NAIC & New York State Department of Financial Services

Annual Statement Checklist and Instructions 

TITLE COMPANIES

COMPANY NAME:                                                                                       NAIC Company Code:                   
Contact:                                                                                                           Telephone:                                       
REQUIRED FILINGS IN THE STATE OF NEW YORK                         Filings Made During the Year 2013

 

(1)
Check-list
 

(2)
Line #
 

(3)
REQUIRED FILINGS FOR THE ABOVE STATE
 

(4)
NUMBER OF COPIES*
 

(5)
DUE DATE
 

(6) 
FORM SOURCE* *

(7)
APPLICABLE NOTES
 

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 

      
 11Actuarial Opinion 

1 

EO 

xxx 

3/1 Company  
 12Investment Risk Interrogatories 

1 

EO 

xxx 

4/1 NAIC  
 13Management Discussion & Analysis 

1 

EO 

xxx 

4/1 Company  
 14Schedule 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 

5/31Company  
 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
 76Management's Report of Internal Control Over Financial Reporting 

1 

N/A

N/A 

5/31 Company  
 77Notification of Adverse Financial Condition 

1 

N/A

1

See Note R Company See NOTE R
 78Report of Significant Deficiencies in Internal Controls 

1 

N/A

1

5/31 Company  
 79Request 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  
 102Certificate of Deposit 

1 

0 

1 

3/1 State  
 103Filings Checklist (with Column 1 completed) 

1 

0 

1 

3/1 State  
 104Corporation Franchise Tax to Dept. of Taxation (copy to Department of Financial Services) 

1 

0

1 

3/15 State  NOTE O
 105Annual Call 

1 

0

1 

3/1State  
 106Signed Notarized Jurat (NAIC Blank) 

1 

0 

1 

3/1NAIC / State Foreign Companies- See NOTE K 
 106(a)Signed Notarized Jurat (Quarterly) 

1 

0 

1 

5/15, 8/15, 11/15 NAICForeign 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:

 

Mr. Gilbert Denton, Senior Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
One State Street
New York, NY 10004
(212) 480-4669

E-mail: Gilbert.Denton@dfs.ny.gov
When answering by e-mail, please include telephone number.
 

 B Mailing Address:

 

Annual Statement and related items (hard copies); Audited Financial Statement; Quarterly Statement (hard copies); Certificate of Compliance; and Certificate of Deposit:

Mr. Gilbert Denton, Senior Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
One State Street
New York, NY 10004

Diskettes (See Note N):

Ms. Nora Dixon
New York State Department of Financial Services
Insurance Regulatory Systems Bureau
One State Street
New York, NY 10004

 

 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.

The Supplement must be bound at the left side in sequential order and it must have a "COVER" page that indicates New York Supplement to the Annual Statement, the FULL Company Name and the Year. Diskettes should be labeled.

 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. 
 GSignature/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. 
 JBar 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:

Mr. Gilbert Denton, Senior Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
One State Street
New York, NY 10004

 

 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.
 NInternet 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
PO Box 22038
Albany NY 12201-2038

Also mail a copy to:

NYS Department of Financial Services
Taxes and Accounts Bureau
One Commerce Plaza
Albany, NY 12257

 P Communication of Internal Control Related Matters Noted in AuditForeign 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 ConditionRequired 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.

 

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