2011 ANNUAL STATEMENT and NEW YORK SUPPLEMENT
Life Insurer - General Filing Instructions

Return to New York Supplement Index page

IMPORTANT FILING REMINDER:

Schedule G is to be submitted in its own PDF file, separate from the New York Supplement PDF file. This follows the practice of recent years. Both pdf files MUST be contained in one zip file. If Schedule G is included in the New York Supplement PDF, the filing will be rejected.

You are required to file ONLY ONE HARD COPY of the 2011 ANNUAL FILING.

Mail to:
Life Bureau
New York State Department of Financial Services
25 Beaver Street
New York, NY 10004        Do NOT mail to Albany.

We are providing for your use the LIFE Annual Statement Checklist & Instructions. This checklist provides filing requirements for submission to the NAIC and the New York Department of Financial Services. This Web site also provides specific instructions for filing the New York Supplement and supplemental forms with our Department. Copies of the New York Supplement and supplemental forms are available in the Download section of this Web site.

Insurers subject to these filing requirements are strongly encouraged to submit copies of all annual and quarterly statement filings electronically with the NAIC. The following electronic submissions to the NAIC will fulfill the electronic filing requirements of New York:

• National Form Annual Statement via the internet or diskette.
• National Form Quarterly Statement via the internet or diskette.
• New York Supplement via the internet.

Any statements not filed as above will require the filing of a diskette with New York.

In all cases, hard copies must still be filed in accordance with the LIFE Annual Statement Checklist & Instructions.

Life Insurer - Specific Filing Information

The Life Insurer Filing INSTRUCTIONS AND FORMS PACKET is a self-extracting zipped file; after downloading file, run EXE to obtain the following PDF (Acrobat) files. You will need the Adobe Acrobat Reader to view or print PDF files. When printing the blanks, be sure to use legal size paper (8 1/2"X14").  NEW YORK STATE LIFE & A&H SUPPLEMENT 2011 is bookmarked with a full table of contents for on-line viewing.

FORMS included for Download and/or Print:

• NEW YORK STATE LIFE & A&H SUPPLEMENT 2011
• NAIC Life Annual Checklist & Instructions
• SCHEDULE S ADDENDUM
• BAR CODE INSTRUCTIONS
• Annual Electronic Filing Requirement Letter
• Schedule Q Worksheets
• Schedule Q Report and Schedule Q Interrogatories
• Schedule Q Supporting Instructions
• HEALTH INSURANCE CLAIMS PAYABLE (NY) QUARTERLY REPORT (Excel Form)

To view full instructions for unzipping compressed files, please select this link.

For the full listing of Life Insurers authorized in New York State as of Dec. 31, 2011 (Schedule S), select Schedule S ADDENDUM.

The NEW YORK STATE LIFE & A&H SUPPLEMENT 2011 (in PDF Format) is also available from the SUPPLEMENT BLANKS PAGE.

Schedule S

The Dodd-Frank Act has pre-empted the requirement of filing Schedule S, Part 4 of the New York Supplement for foreign licensed life insurers and accredited reinsurers. While the Schedule is included in the current filing package, there is no need to fill it out.

Schedule I

This schedule is for the reporting of investments, contributions and activities in New York State. It replaces item 15 of the General Interrogatories. If you would normally answer "Yes" to Interrogatory 15, then you should complete Schedule I instead of the statement described in the interrogatory. When preparing the schedule please follow the directions given in the notes at the bottom of the form.

Schedule G

Beginning with the 2008 reporting year, substantial changes were made to Schedule G. Please follow the instructions on the form when completing the schedule, specifically with regard to allocations. Wherever a title or name is entered, do not leave the amount paid column blank. Only one hard copy and one electronic copy are required to be filed. Schedule G is not to be redacted.

Health Insurance Claims Payable (Quarterly)

The Health Insurance Claims Payable report, which is part of the New York Supplement is now required to be submitted quarterly by all companies writing Accident and Health insurance in New York State. Click here for filing instructions.

Schedule Q Forms, Instructions & Worksheets

The Schedule Q packet necessary for filing of the 2011 New York Supplement, to be filed by all life insurance companies licensed to do business in New York, consists of the following:

• Schedule Q Report (2 pages) and Schedule Q Interrogatories (2 pages)
  To be filed with the New York Supplement (these forms should be printed on legal size 8 ½" x 14" paper)

• Schedule Q Worksheets (13 pages)
  Not to be submitted but must be retained by the Company for six years; and

• Schedule Q Supporting Instructions (30 pages)

The Schedule Q files above are in PDF format; an Adobe Acrobat Reader is required to view and print the documents.

Questions on the Schedule Q filing should be directed to Mr. James MacDonald, Supervising Actuary, at (212) 480-4933.

Separate Schedule Q filings for participating and non-participating business are not required.

DUE DATE & MAILING:
Please refer to the LIFE Annual Statement Checklist & Instructions.

For NAIC Numbers and Company Names:
To view the company listing for this blank type, select Life Companies (Schedule S).

PROBLEMS AND QUESTIONS:
If you need help filling out your forms, call: Life Bureau, Mr. Stephen Pallas, New York City (212) 480-4765. For diskette related questions, contact Information Systems & Technology Bureau, Albany (518) 473-3775.

MAILING INSTRUCTIONS:
Please see the LIFE Annual Statement Checklist & Instructions due dates and other related information.