the insurance industry’s collective memory. response efforts. We did it the same way we have LETTER This solution starts with something the NICB has • We introduced a new website in 2017 for since 1912: Selflessly and with the best interests of They were among the 17 named storms and 10 Atlantic during natural catastrophes that private companies consumers to more easily gather information our members, law enforcement agencies and the hurricanes that battered the United States and NICB lack: Access to affected areas given our century- that can help them avoid becoming crime American public top of mind.
    [Show full text]
  • National Healthcare Medical Professional Liability Insurance Application
    National Healthcare Medical Professional Liability Insurance Application ProAssurance Casualty Company/ProAssurance Indemnity Company, Inc. PO Box 150 • Okemos, MI 48805-0150 • 800.282.6242 • Fax 608.828.1100 With your fully completed, signed and dated application, please submit the following information: 1. Current insurance policy declaration page. 2. Loss runs from prior insurance companies or explanation as to why they are not available. Note: Submission of a completed application confers no obligation upon the Company to bind coverage. 1. Organization Information Name of Insured/Policyholder: Federal Tax ID (FEIN): ______-______________________ Primary Business Address: Mailing Address (if different from above): ____________________________________________________________ ____________________ City: County: State: ZIP: Office Phone: Office Fax: Website: Contact Name/Representative for Insurance Matters: Title: Phone: Email: A. Type of Corporation Corporation – Not for Profit Solo Corporation Partnership Multi-shareholder Corporation Limited Liability Corporation Other: B. For-profit Non-profit C. How long in operation? D. Does the policyholder, or any entity for which coverage is requested, practice under any dba/fka names? Yes No If yes, please list the names (attach a separate sheet if necessary): E. Please list (attach a separate sheet if necessary) all wholly owned or majority owned (51% or more) entities for which coverage is requested. Please include FEIN and retro dates: F. If requesting coverage for partially owned (under 50%) or affiliated entities, please list (attach a separate sheet if necessary) and explain why: 2. Coverage Information A. Requested Effective Date: / / MONTH DAY YEAR B. Primary Limits: i. Organizations: Per Claim: $_________ ___ Annual Aggregate: $_________ ____ Shared Separate ii. Physicians: Per Claim: $_________ ___ Annual Aggregate: $_________ ____ Shared Separate (Non-physician employees will automatically share in the limits available to the entity.
    [Show full text]
  • 38954201820100100
    *38954201820100100* PROPERTY AND CASUALTY COMPANIES—ASSOCIATION EDITION ANNUAL STATEMENT For the Year Ended December 31, 2018 OF THE CONDITION AND AFFAIRS OF THE PROASSURANCE CASUALTY COMPANY NAIC Group Code 02698 , 02698 NAIC Company Code 38954 Employer’s ID Number 38-2317569 (Current Period) (Prior Period) Organized under the Laws of Michigan , State of Domicile or Port of Entry Michigan Country of Domicile United States Incorporated/Organized 06/27/1980 Commenced Business 06/27/1980 Statutory Home Office 2600 PROFESSIONALS DRIVE , OKEMOS, MI, US 48864 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 100 BROOKWOOD PLACE BIRMINGHAM, AL, US 35209 205-877-4400 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address PO BOX 590009 , BIRMINGHAM, AL, US 35259-0009 (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 100 BROOKWOOD PLACE BIRMINGHAM, AL, US 35209 205-877-4400 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Web Site Address www.proassurance.com Statutory Statement Contact ELAINE MARIE SPARKS 615-301-1445 (Name) (Area Code) (Telephone Number) (Extension) [email protected] 615-324-9169 (E-Mail Address) (Fax Number) OFFICERS Name Title Name Title PRESIDENT, CHIEF CLAIMS DARRYL KEITH THOMAS , OFFICER KATHRYN ANNE NEVILLE , SECRETARY DANA SHANNON HENDRICKS # , TREASURER WILLIAM STANCIL STARNES , CHAIRMAN OTHER OFFICERS ROGER SMITH , SENIOR VICE PRESIDENT JEFFREY LYNN BOWLBY , SENIOR VICE PRESIDENT LAWRENCE KERRY COCHRAN , VICE PRESIDENT HOWARD HARLEY FRIEDMAN , CHIEF UNDERWRITING OFFICER FRANK BERRY O'NEIL , SENIOR VICE PRESIDENT EDWARD LEWIS RAND, JR.
    [Show full text]
  • *38954201520100101* Quarterly Statement
    *38954201520100101* PROPERTY AND CASUALTY COMPANIES—ASSOCIATION EDITION QUARTERLY STATEMENT AS OF MARCH 31, 2015 OF THE CONDITION AND AFFAIRS OF THE PROASSURANCE CASUALTY COMPANY NAIC Group Code 2698 , 2698 NAIC Company Code 38954 Employer’s ID Number 38-2317569 (Current Period) (Prior Period) Organized under the Laws of Michigan , State of Domicile or Port of Entry Michigan Country of Domicile United States Incorporated/Organized 06/27/1980 Commenced Business 06/27/1980 Statutory Home Office 2600 PROFESSIONALS DRIVE , OKEMOS, MI, US 48864 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 100 BROOKWOOD PLACE BIRMINGHAM, AL, US 35209 205-877-4400 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address PO BOX 590009 , BIRMINGHAM, AL, US 35259-0009 (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 100 BROOKWOOD PLACE BIRMINGHAM, AL, US 35209 205-877-4400 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Web Site Address www.proassurance.com Statutory Statement Contact ELLEN MARCHMAN CHANDLER 205-445-2638 (Name) (Area Code) (Telephone Number) (Extension) [email protected] 205-868-4015 (E-Mail Address) (Fax Number) OFFICERS Name Title Name Title PRESIDENT, CHIEF CLAIMS DARRYL KEITH THOMAS , OFFICER KATHRYN ANNE NEVILLE , SECRETARY EDWARD LEWIS RAND, JR. , TREASURER, VICE PRESIDENT WILLIAM STANCIL STARNES , CHAIRMAN OTHER
    [Show full text]
  • *33391201920100103* Quarterly Statement
    *33391201920100103* PROPERTY AND CASUALTY COMPANIES—ASSOCIATION EDITION QUARTERLY STATEMENT AS OF SEPTEMBER 30, 2019 OF THE CONDITION AND AFFAIRS OF THE PROASSURANCE INDEMNITY COMPANY, INC. NAIC Group Code 02698 , 02698 NAIC Company Code 33391 Employer’s ID Number 63-0720042 (Current Period) (Prior Period) Organized under the Laws of Alabama , State of Domicile or Port of Entry Alabama Country of Domicile United States Incorporated/Organized 10/01/1976 Commenced Business 04/15/1977 Statutory Home Office 100 BROOKWOOD PLACE , BIRMINGHAM, AL, USA 35209 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 100 BROOKWOOD PLACE BIRMINGHAM, AL, USA 35209 205-877-4400 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address PO BOX 590009 , BIRMINGHAM, AL, USA 35259-0009 (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 100 BROOKWOOD PLACE BIRMINGHAM, AL, USA 35209 205-877-4400 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Web Site Address www.proassurance.com Statutory Statement Contact ELAINE MARIE SPARKS 615-301-1445 (Name) (Area Code) (Telephone Number) (Extension) [email protected] 615-324-9169 (E-Mail Address) (Fax Number) OFFICERS Name Title Name Title MICHAEL LEONARD BOGUSKI # , PRESIDENT KATHRYN ANNE NEVILLE , SECRETARY DANA SHANNON HENDRICKS , TREASURER EDWARD LEWIS RAND, JR. # , CHAIRMAN OTHER OFFICERS JEFFREY LYNN BOWLBY , SENIOR VICE PRESIDENT ROBERT DAVID FRANCIS # , EXECUTIVE VICE PRESIDENT DARRYL KEITH THOMAS # , SENIOR VICE PRESIDENT HAYES VANCE WHITESIDE, MD , SENIOR VICE PRESIDENT CRAIG GRANVILLE MUSGRAVE #, SENIOR VICE PRESIDENT SHEPHERD MOTT TAPASAK # , SENIOR VICE PRESIDENT KAREN BANKS CARLILE # , SENIOR VICE PRESIDENT LAWRENCE KERRY COCHRAN , VICE PRESIDENT DIRECTORS OR TRUSTEES MICHAEL LEONARD BOGUSKI # JEFFREY PATTON LISENBY EDWARD LEWIS RAND, JR.
    [Show full text]
  • F: \ Word \ Deborah\ 12 00 AL
    National Healthcare Medical Professional Liability Insurance Application ProAssurance Casualty Company/ProAssurance Indemnity Company, Inc. PO Box 150 • Okemos, MI 48805-0150 • 800.282.6242 • Fax 608.828.1100 With your fully completed, signed and dated application, please submit the following information: 1. Current insurance policy declaration page. 2. Loss runs from prior insurance companies or explanation as to why they are not available. Note: Submission of a completed application confers no obligation upon the Company to bind coverage. 1. Organization Information Name of Insured/Policyholder: Federal Tax ID (FEIN): ______-______________________ Primary Business Address: Mailing Address (if different from above): _________________________________________ _______________________________________ City: County: State: ZIP: Office Phone: Office Fax: Website: Contact Name/Representative for Insurance Matters: Title: Phone: Email: A. Type of Corporation Corporation – Not for Profit Solo Corporation Partnership Multi-shareholder Corporation Limited Liability Corporation Other: B. For-profit Non-profit C. How long in operation? D. Does the policyholder, or any entity for which coverage is requested, practice under any dba/fka names? Yes No If yes, please list the names (attach a separate sheet if necessary): E. Please list (attach a separate sheet if necessary) all wholly owned or majority owned (51% or more) entities for which coverage is requested. Please include FEIN and retro dates: F. If requesting coverage for partially owned (under 50%) or affiliated entities, please list (attach a separate sheet if necessary) and explain why: 2. Coverage Information A. Requested Effective Date: / / MONTH DAY YEAR B. Primary Limits: i. Organizations: Per Claim: $_________ ___ Annual Aggregate: $_________ ____ Shared Separate ii. Physicians: Per Claim: $_________ ___ Annual Aggregate: $_________ ____ Shared Separate (Non-physician employees will automatically share in the limits available to the entity.
    [Show full text]
  • EASTERN ALLIANCE INSURANCE COMPANY NAIC Group Code.....2698, 2698 NAIC Company Code
    PROPERTY AND CASUALTY COMPANIES - ASSOCIATION EDITION *10724201920100102* QUARTERLY STATEMENT As of June 30, 2019 of the Condition and Affairs of the EASTERN ALLIANCE INSURANCE COMPANY NAIC Group Code.....2698, 2698 NAIC Company Code..... 10724 Employer's ID Number..... 23-2900463 (Current Period) (Prior Period) Organized under the Laws of PA State of Domicile or Port of Entry PA Country of Domicile US Incorporated/Organized..... January 16, 1997 Commenced Business..... December 11, 1997 Statutory Home Office 25 Race Avenue .. Lancaster .. PA .. US .. 17603 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 25 Race Avenue .. Lancaster .. PA .. US .. 17603 855-533-3444 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address PO Box 83777 .. Lancaster .. PA .. US .. 17608-3777 (Street and Number or P. O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 25 Race Avenue .. Lancaster .. PA .. US .. 17603 855-533-3444 (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Web Site Address www.easternalliance.com Statutory Statement Contact Joseph Francis Bilder Jr 717-239-1653 (Name) (Area Code) (Telephone Number) (Extension) [email protected] 717-735-1775 (E-Mail Address) (Fax Number) OFFICERS Name Title Name Title 1. Kevin Merrick Shook # President 2. Kathryn Anne Neville Secretary 3. Brent Lamar Shirk # Treasurer 4. OTHER Lawrence Kerry Cochran Vice President Noreen Lynn Dishart Vice President Suzanne Marie Emmet Senior Vice President Robert Michael Enderlein # Senior Vice President Robert Anthony Gilpin Senior Vice President Curtis Leandro Melville Jr.
    [Show full text]