NAIC & DFS Annual Statement Checklist and Instructions

Property & Casualty Insurers 2020

COMPANY NAME:                                                                                                            NAIC Company Code:                 
Contact:                                                                                                                                         Telephone:                        
REQUIRED FILINGS IN THE STATE OF NEW YORK                                         Filings Made During the Year 2021

(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” x 14”)

1

EO

xxx

 

3/1

NAIC

RRG’s - See NOTE P

 

1.1

Printed Investment Schedule detail (Pages E01-E29)

1

EO

xxx

3/1

NAIC

RRG’s - See NOTE P

 

2

Quarterly Financial Statement (8 ½” x 14”)

1

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

 

 

4

Combined Annual Statement (8 ½” x 14”)

1

EO

xxx

5/1

NAIC

 

 

 

II.  NAIC SUPPLEMENTS

 

 

 

 

 

 

 

11

Accident & Health Policy Experience Exhibit

1

EO

xxx

4/1

NAIC

 

 

12

Actuarial Opinion

1

EO

xxx

3/1

Company

RRG’s - See NOTE P

 

13

Actuarial Opinion Summary

1

N/A

N/A

3/15

Company

NOTE   B

 

14

Bail Bond Supplement

1

EO

xxx

3/1

NAIC

 

 

15

Combined Insurance Expense Exhibit

1

EO

xxx

5/1

NAIC

 

 

16

Credit Insurance Experience Exhibit

1

EO

xxx

4/1

NAIC

 

 

17

Cybersecurity and Identity Theft Insurance Coverage Supplement

 

1

 

EO

 

xxx

 

4/1

 

NAIC

 

 

18

Director and Officer Insurance Coverage Supplement

1

EO

xxx

5/15, 8/15, 11/15

NAIC

 

 

19

Financial Guaranty Insurance Exhibit

1

EO

xxx

3/1

NAIC

 

 

20

Insurance Expense Exhibit

1

EO

xxx

4/1

NAIC

 

 

21

Life, Health & Annuity Guaranty Assessment Base Reconciliation Exhibit

1

EO

xxx

4/1

NAIC

 

 

22

Life, Health & Annuity Guaranty Assessment Base Reconciliation Exhibit Adjustment Form

1

EO

xxx

4/1

NAIC

 

 

23

Long Term Care Experience Reporting Forms

1

EO

xxx

4/1

NAIC

 

 

24

Management Discussion & Analysis

1

EO

xxx

4/1

Company

 

 

25

Medicare Part D Coverage Supplement

1

EO

xxx

3/1,   5/15, 8/15, 11/15

NAIC

 

 

26

Medicare Supplement Insurance Experience Exhibit

1

EO

xxx

3/1

NAIC

 

 

27

Premiums Attributed to Protected Cells Exhibit

1

EO

xxx

3/1

NAIC

 

 

28

Private Flood Insurance Supplement

1

EO

xxx

4/1

NAIC

 

 

29

Reinsurance Attestation Supplement

1

EO

xxx

3/1

Company

 

 

30

Exceptions to Reinsurance Attestation Supplement

1

N/A

N/A

3/1

Company

 

 

31

Reinsurance Summary Supplemental

1

EO

xxx

3/1

NAIC

 

 

32

Risk-Based   Capital Report

1

EO

xxx

3/1

NAIC

 

 

33

Schedule SIS

1

N/A

N/A

3/1

NAIC

 

 

34

Supplement A to Schedule T

1

EO

xxx

3/1,   5/15, 8/15, 11/15

NAIC

 

 

35

Supplemental Compensation Exhibit

1

N/A

N/A

3/1

NAIC

 

 

36

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

1

EO

xxx

4/1

NAIC

 

 

37

Supplemental Health Care Exhibit’s Allocation Report Supplement

1

EO

xxx

4/1

NAIC

 

 

38

Supplemental Investment Risk Interrogatories

1

EO

xxx

4/1

NAIC

 

 

39

Supplemental Schedule for Reinsurance Counterparty Reporting Exception - Asbestos and Pollution Contracts

1

EO

xxx

3/1

NAIC

 

 

40

Trusteed Surplus Statement

1

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

1

EO

N/A

5/31

Company

 

 

82

Audited Financial Reports

1

EO

xxx

5/31

Company

RRG’s - See NOTE P

 

83

Audited Financial Reports Exemption Affidavit

1

N/A

N/A

5/31

Company

 

 

84

Communication of Internal Control Related Matters Noted in Audit

1

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

N/A

5/31

Company

 

 

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

E/O

N/A

Prior   to 12/31

Company

 

 

89

Relief from the one-year cooling off period for

Independent CPA

1

E/O

N/A

Prior   to 12/31

Company

 

 

90

Relief from the Requirements for Audit Committees

1

E/O

N/A

Prior   to 12/31

Company

 

 

91

Request to File Consolidated Audited Annual Statements

1

N/A

N/A

Prior   to 12/31

Company

 

 

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

 

 

93

Report of Significant Deficiencies in Internal Controls

1

N/A

1

5/31

Company

Foreign Companies See NOTE Q

 

 

V.  STATE REQUIRED FILINGS

 

 

 

 

 

 

 

101

New York Supplement

1

0

0

3/1

State

Foreign   Companies- See NOTE K; RRG’s See NOTE P

 

102

Electronic Filing New York  Supplement

1

EO

1

3/1

State

 

 

103

Filings Checklist (with Column 1 completed)

1

0

0

3/1

State

 

 

104

Corporation Franchise Tax to Dept. of Taxation (copy to Department of Financial Services)

1

0

1

3/15

State

NOTE   O

 

105

Signed Notarized Jurat (Annual NAIC Blank)

1

0

0

3/1

NAIC/State

Foreign Companies - See NOTE K; RRG’s - See NOTE P

 

105(a)

Signed Notarized New York Supplement Jurat

1

0

1

3/1

NAIC/State

Foreign Companies - See NOTE K

 

105(b)

Signed Notarized Jurat (Quarterly)

1

0

0

5/15, 8/15, 11/15

NAIC/State

Foreign Companies - See NOTE K; RRG’s - See NOTE P

 

106

Special Risk Schedule C-1 (Schedule C-1)

1

N/A

1

5/15, 8/15, 11/15

State

Applicable   to Article 63 licensee.  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

*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.

***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 on the NYCRR.

NOTES AND INSTRUCTIONS (A-V Apply to All Filings)

  A  Required Filings Contact Person:

 

Mr. Gilbert Denton, Senior Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
One State Street
New York, NY 10004
(212) 480-4669

Email: [email protected] When answering by email, please include telephone number. 

  B  Mailing Address:

 

Annual Statement, New York Supplement, and related items (hard copies); Audited Financial Statement; Quarterly Statement (hard copies); Risk-Based Capital Report; Certificate of Compliance; and Certificate of Deposit:

Mr. Gilbert Denton, Senior Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
One State Street
New York, NY 10004

All Mortgage Guaranty Insurance Companies and Financial Guaranty Insurance Companies Annual Statement, New York Supplement, and related items (hard copies); Audited Financial Statement; Quarterly Statement (hard copies); Risk-Based Capital Report; Certificate of Compliance; and Certificate of Deposit:

Ms. Wendy Hung, Senior Insurance Examiner
New York State Department of Financial Services
Markets Bureau - 7th Floor
One State Street
New York, NY 10004
(212) 709-1562

Actuarial Opinion Summary should be sent electronically directly via email to:  [email protected]

CD (See Note N):

Mr. Gilbert Denton, Senior Insurance Examiner
New York State Department of Financial Services
Property Bureau
One State Street
New York, NY 10004

  C  Mailing Address for Filing Fees:   N/A 
  D  Delivery Instructions:

 

All Department of Financial Services 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. If the due date falls on a weekend or a legal holiday, then the filing must be received by the Department by the end of the next business day.

The 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. Diskettes should be labeled.

  E 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.

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:   Actual live signatures required. 
  G Signature/Notarization/Certification: Appropriate notarization required on the actual document.
  H  Amended Filings: Only accepted in accordance with the Department's prior instructions.

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

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

  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  Signed Jurat:

 

Foreign companies do not have to file a hard copy of the signed notarized property and casualty annual statement jurat page and the signed notarized property and casualty quarterly statement jurat page with the Department.

Foreign Companies are required to file the New York Supplement electronically with the NAIC and a hard copy of the signed notarized New York Supplement jurat page with the Department.

Hard copy filings of the signed notarized New York Supplement jurat page should be directed to:

Mr. Gilbert Denton, Senior Insurance Examiner
New York State Department of Financial Services
Property Bureau - 4th Floor
One State Street
New York, NY 10004

  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:  None.
  N  Internet Filing:

 

Instructions concerning internet filing alternative to filing a CD with New York for the New York Supplement are set forth in the Department's Circular Letter No. 4 (2001) and Supplement 1 to Circular Letter No. 4 (2001), dated 2/6/08.

All companies are strongly encouraged to file national form filings (as identified in items 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 and 71 in the checklist) with the NAIC preferably via the Internet. By filing over the Internet 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.

  O  Corporation Franchise Tax to Dept. of Taxation 

Mail the CT-33NL return and payment to:

NYS Corporation Tax
PO Box 15181
Albany NY 12212-5181

Also mail a copy to:

NYS Department of Financial Services, Office of Financial Management, One Commerce Plaza Albany, NY 12257

  P  Risk Retention Groups 

All RRG’s are required to submit the filings identified in items 1, 1.1, 12, 31 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
New York State Department of Financial Services
Property Bureau - 6th Floor
One State Street
New York, NY 10004
(212) 480-4217

E-mail: [email protected]

When answering by email, please include telephone number.

Note: The New York Supplement (Items # 101 and 102) are not required filings for Foreign RRG's.

  Q  Report of Significant Deficiencies in Internal Controls

Foreign companies submit 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.

  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.

  T Special Risk Schedule C-1

All companies that are required to file Schedule C-1 should submit the schedule electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal. The electronic Schedule C-1 can be found on the Quarterly and Annual Submission of Free Trade Zone Reports page.

  U Form B-Holding Company Registration Statement and Corporate Governance Annual Disclosure

Submit electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal.

  V Form F-Enterprise Risk Report and ORSA

Submit electronically through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal.

GENERAL INSTRUCTIONS FOR COMPANIES TO USE CHECKLIST

Please Note:

New York State 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 (generally on its 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.