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NAIC & Department of Financial Services Annual Statement Checklist and Instructions

ARTICLE 43 CORPORATIONS 2016

COMPANY NAME:                                                                                                            NAIC Company Code:                 
Contact:                                                                                                                                         Telephone:                        
REQUIRED FILINGS IN THE STATE OF NEW YORK                                         Filings Made During the Year 2017

 

(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 ½”X14”)

1

EO

 

3/1

NAIC

Note   B

 

1.1

Printed Investment Schedule detail (Pages E01-E28)

1

EO

 

3/1

NAIC

Note   B

 

2

Quarterly  Financial Statement (8 ½” x 14”)

1

EO

 

5/15,   8/15, 11/15

NAIC

Note   B

 

 

 

 

 

 

 

 

 

 

 

II.  NAIC SUPPLEMENTS

 

 

 

 

 

 

 

11

Accident & Health Policy Experience Exhibit

1

EO

 

4/1

NAIC

 

 

12

Actuarial Opinion

1

EO

 

3/1

Company

 

 

17

Long-Term Care Experience Reporting Forms

1

EO

 

4/1

NAIC

 

 

18

Management’s Discussion & Analysis

1

EO

 

4/1

Company

 

 

19

Medicare Part D Coverage Supplement

1

EO

 

3/1, 5/15, 8/15, 11/15

NAIC

 

 

20

Medicare Supplement Insurance Experience Exhibit

1

EO

 

3/1

NAIC

 

 

23

Risk-Based Capital Report

1

EO

 

3/1

NAIC

 

 

25

Supplemental Compensation Exhibit

1

N/A

 

3/1

NAIC

 

 

26

Supplemental Health Care Exhibit (Parts 1, 2 and 3)

1

EO

 

4/1

NAIC

 

 

27

Supplemental Health Care Exhibit’s Allocation Report

1

EO

 

4/1

NAIC

 

 

28

Supplemental Investment Risk Interrogatories

1

EO

 

4/1

NAIC

 

 

 

 

 

 

 

 

 

 

 

 

III.  ELECTRONIC FILING REQUIREMENTS

 

 

 

 

 

 

 

61

Annual Statement Electronic Filing

xxx

EO

 

3/1

NAIC

 

 

62

March .PDF Filing

xxx

EO

 

3/1

NAIC

 

 

63

Risk-Based Capital  Electronic Filing

xxx

EO

 

3/1

NAIC

 

 

64

Risk-Based Capital .PDF Filing

xxx

EO

 

3/1

NAIC

 

 

65

Supplemental Electronic Filing

xxx

EO

 

4/1

NAIC

 

 

66

Supplemental .PDF Filing

xxx

EO

 

4/1

NAIC

 

 

67

Quarterly Statement Electronic Filing

xxx

EO

 

5/15, 8/15, 11/15

NAIC

 

 

68

Quarterly .PDF Filing

xxx

EO

 

5/15, 8/15, 11/15

NAIC

 

 

69

June .PDF Filing

xxx

EO

 

5/31

NAIC

 

 

 

 

 

 

 

 

 

 

 

 

IV.  AUDIT/INTERNAL CONTROL

RELATED REPORTS

 

 

 

 

 

 

 

81

Accountants Letter of Qualifications

1

EO

 

5/31

Company

 

 

82

Audited Financial Reports

1

EO

 

5/31

Company

Note   B

 

83

Audited Financial Reports Exemption Affidavit

1

N/A

 

5/31

Company

 

 

84

Communication of Internal Control Related Matters Noted in Audit

1

EO

 

5/31

Company

 

 

85

Independent CPA (Change)

1

N/A

 

Within   60 days of any change

Company

 

 

86

Management's Report of Internal Control Over Financial Reporting

1

N/A

 

5/31

Company

 

 

87

Notification of Adverse Financial Condition

1

N/A

 

5/31

Company

 

 

88

Relief from the five-year rotation requirement for lead audit partner

1

EO

 

3/1

Company

 

 

89

Relief from the one-year cooling off period for independent CPA

1

EO

 

3/1

Company

 

 

90

Relief from the Requirements for Audit Committees

1

EO

 

3/1

Company

 

 

91

Hardship Exemption

1

N/A

 

3/1

Company

Note   P

 

 

 

 

 

 

 

 

 

 

 

V.  STATE REQUIRED FILINGS

 

 

 

 

 

 

 

101

New YorkAnnual Supplement

1

N/A

 

3/1

State

Note   B

 

102

New YorkQuarterly Supplement

1

N/A

 

5/15,   8/15, 11/15

State

Note   B

 

103

New YorkAnnual Supplement Electronic Filing

1

N/A

 

3/1

State

 

 

104

New YorkQuarterly Supplement Electronic Filing

1

N/A

 

5/15,   8/15, 11/15

State

 

 

105

Certificate of Compliance

1

0

 

3/1

 

 

 

106

Filings Checklist (with Column 1 completed)

1

0

 

3/1

State

 

 

107

ORSA Electronic Filing

1

0

 

12/1

Company

Note   Q

 

108

Form F - Enterprise Risk Report Electronic Filing

1

0

 

4/30

Company

Note   Q

 

109

Form HC-1 Electronic Filing

1

0

 

5/1  

State

Note   Q

 

110

Form IR Electronic Filing

1

0

 

5/1

State

Note   Q

*If XXX appears in this column, this state does not require this filing, providing 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-Q Apply to All Filings)

  A  Required Filings Contact Person:

 

Ms. Jo Lo Hsia, Health Bureau
New York State Department of Financial Services
One State Street
New York, NY 10004
(212) 480-5062

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

  B  Mailing Address:

 

Annual Statement and New York Supplement, and related items (hard copies):

Ms. Christine Gralton, Health Bureau
New York State Department of Financial Services
One State Street
New York, NY 10004

Audited Annual Statements:

Ms. Christine Gralton, Health Bureau
New York State Department of Financial Services
One State Street
New York, NY 10004

Quarterly Statement and New York Quarterly Supplement (hard copies):

Ms. Christine Gralton, Health Bureau
New York State Department of Financial Services
One State Street
New York, NY 10004

CDs (See Note O):

Mr. William Pow, Information Technology
New York State Department of Financial Services
One State Street
New York, NY 10004

 

  C  Mailing Address for Filing Fees:   N/A 
  D  Mailing Address for Premium Tax Payments:   N/A 
  E  Delivery Instructions:

 

All Department 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.

The NAIC Statement and 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. CDs should be labeled. 

  F  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. 
  G  Original Signatures:   Actual live signatures required. 
  H  Signature/Notarization/Certification:   Appropriate notarization required 
  I  Amended Filings:

 

Only accepted in accordance with the Department's prior instructions.

All amendments to your Annual and Quarterly Statement and/or New York Supplement must be provided in hard copy as well as an amended ELECTRONIC filing. 

Note: For Amended New York Supplement filings, the entire electronic filing is required.

  J  Exceptions from normal filings:   Only accepted in accordance with the Department's prior instructions. 
  K  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. General Bar Coding instructions and a full listing of New York required bar coded forms are included on the web site. 
  L  NONE Filings:

 

All parts of the Annual Statement except those schedules identified by the use of "xxx" 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  Investment Schedules:  Investment Schedules required for all filings. 
  N  Filings new, discontinued or modified materially since last year:  Instructions will be provided by the Department as needed. 
  O  Internet Filing:  Instructions concerning internet filing alternative to filing CDs with New York for New York Supplement are set forth in Insurance Circular Letter No. 4 (2001).

All companies are strongly encouraged to file national form filings (as identified in items 61, 62, 63, 64, 65, 66, 67, 68 and 69 in the checklist) with the NAIC preferably via the Internet. By filing over the Internet or via CD with the NAIC an insurer will have fulfilled its electronic filing requirement for national forms with New York and therefore should not file a CD with the Department. 

  P  Hardship Exemption  Application for exemption to file must be filed with the Superintendent prior to the event or period for which the exemption is being requested. The company shall file, with its annual statement filing, both its request for relief and the approval of that request with the New York State Department of Financial Services and the NAIC.
  Q  ORSA, Form F Enterprise Risk Report, Form HC-1 and Form IR Electronic Filings 

Companies are required to file ORSA and Form F through the Department's Holding Company and Parent Corporation Filing Portal ("the Portal"). Furthermore, companies are strongly encouraged to file Forms HC-1 and IR through the Portal as well.

ORSA and Form F Enterprise Risk Report:
http://www.dfs.ny.gov/insurance/insurers/erm_holding.htm

Form HC-1 and Form IR:
http://www.dfs.ny.gov/insurance/insurers/art15_filings.htm


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 CD with the NAIC. Companies that file with the NAIC via the Internet are not required to submit CDs to the NAIC. Companies are not required to file hard copy filings with the NAIC.

Column (1) (Checklist) The checklist is a required filing. 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 exemptprinted detail.

The March .PDF Filing is the .pdf file for annual statement data, detail for investment schedules and supplements due March 1.

The Risk-Based Capital Electronic Filing includes all risk-based capital data.

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 Electronic Filing includes the complete quarterly filing and the PDF files for all quarterly data.

The Quarterly .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 have chosen 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 the state 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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