Annual Statement Checklist and Instructions |
| COMPANY
NAME:
NAIC
Company Code: Contact: Telephone: REQUIRED FILINGS IN THE STATE OF NEW YORK Filings Made During the Year 2012 |
(1) | (2) | (3) | (4) | (5) | (6) | (7) | ||
Domestic | Foreign | |||||||
State | NAIC | State | ||||||
I. NAIC FINANCIAL STATEMENTS | ||||||||
| 1 | Annual Statement (8 1/2" x 14") | 1 | EO | xxx | 3/1 | NAIC | Foreign Companies - See NOTE K | |
| 1.1 | Printed Investment Schedule detail (Pages E01-E27) | 1 | EO | xxx | 3/1 | NAIC | ||
| 2 | Quarterly Financial Statement (8 1/2" x 14") | 1 | EO | xxx | 5/15, 8/15, 11/15 | NAIC | Foreign Companies - See NOTE K | |
II. NAIC SUPPLEMENTS | ||||||||
| 11 | Actuarial Opinion | 1 | EO | xxx | 3/1 | Company | ||
| 12 | Investment Risk Interrogatories | 1 | EO | xxx | 4/1 | NAIC | ||
| 13 | Management Discussion & Analysis | 1 | EO | xxx | 4/1 | Company | ||
| 14 | Schedule SIS | 1 | N/A | N/A | 3/1 | NAIC | ||
| 15 | Supplemental Compensation Exhibit | 1 | N/A | N/A | 3/1 | NAIC | ||
| 16 | Supplemental Schedule of Business Written By Agency | 1 | EO | xxx | 4/1 | NAIC | ||
III. ELECTRONIC FILING REQUIREMENTS | ||||||||
| 50 | Annual Statement Electronic Filing | xxx | 1 | xxx | 3/1 | NAIC | ||
| 51 | March .PDF Filing | xxx | 1 | xxx | 3/1 | NAIC | ||
| 52 | Supplemental Electronic Filing | xxx | 1 | xxx | 4/1 | NAIC | ||
| 53 | Supplemental .PDF Filing | xxx | 1 | xxx | 4/1 | NAIC | ||
| 54 | Quarterly Electronic Filing | xxx | 1 | xxx | 5/15, 8/15, 11/15 | NAIC | ||
| 55 | Quarterly .PDF Filing | xxx | 1 | xxx | 5/15, 8/15, 11/15 | NAIC | ||
| 56 | June .PDF Filing | xxx | 1 | xxx | 5/31 | NAIC | ||
IV. AUDIT/INTERNAL CONTROL RELATED REPORTS | ||||||||
| 71 | Accountants Letter of Qualifications | 1 | EO | N/A | 5/31 | Company | ||
| 72 | Audited Financial Reports | 1 | EO | xxx | 5/31 | Company | ||
| 73 | Audited Financial Reports Exemption Affidavit | 1 | N/A | N/A | 5/31 | Company | ||
| 74 | Communication of Internal Control Related Matters Noted in Audit | 1 | N/A | 1 | 5/31 | Company | See NOTE P | |
| 75 | Independent CPA (change) | 1 | N/A | N/A | See Note Q | Company | See NOTE Q | |
| 76 | Management's Report of Internal Control Over Financial Reporting | 1 | N/A | N/A | 5/31 | Company | ||
| 77 | Notification of Adverse Financial Condition | 1 | N/A | 1 | See Note R | Company | See NOTE R | |
| 78 | Report of Significant Deficiencies in Internal Controls | 1 | N/A | 1 | 5/31 | Company | ||
| 79 | Request for Exemption to File | 1 | N/A | N/A | prior to 12/31 | Company | ||
V. STATE REQUIRED FILINGS | ||||||||
| 101 | Certificate of Compliance | 1 | 0 | 1 | 3/1 | State | ||
| 102 | Certificate of Deposit | 1 | 0 | 1 | 3/1 | State | ||
| 103 | Filings Checklist (with Column 1 completed) | 1 | 0 | 1 | 3/1 | State | ||
| 104 | Corporation Franchise Tax to Dept. of Taxation (copy to Department of Financial Services) | 1 | 0 | 1 | 3/15 | State | NOTE O | |
| 105 | Annual Call | 1 | 0 | 1 | 3/1 | State | ||
| 106 | Signed Notarized Jurat (NAIC Blank) | 1 | 0 | 1 | 3/1 | NAIC / State | Foreign Companies- See NOTE K | |
| 106(a) | Signed Notarized Jurat (Quarterly) | 1 | 0 | 1 | 5/15, 8/15, 11/15 | NAIC | Foreign Companies- See NOTE K | |
*If XXX appears in this column, this state does not require this filing, if hard and/or electronic copy is filed with the state of domicile and if the data is filed electronically with the NAIC. If N/A appears in this column, the filing is required with the domiciliary state. EO (electronic only filing).
*If Form Source is NAIC, the form should be obtained from the appropriate vendor.
Notes and Instructions (A-R Apply to All Filings)
| A | Required
Filings Contact Person:
|
E-mail:
Niranjan.Robert@dfs.ny.gov | |
| B | Mailing
Address:
| Annual Statement
and related items (hard copies); Audited Financial Statement; Quarterly Statement
(hard copies); Certificate of Compliance; and Certificate of Deposit:
Diskettes (See Note N): Ms. Nora Dixon | |
| C | Mailing
Address for Filing Fees:
| N/A | |
| D | Delivery
Instructions:
| All
Department of Financial Services filings must be physically received at the appropriate
address as indicated in NOTE B no later than the indicated due date. Companies
should file ONLY ONE COMPANY per package. If the due date falls on a weekend
or a legal holiday, then the filing must be received by the Department by the
end of the next business day. | |
| E | Late
Filings:
| Failure to
timely file any component of an annual, quarterly or NY supplement filing subjects
insurer to penalties set forth in NY Insurance Law Section 307 and 308. New
York statute does not provide for any extensions in the filing deadlines for Annual
Statements. Further, extensions for the filing of audited financial statements
are only provided upon written application by the insurer to the superintendent,
and such extension is only granted if the superintendent finds that compliance
would constitute a financial or organizational hardship, as provided in Section
307(b)(3) of the Insurance Law. | |
| F | Original Signatures: | Actual live signatures required. | |
| G | Signature/Notarization/Certification: | Appropriate notarization required on the actual document. | |
| H | Amended
Filings:
| Only accepted
in accordance with the Department’s prior instructions. All amendments to your Annual Statement and/or New York Supplement must be provided in hard copy as well as an amended ELECTRONIC filing. Foreign insurers can file electronically. Note: For Amended New York Supplement filings, the entire electronic filing is required. | |
| I | Exceptions from normal filings: | Only accepted in accordance with the Department’s prior instructions. | |
| J | Bar
Codes (State or NAIC)
| The NAIC Annual Statement and New York Supplement require the use of bar codes on the jurat page and certain other pages and forms. In addition, the Department requires the Audited Financial Statements and the documents submitted pursuant to Regulation 118 to be bar coded. General Bar Coding instructions and a full listing of New York required bar coded forms are included on the web site. | |
| K | Signed
Jurat:
| Foreign Companies - Refer to - Supplement No. 1 to Circular Letter No. 4 (2001) dated February 6, 2008, which can be found at the following link: http://www.dfs.ny.gov/insurance/circltr/2008/cl08_04s1.htm Hard copy filings of the jurat page should be directed to:
| |
| L | NONE
Filings:
| All parts of the Annual Statement except those schedules identified as N/A on the checklist and all parts of the New York Supplement must be accounted for. If there is nothing to report, you may complete the NAIC Annual Statement page entitled "Supplemental Exhibits and Schedules Interrogatories" INSTEAD OF filing reports marked "None". Also, you must complete the New York Supplement page entitled "Supplemental Exhibits and Schedules Interrogatories" if there is nothing to report for those New York Supplement, exhibits or schedules. You need not file reports marked "None". | |
| M | Filings new, discontinued or modified materially since last year: | None. | |
| N | Internet Filing: | Instructions concerning internet filing alternative to filing a diskette with New York for the New York Supplement are set forth in Department of Financial Services Circular Letter No. 4 (2001) and Supplement 1 to Circular Letter No. 4 (2001), dated 2/6/08. All companies are strongly encouraged to file national form filings (as identified in items 50, 51, 52, 53, 54, 55 and 56 in the checklist) with the NAIC preferably via the Internet. By filing over the Internet or via diskette with the NAIC, an insurer will have fulfilled its electronic filing requirement for national forms with New York and therefore should not file a diskette with the Department.
| |
| O | Corporation Franchise Tax to Dept. of Taxation: | Mail
the CT-33NL return and payment to: NYS Corporation
Tax Processing Unit Also mail a copy to: NYS Department of Financial Services | |
| P | Communication of Internal Control Related Matters Noted in Audit | Foreign Companies may submit via E-mail to: specialprojectsprp@dfs.ny.gov | |
| Q | Independent CPA (change) | Provide updated information (name, address, telephone number and e-mail address) within 60 days of any change in CPA. See Regulation 118, Section 89.4(c) for additional reporting requirements if the CPA is dismissed or resigns. | |
| R | Notification of Adverse Financial Condition | Required to be furnished, in writing, to the Superintendent, within five business days of any determination by the CPA that the Company has materially misstated its financial condition as reported to the superintendent as of the balance sheet currently under audit or that the Company does not meet the minimum capital or surplus requirement of the insurance law as of that date. |
General
Instructions
For Companies to Use Checklist
Please Note:
This state’s instructions for companies to file with the NAIC are included in this Checklist. The NAIC will not be sending their own checklist this year.
Electronic filing is intended to include filing via the Internet or filing via diskette with the NAIC. Companies that file with the NAIC via the Internet are not required to submit diskettes to the NAIC. Companies are not required to file hard copy filings with the NAIC.
Column (1) (Checklist)
Companies may use the checklist
to submit to a state, if the state requests it. Companies should copy the checklist
and place an "x" in this column when mailing information to the state.
Column (2) (Line #)
Line # refers to a standard filing
number used for easy reference. This line number may change from year to year.
Column (3) (Required Filings)
Name of item or form to
be filed.
The Annual Statement Electronic Filing includes the annual statement data and all supplements due March 1, per the Annual Statement Instructions. This includes all detail investment schedules and other supplements for which the Annual Statement Instructions exempt printed detail.
The March .PDF Filing is the .pdf file for annual statement data, detail for investment schedules and supplements due March 1.
The Supplemental Electronic Filing includes all supplements due April 1, per the Annual Statement Instructions.
The Supplemental .PDF Filing is the .pdf file for all supplemental schedules and exhibits due April 1.
The Quarterly Statement Electronic Filing includes the complete quarterly statement data.
The Quarterly Statement .PDF Filing is the .pdf file for quarterly statement data.
The June .PDF Filing is the .pdf file for the Audited Financial Statements and Accountants Letter of Qualifications.
Column
(4) (Number of Copies)
Indicates the number of copies that each foreign
or domestic company is required to file for each type of form. The Blanks (E)
Task Force modified the 1999 Annual Statement Instructions to waive paper
filings of certain NAIC supplements and certain investment schedule detail if
such investment schedule data is available to the states via the NAIC database.
The checklists reflect this action taken by the Blanks (EX4) Task Force. XXX appears
in the "Number of Copies" "Foreign" column for the appropriate
schedules and exhibits. Some states have chosen to waive printed quarterly
and annual statements from their foreign insurers and to rely upon the NAIC database
for these filings. This waiver could include supplemental annual statement filings.
The XXX in this column might signify that the state has waived the paper filing
of the annual statement and all supplements.
Column (5) (Due Date)
Indicates the date on which the
company must file the form.
Column
(6) (Form Source)
This column contains one of three words: "NAIC,"
"State," or "Company," If this column contains "NAIC,"
the company must obtain the forms from the appropriate vendor. If this column
contains "State," the state will provide the forms with the filing instructions
(generally on its web site). If this column contains "Company," the
company, or its representative (e.g., its CPA firm), is expected to provide the
form based upon the appropriate state instructions or the NAIC Annual Statement
Instructions.
Column (7) (Applicable Notes)
This column contains references to the Notes to the Instructions that apply to
each item listed on the checklist. The company should carefully read these notes
before submitting a filing.