NAIC & DFS Annual Statement Checklist and Instructions

COMPANY NAME:

NAIC Company Code:

Contact:

Telephone:

REQUIRED FILINGS IN THE STATE OF: NEW YORK

Filings Made During the Year 2023

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

See NOTE Q

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

See NOTE B

14

Bail Bond Supplement

1

EO

xxx

3/1

NAIC

15

Combined Insurance Expense Exhibit

1

EO

xxx

5/1

NAIC

See NOTE Q

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

3/1,
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 Association Assessable Premium Exhibit, Parts 1 and 2

1

EO

xxx

4/1

NAIC

22

Long Term Care Experience Reporting Forms

1

EO

xxx

4/1

NAIC

23

Management Discussion & Analysis

1

EO

xxx

4/1

Company

24

Medicare Part D Coverage Supplement

1

EO

xxx

3/1, 5/15, 8/15, 11/15

NAIC

25

Medicare Supplement Insurance Experience Exhibit

1

EO

xxx

3/1

NAIC

26

Mortgage Guaranty Insurance Exhibit

1

EO

xxx

4/1

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

RRG’s – See NOTE P

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

See NOTE Q

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

See NOTE Q

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

See NOTE Q

84

Communication of Internal Control Related Matters Noted in
Audit

1

EO

xxx

5/31

Company

See NOTE Q

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

E/O

N/A

Prior to 12/31

Company

See NOTE Q

89

Relief from the one-year cooling off period for
Independent CPA

1

E/O

N/A

Prior to 12/31

Company

See NOTE Q

90

Relief from the Requirements for Audit Committees

1

E/O

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

New York Supplement

1

0

0

3/1

State

RRG’s - See
NOTE P

102

Electronic Filing New York Supplement

1

EO

1

3/1

State

See NOTE Y

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

See NOTE O

105

Signed Notarized Jurat (Annual NAIC Blank)

1

0

0

3/1

NAIC

RRG’s – See NOTE P

105(a)

Signed Notarized Jurat (New York Supplement)

1

0

1

3/1

State

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

105(b)

Signed Notarized Jurat (Quarterly)

1

0

0

5/15, 8/15, 11/15

NAIC

RRG’s – See NOTE P

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

NOTES AND INSTRUCTIONS

(A-Y 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
E-mail: [email protected]
When answering by e-mail, please include telephone number.

B

Mailing Address:

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

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); and Risk- Based Capital Report:

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

Actuarial Opinion Summary should be sent electronically via e-mail to: [email protected]

CD (See Note N):
Mr. Gilbert Denton, Senior Insurance Examiner
New York State Department of Financial Services
Property Bureau – 4th Floor
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 property and casualty insurance companies 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    through the Department’s Insurance Company and Fraternal Benefit Society Filings Portal.

All foreign mortgage guaranty insurance companies and foreign financial guaranty insurance 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:

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

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

Internet Filing:

Instructions concerning internet filing alternative to filing a CD with New York for the New York Supplement are set forth in 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 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, 2, 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 Financial Services
Property Bureau – 6th Floor
One State Street
New York, NY 10004
(212) 480-4217

E-mail: [email protected]
When answering by e-mail, please include telephone number.

Note: The New York Supplement (Items # 101, 102 and 105(a)) are not required filings for Foreign RRG’s.

Q

The filings identified in items # 4, 15, 35, 81, 83, 84, 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

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 and Corporate Governance Annual Disclosure

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 attach a statement to its audited annual financial statement, when filed, 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.

Y

Electronic Filing New York Supplement

File electronically with the NAIC.