2012 ANNUAL STATEMENT and NEW YORK SUPPLEMENT
Fraternal Benefit Society - General Filing Instructions

Return to New York Supplement Index page

IMPORTANT FILING REMINDER:

You are required to file ONLY ONE HARD COPY of the 2012 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 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.

In 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. 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 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

Beginning with 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.

For NAIC Numbers and Company Names:
To view the company listing for this blank type, select Fraternal Companies List.

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 Fraternal Annual Statement Checklist & Instructions due dates and other related information.