NAIC and DFS Annual Statement Checklist and Instructions
Property and Casualty Insurers 2023-2024
| COMPANY NAME: | NAIC Company Code: |
| Contact: | Telephone: |
| REQUIRED FILINGS IN THE STATE OF: NEW YORK | Filings Made During the Year 2024 |
| (1) Checklist | (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” x 14”) | EF*** | EO | xxx | 3/1 | NAIC | RRG’s – See NOTE P | |
| 1.1 | Printed Investment Schedule detail (Pages E01-E29) | EF*** | EO | xxx | 3/1 | NAIC | RRG’s – See NOTE P | |
| 2 | Quarterly Financial Statement (8 ½” x 14”) | EF*** | EO | xxx | 5/15, 8/15, 11/15 | NAIC | RRG’s – See NOTE P | |
| 3 | Protected Cell Annual Statement | 1 | 0 | xxx | 3/1 | NAIC | See NOTE Q | |
| 4 | Combined Annual Statement (8 ½” x 14”) | EF*** | EO | xxx | 5/1 | NAIC | ||
| II. NAIC SUPPLEMENTS | ||||||||
| 11 | Accident & Health Policy Experience Exhibit | EF*** | EO | xxx | 4/1 | NAIC | ||
| 12 | Actuarial Opinion | EF*** | EO | xxx | 3/1 | Company | RRG’s – See NOTE P | |
| 13 | Actuarial Opinion Summary | 1 | N/A | N/A | 3/15 | Company | See NOTE N | |
| 14 | Bail Bond Supplement | EF*** | EO | xxx | 3/1 | NAIC | ||
| 15 | Combined Insurance Expense Exhibit | EF*** | EO | xxx | 5/1 | NAIC | ||
| 16 | Credit Insurance Experience Exhibit | EF*** | EO | xxx | 4/1 | NAIC | ||
| 17 | Cybersecurity and Identity Theft Insurance Coverage Supplement | EF*** | EO | xxx | 4/1 | NAIC | ||
| 18 | Director and Officer Insurance Coverage Supplement | EF*** | EO | xxx | 3/1, 5/15, 8/15, 11/15 | NAIC | ||
| 19 | Exhibit of Other Liabilities By Lines of Business as Reported on Line 17 of the Exhibit of Premiums and Losses | EF*** | EO | xxx | 3/1 | NAIC | ||
| 20 | Financial Guaranty Insurance Exhibit | EF*** | EO | xxx | 3/1 | NAIC | ||
| 21 | Insurance Expense Exhibit | EF*** | EO | xxx | 4/1 | NAIC | ||
| 22 | Life, Health & Annuity Guaranty Association Assessable Premium Exhibit, Parts 1 and 2 | EF*** | EO | xxx | 4/1 | NAIC | ||
| 23 | Long Term Care Experience Reporting Forms | EF*** | EO | xxx | 4/1 | NAIC | ||
| 24 | Management Discussion & Analysis | EF*** | EO | xxx | 4/1 | Company | ||
| 25 | Market Conduct Annual Statement Premium Exhibit for Year | N/A | EO | N/A | 3/1 | NAIC | ||
| 26 | Medicare Part D Coverage Supplement | EF*** | EO | xxx | 3/1, 5/15, 8/15, 11/15 | NAIC | ||
| 27 | Medicare Supplement Insurance Experience Exhibit | EF*** | EO | xxx | 3/1 | NAIC | ||
| 28 | Mortgage Guaranty Insurance Exhibit | EF*** | EO | xxx | 4/1 | NAIC | ||
| 29 | Premiums Attributed to Protected Cells Exhibit | EF*** | EO | xxx | 3/1 | NAIC | ||
| 30 | Private Flood Insurance Supplement | EF*** | EO | xxx | 4/1 | NAIC | ||
| 31 | Reinsurance Attestation Supplement | EF*** | EO | xxx | 3/1 | Company | ||
| 32 | Exceptions to Reinsurance Attestation Supplement | 1 | N/A | N/A | 3/1 | Company | See NOTE Q | |
| 33 | Reinsurance Summary Supplemental | EF*** | EO | xxx | 3/1 | NAIC | RRG’s – See NOTE P | |
| 34 | Risk-Based Capital Report | EF*** | EO | xxx | 3/1 | NAIC | ||
| 35 | Schedule SIS | 1 | N/A | N/A | 3/1 | NAIC | See NOTE Q | |
| 36 | Supplement A to Schedule T | EF*** | EO | xxx | 3/1, 5/15, 8/15, 11/15 | NAIC | ||
| 37 | Supplemental Compensation Exhibit | 1 | N/A | N/A | 3/1 | NAIC | See NOTE Q | |
| 38 | Supplemental Health Care Exhibit (Parts 1 and 2) | EF*** | EO | xxx | 4/1 | NAIC | ||
| 39 | Supplemental Investment Risk Interrogatories | EF*** | EO | xxx | 4/1 | NAIC | ||
| 40 | Supplemental Schedule for Reinsurance Counterparty Reporting Exception – Asbestos and Pollution Contracts | EF*** | EO | xxx | 3/1 | NAIC | ||
| 41 | Trusteed Surplus Statement | EF*** | EO | xxx | 3/1, 5/15, 8/15, 11/15 | NAIC | ||
| III. ELECTRONIC FILING REQUIREMENTS | ||||||||
| 61 | Annual Statement Electronic Filing | xxx | 1 | xxx | 3/1 | NAIC | ||
| 62 | March .PDF Filing | xxx | 1 | xxx | 3/1 | NAIC | ||
| 63 | Risk-Based Capital Electronic Filing | xxx | 1 | xxx | 3/1 | NAIC | ||
| 64 | Risk-Based Capital .PDF Filing | xxx | 1 | xxx | 3/1 | NAIC | ||
| 65 | Combined Annual Statement Electronic Filing | xxx | 1 | xxx | 5/1 | NAIC | ||
| 66 | Combined Annual Statement .PDF Filing | xxx | 1 | xxx | 5/1 | NAIC | ||
| 67 | Supplemental Electronic Filing | xxx | 1 | xxx | 4/1 | NAIC | ||
| 68 | Supplemental .PDF Filing | xxx | 1 | xxx | 4/1 | NAIC | ||
| 69 | Quarterly Statement Electronic Filing | xxx | 1 | xxx | 5/15, 8/15, 11/15 | NAIC | ||
| 70 | Quarterly .PDF Filing | xxx | 1 | xxx | 5/15, 8/15, 11/15 | NAIC | ||
| 71 | June .PDF Filing | xxx | 1 | xxx | 5/31 | NAIC | ||
| IV. AUDIT/INTERNAL CONTROL RELATED REPORTS | ||||||||
| 81 | Accountants Letter of Qualifications | EF*** | EO | N/A | 5/31 | Company | ||
| 82 | Audited Financial Reports | EF*** | EO | xxx | 5/31 | Company | RRG’s – See NOTE P | |
| 83 | Audited Financial Reports Exemption Affidavit | 1 | N/A | N/A | 5/31 | Company | See NOTE Q | |
| 84 | Communication of Internal Control Related Matters Noted in Audit | EF*** | EO | xxx | 5/31 | Company | ||
| 85 | Independent CPA (change) | 1 | N/A | N/A | See Note R | Company | See NOTE R | |
| 86 | Management’s Report of Internal Control Over Financial Reporting | 1 | N/A | 1 | 5/31 | Company | See NOTE Q | |
| 87 | Notification of Adverse Financial Condition | 1 | N/A | 1 | See Note S | Company | See NOTE S | |
| 88 | Relief from the five-year rotation requirement for Lead audit partner | 1 | EO | N/A | Prior to 12/31 | Company | See NOTE Q | |
| 89 | Relief from the one-year cooling off period for Independent CPA | 1 | EO | N/A | Prior to 12/31 | Company | See NOTE Q | |
| 90 | Relief from the Requirements for Audit Committees | 1 | EO | N/A | Prior to 12/31 | Company | See NOTE Q | |
| 91 | Request to File Consolidated Audited Annual Statements | 1 | N/A | N/A | Prior to 12/31 | Company | See NOTE Q | |
| 92 | Request for Exemption to File Management’s Report of Internal Control Over Financial Reporting | 1 | N/A | N/A | Prior to 12/31 | Company | See NOTE Q | |
| 93 | Report of Significant Deficiencies in Internal Controls | 1 | N/A | 1 | 5/31 | Company | See NOTE Q | |
| V. STATE REQUIRED FILINGS | ||||||||
| 101 | Electronic Filing New York Supplement | EF*** | EO | EF*** | 3/1 | State | ||
| 102 | Corporation Franchise Tax to Dept. of Taxation (copy to Department of Financial Services) | 1 | 0 | 1 | 3/15 | State | See NOTE O | |
| 103 | Signed Notarized Jurat (Annual NAIC Blank) | 1 | 0 | 0 | 3/1 | NAIC | See NOTE K; RRG’s – See NOTE P | |
| 103(a) | Signed Notarized Jurat (New York Supplement) | 1 | 0 | 1 | 3/1 | State | See NOTE K; RRG’s – See NOTE P | |
| 103(b) | Signed Notarized Jurat (Quarterly) | 1 | 0 | 0 | 5/15, 8/15, 11/15 | NAIC | See NOTE K; RRG’s – See NOTE P | |
| 104 | Signed Notarized Certificate of Compliance with the advertising requirements of Regulation 34 (11 NYCRR 215) (New York Supplement Exhibit Page 12) | 1 | 0 | 1 | 3/1 | State | See NOTE K | |
| 105 | Signed Report of Premiums Certification (New York Supplement Exhibit Page 33) | 1 | 0 | 1 | 3/1 | State | See NOTE K | |
| 106 | Special Risk Schedule C-1 (Schedule C-1) | 1 | 0 | 1 | 5/15, 8/15, 11/15 | State | Applicable to Article 63 licensee – See NOTE T | |
| 107 | Form B-Holding Company Registration Statement | 1 | 0 | 1 | 5/1 | Company | See NOTE U | |
| 108 | Corporate Governance Annual Disclosure**** | 1 | 0 | 1 | 6/1 | Company | See NOTE U | |
| 109 | Form F-Enterprise Risk Report ***** | 1 | 0 | 1 | 4/30 | Company | See NOTE V | |
| 110 | ORSA ****** | 1 | 0 | 0 | 12/1 | Company | See NOTE V | |
| 111 | Independent CPA Assessment of Internal Controls Relative to Derivatives (where applicable) | 1 | 0 | 1 | 5/31 | Company | See NOTE Q | |
| 112 | Qualifications of CPA – Section 89.5(e)(2) of DFS Insurance Regulation 118 | 1 | 0 | 1 | 5/31 | Company | See NOTE W | |
| 113 | Cybersecurity Certification of Compliance | 1 | 0 | 1 | 4/15 | Company | See NOTE X | |
| 114 | Group Capital Calculation (File with lead state only) | 1 | 0 | 0 | 6/30 | Company | See NOTE U | |
*If XXX appears in this column, this state does not require this filing, if hard/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.
***If EF appears in this column, electronic filings (“EF”) to the NAIC are equivalent to filing with DFS. The Department reserves the right to request hard copies.
****The Corporate Governance Annual Disclosure is required to be filed annually by authorized insurers. The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by the company to the NAIC. For more information, please refer to Regulation 215 (11 NYCRR 90).
*****A Form F filing is required to be filed annually by a New York domestic insurer that is not part of a group and meets a specified premium threshold. For groups, it must be filed by the ultimate holding company for an Article 15 group and by the parent domestic insurer in an Article 16 group. Consistent with the Form B filing requirements, the Form F is a state filing only and should not be submitted by the company to the NAIC. For more information, please refer to Regulation 203 (11 NYCRR 82) on the NYCRR.
******An ORSA Summary Report is required to be filed annually by a New York domestic insurer that meets a specified premium threshold and/or where the New York domestic insurer is a member of a group that meets a specified premium threshold. The ORSA Summary Report is a state filing only and should not be submitted by the company to the NAIC. For more information, please refer to Regulation 203 (11 NYCRR 82) on the NYCRR.
| NOTES AND INSTRUCTIONS | (A-X APPLY TO ALL FILINGS) | |
| A | Required Filings Contact Person: | Mr. Gilbert Denton E-mail: [email protected] |
| B | Mailing Address: | N/A |
| C | Mailing Address for Filing Fees: | N/A |
| D | Delivery Instructions: | If the due date falls on a weekend or a legal holiday, then the filing must be submitted by the end of the next business day. |
| E | Late Filings: | Failure to timely file any component of an annual, quarterly or NY supplement filing will subject the 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: | “Wet” or electronic signatures are required. See Note K for further instructions. |
| G | Signature/Notarization/Certification: | Appropriate notarization required on the actual document. See Note K for further instructions. |
| H | Amended Filings: | Only accepted in accordance with the Department’s prior instructions. All amendments to your Annual Statement are required to be filed electronically with the NAIC. For Amended New York Supplement filings, the entire electronic filing is required to be filed with the NAIC. |
| I | Exceptions from normal filings: | Only accepted in accordance with the Department’s prior instructions. |
| J | 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. 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 | Signatures/Notarizations: | Foreign property and casualty insurance companies licensed in New York are required to file the New York Supplement electronically with the NAIC and file an electronic copy of the signed notarized New York Supplement jurat page, Certificate of Compliance and Report of Premiums Certification (signature only, notarization is not required) through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. All domestic property and casualty insurance companies licensed in New York are required to file the New York Supplement electronically with the NAIC. An electronic copy of the signed and notarized Annual Statement jurat page, Quarterly Statement jurat pages, New York Supplement jurat page, Certificate of Compliance and Report of Premiums Certification (signature only, notarization is not required) are required to be filed through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. |
| 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: | Please review checklist for the changes made this year. |
| N | Actuarial Opinion Summary | Actuarial Opinion Summary should be sent electronically via e-mail to: [email protected] |
| O | Corporation Franchise Tax to Dept. of Taxation | Mail the CT-33NL return and payment to: NYS Corporation Tax Also mail a copy to: NYS Department of Financial Services |
| P | Risk Retention Groups | All RRG’s are required to submit the filings identified in items 1, 1.1, 2, 12, 33 and 82. The filings should be submitted electronically to the NAIC. RRG’s do not have to file hard copy filings with the Department. Any questions regarding filings made by RRG’s should be sent directly to: Mr. Kyn Mo, Associate Insurance Examiner E-mail: [email protected] Note: The New York Supplement (Items # 101 and 103(a)) are not required filings for Foreign RRG’s. |
| Q | The filings identified in items # 3, 32, 35, 37, 83, 86, 88, 89, 90, 91, 92, 93 and 111. | File electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. |
| R | 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. File electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. |
| S | Notification of Adverse Financial Condition | Required 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. File electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. |
| T | Special Risk Schedule C-1 Governance Annual | All companies that are required to file Schedule C-1 should file the schedule electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. The electronic Schedule C-1 can be found on Quarterly and Annual Submission of Free Trade Zone Reports page. |
| U | Form B-Holding Company Registration Statement, Corporate Governance Annual Disclosure and Group Capital Calculation | File electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. |
| V | Form F-Enterprise Risk Report and ORSA | File electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. |
| W | Qualifications of CPA – Section 89.5(e)(2) of DFS Insurance Regulation 118 | The company shall provide a statement that the CPA does not function in the role of management, does not audit his or her own work, and does not serve in an advocacy role for company. File electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. |
| X | Cybersecurity Certificate of Compliance | File electronically through the Department’s Cybersecurity Portal. |
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 submitting 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 Risk-Based Capital Electronic Filing includes all risk-based capital data.
The Risk -Based Capital .PDF Filing is the .pdf file for 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 Statement Electronic Filing includes the complete quarterly statement data.
The Quarterly Statement .PDF Filing is the .pdf file for quarterly statement data.
The Combined Annual Statement Electronic Filing includes the required pages of the combined annual statement and the combined Insurance Expense Exhibit.
The Combined Annual Statement.PDF Filing is the .pdf file for the Combined annual statement data and the combined Insurance Expense Exhibit.
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. 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.