ANNUAL STATEMENT and NEW YORK SUPPLEMENT
Fraternal Benefit Society - General
IMPORTANT FILING REMINDER:
You are required to file ONLY ONE
HARD COPY of the 2012 ANNUAL FILING.
New York State Department of Financial Services
One State Street
New York, NY 10004 Do NOT mail to Albany.
We are providing for your use the Fraternal Annual Statement Checklist & Instructions. This checklist provides filing requirements for submission to the NAIC and the New York State 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 Statements via the internet or diskette.
- New York Supplement via the internet only.
Any statements not filed as above will require the filing of a diskette with New York.
all cases, hard copies must still be filed in accordance with the Fraternal
Annual Statement Checklist & Instructions.
FRATERNAL BENEFIT SOCIETY - SPECIFIC FILING INFORMATION
The Fraternal Benefit Society Filing INSTRUCTIONS AND FORMS PACKET is a self-extracting zipped file; after downloading file, run EXE to obtain the following PDF (Acrobat) files. When printing the blanks, be sure to use legal size paper (8 1/2" X 14"). NEW YORK STATE FRATERNAL SUPPLEMENT 2012 is bookmarked with a full table of contents for on-line viewing.
FORMS included for Download and/or Print:
- NEW YORK STATE FRATERNAL SUPPLEMENT 2012
- NAIC Fraternal Annual Checklist & Instructions
- SCHEDULE S ADDENDUM
- BAR CODE INSTRUCTIONS
- Annual Electronic Filing Requirement Letter
To view full instructions for unzipping compressed files, please select this link.
The NEW YORK STATE FRATERNAL SUPPLEMENT 2012 (in PDF Format) is also available from the SUPPLEMENT BLANKS DOWNLOAD PAGE.
Risk Based Capital Report
the 2009 reporting year fraternal organizations have been required to file their
risk based capital report in hard copy, in addition to the electronic filing.
DUE DATE & MAILING:
Please refer to the Fraternal Annual Statement Checklist & Instructions.
NAIC Numbers and Company Names:
To view the company listing for this blank type, select Fraternal Companies List.
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.
For NAIC forms, contact:
National Association of Insurance Commissioners
2301 McGee, Suite 800
Kansas City, MO 64108-2604
Please see the Fraternal Annual Statement Checklist & Instructions due dates and other related information.