To: Sean O’Donnell, Associate Commissioner for Risk Finance
In accordance with the reporting requirement that every captive insurance company must notify the Commissioner within thirty (30) days of any change in its executive officers or directors,
hereby submits the following information regarding a recent change in our company’s leadership:
New Director or Officer Information
Full Name
Effective Date of New Appointment
Outgoing Director or Officer Information
Separation Date
Employment Background for New Appointee
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