Filings Made During the Year 2022 (1) Check- List (2) Line # (3) REQUIRED FILING FOR THE ABOVE STATE (4) NUMBER OF COPIES* (5) DUE DATE (6) FORM SOURCE** (7) APPLICABLE NOTES; Domestic Foreign; . LIFE, ACCIDENT AND HEALTH/FRATERNAL INSURERS . NE EO 0 EO 3/1 NAIC V 111 Annual Statement Schedule T Page (Page 49-50) EO 0 EO 3/1 NAIC V . 1.1 Printed Investment Schedule detail (Pages E01-E29) 0 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") 0 EO xxx 5/16, 8/15 , 11/15 NAIC 3 Protected Cell Annual Statement 0 0 xxx 3/1 NAIC 4 Combined Annual Statement (8 ½" x 14") 0 EO xxx 5/2 NAIC State NAIC State . Up to $25.00 per day -Certificate of Disclosure Form E-178. L Signed Jurat The following statutes govern the individuals who are authorized to sign the Jurat. P & C Annual Statement March 1, 2022 Insurance Expense Exhibit April 4, 2022 Automobile Expense Experience April 21, 2022 Installment Premium Charges May 5, 2022 . Fax to 816-460-7666 or email, meetingsmail@naic.org. DUE DATE (6) FORM SOURCE ** (7) APPLICABLE NOTES Domestic Foreign State NAIC State I. NAIC FINANCIAL STATEMENTS . ****For those states that have adopted the NAIC Corporate Governance Annual Disclosure Model Act, an annual disclosure is required of all insurers or insurance groups by June 1. B. 1 . If this column contains "State," the state will provide the forms with the filing instructions. To download the latest New York Statement and Supplement blank forms, use the links below. DUE DATE (6) FORM SOURCE ** (7) APPLICABLE NOTES Domestic Foreign State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 1/2" X 14") 1 EO XXX 3/1 NAIC 1.1 Investment Schedule detail (pages E01-E29) 1 EO XXX 3/1 NAIC 2 Quarterly Financial Statement (8 1/2" X 14") 1 EO XXX 5/15, 8/15, 11/15 NAIC . 66 Supplemental .PDF Filing xxx EO xxx 4/1 NAIC 67 Quarterly Statement Electronic Filing xxx EO . Up to $25.00 per day -Annual Statement, Annual Fees, Actuarial Opinion, Management Discussion and Analysis or Audited Financial Report. 61 Annual Statement Electronic Filing xxx EO xxx 3/1 NAIC E . Ending June 30, 2022 (Property) • PBR Exemption due to state 7/1 and NAIC 8/15 (Life/Fraternal) (PDF file only) [Only filed with 2nd Quarter Statement] o Nov. 15, 2022 Quarterly Statement Filing as of September 30, 2022 (Property, Life/Fraternal, Health Title) • Trusteed Surplus Statement - Quarter Ending September 30, ***For those states that have adopted the NAIC Corporate Governance Annual Disclosure . for Supplemental Interrogatories should be . Annual Statement: Per IC 27-1-20-21.2, a $500 late fee may be assessed if the Annual Statement is not received in our office on or before the indicated due date. . submit their NAIC Annual Statement, Installment Premium charges, and Automobile and Property Expens e Experience data. statement. 18. must be physically received at the address in Note C no later than April 30th. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½"x14") 2 EO 0 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 2 EO xxx 3/1 NAIC . Refunds are issued accordingly: Registration fees are NOT transferable to future meetings however substitutions are accepted. 2021-2022 New York Annual Statement and Supplement Filing Blanks. Annual Statement Instructions. The Combined Statement filing fee is due May 1, 2022. . If the filing due date falls on a weekend, you must consult your state of domicile on whether filings are due the Friday before the due date or the Monday after the due date. Puerto Rico will begin collecting MCAS filings beginning with the 2022 data to be reported on the filing due dates in 2023. License applications. L. NONE Filings: . The department will invoice approved surplus lines insurers for the $1,000 annual fee. State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½" x 14") 1 EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 . EO : xxx . REQUIRED FILINGS IN VIRGINIA Filings Made During the Year 2022. 5/15, 8/15, 11/15 NAIC G Original Signatures: Original Signatures required on all filings from domestic companies. Mar. Foreign NOTES . The interest penalty for late filing is 1% of the payment due for each month or part of a month. Cancellation refund checks will be processed after August 22, 2022. This package has been designed to conform to the format adopted by the National Association of Insurance Commissioners (NAIC). ©2021 National Association of Insurance Commissioners 1 Life . to the due date. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½"X14") 1 EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC II. Foreign companies should follow the instructions in the NAIC's Annual . DUE DATE (6) FORM SOURCE** (7) APPLICABLE . Financial Statement Filings due March 31 st and beyond, please consult your domiciliary state for any information on obtaining a waiver or extension. NAIC . NAIC Report: 2022 Spring National Meeting. 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 . Up to $100.00 per day - Quarterly Statements. Other financial filings must be postmarked no later than the indicated due date. must be physically received at the address in Note C no later than April 30th. Due Dates . 1 Annual Statement (8 ½" x 14") EO EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) EO EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") EO EO xxx 5/16, 8/1 5, Foreign NOTES ; State NAIC State ; I. NAIC FINANCIAL STATEMENTS ; 1 Annual Statement (8 ½" x 14") 2 EO xxx 3/1 A-R,T-V,X,Y,Z 1.1 Printed Investment Schedule detail (E01-E25) 2 EO xxx 3/1 O . Date, Sunday Due Date requires next day receipt. DUE DATE (6) APPLICABLE : Domestic. EO : xxx . This waiver could include supplemental annual statement filings. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½" x 14") KY EO EO KY EO* 3/1** NAIC *Jurat page for Foreign only **See Letter E and F 1.1 Printed Investment Schedule detail (Pages E01-E29) KY EO EO 0 3/1* NAIC *See Letter E 2021-22 Annual Statements and New York Supplement Filing Instructions & Forms. Very large files may . Forms & Endorsements. The National Association of Insurance Commissioners (NAIC) held its 2022 Spring National Meeting from March 4 to 8 in Kansas City, Missouri. you may complete the NAIC Annual Statement page entitled "Supplemental Exhibits and Schedules Interrogatories" INSTEAD OF filing reports marked . 1 Annual Statement (8 ½" x 14") EO EO xxx 3/ 1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29 ) @ EO EO xxx 3/1 NAIC A-K , M . DUE DATE (6) FORM SOURCE** (7) APPLICABLE Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½" x 14") 1 EO xxx 3/1 NAIC Note G, H & L 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC SUPPLEMENTS License applications and filing fees. Premium tax . The State of Ohio does not require annual filings or Annual Statements as long as the filings required by the National Association of Insurance Commissioners (NAIC) are filed with the NAIC by their due dates. 1 Annual Statement (8 ½" x 14") 2 EO xxx 3/1 NAIC A-O 1.1 Printed Investment Schedule detail (Pages E01-E29 ) 2 EO xxx 3/1 NAIC A-O 2 Quarterly Financial Statement (8 ½" x 14") 2 EO xxx 5/15, 8/15, 11/15 NAIC A-O 3 Protected Cell Annual Statement 2 0 xxx 3/1 NAIC A-O I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½"X14") 1 EO xxx 3/1 NAIC B . 1.2 Printed Investment Schedule detail (Pages E01-E29) AFF EO xxx 3/1 NAIC M,W 2 Quarterly Financial Statement (8 ½" x 14") AFF EO 0 5/15, 8/15, 11/15 NAIC M,W 3 Protected Cell Annual Statement 1 0 xxx 3/1 NAIC R 4 Combined Annual Statement (8 ½" x 14") AFF EO 0 5/1 NAIC M,W II. The format to be used is the 2021 edition of the quarterly blank adopted by the NAIC for the 2022 reporting year. There is no separate regulation in PA. See 40 Pa. CS §3901, et al. Although the meeting was held in a hybrid in-person and . later than the indicated due date. DUE DATE (6) FORM SOURCE**Domestic (7) APPLICABLE Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½"X14") 1 EO xxx 3/1 NAIC G, H 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC G, H DUE DATE (6) FORM SOURCE ** (7) APPLICABLE ; Foreign NOTES. Annual Statement Filing Requirements. . F Late Filings: Companies will be fined $100 per day for a late filing. These are available in PDF format unless otherwise specified. Since the NAIC's electronic . Information on Annual Report (Due: 4/15/2022) filing for Dusty Kautz Trucking, LLC (Montana (US)) Learn how to leverage transparent company data at scale. Foreign. indicated due date. State NAIC State ; I. NAIC FINANCIAL STATEMENTS ; 1 Annual Statement (8 ½"x1 4") EO EO xx x 3/ 1 NAIC A-K, M 1.1 Printed Investment Schedule detail (Pages E01-E29) @ EO EO xxx 3/1 NAIC A-K, M . > The REFS filings must be received by the Office no later than 5:00 PM on the applicable due date. Due date of Filing, Full Company Name, NAIC# (i.e., 3/1 Filing, . A. Note M - NONE Filings See NAIC . supplements due March 1, per the Annual Statement Instructions. Annual Statement Verification and Acknowledgement Form. Foreign companies: file . 1 Annual Statement (8 ½" x 14") 2 EO xxx 3/1 NAIC A-O 1.1 Printed Investment Schedule detail (Pages E01-E29 ) 2 EO xxx 3/1 NAIC A-O 2 Quarterly Financial Statement (8 ½" x 14") 2 EO xxx 5/15, 8/15, 11/15 NAIC A-O 3 Protected Cell Annual Statement 2 0 xxx 3/1 NAIC A-O State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½"x14") 1 EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC Please follow the NAIC Annual Statement Instructions for NAIC bar codes. This Sidley Update summarizes the highlights from this . . only. Filings Made During the Year 2022 (1) Checklist (2) Line # (3) REQUIRED FILINGS FOR THE ABOVE STATE (4) NUMBER OF COPIES* (5) DUE DATE (6) FORM SOURCE** (7) APPLICABLE NOTES. Not applicable Note L - Signed Jurat See NAIC Annual Statement Instructions. Domestic companies should apply at least 30 days prior to the due date and, for extensions, must submit a written request explaining the reason for the delay and detailed "time-line" of any expected component completion dates and contingencies. NAIC Annual Statement Instructions. DATE: February 9, 2022 TO: Property & Casualty Insurers - Financial Statement Contact Person . DUE DATE (6) FORM SOURCE** (7) APPLICABLE ; Domestic Foreign NOTES . Other financial filings must be postmarked no later than the indicated due date. Pet Insurance Model Act Not Yet Adopted by NAIC. . The NAIC is using a streamlined formulaic approach for the calculation of the 2021 annual financial filing . DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½" x 14") 2 EO 0 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 2 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") 2 EO 0 5/15, 8/15, 11/15 NAIC filing due date. Created Date: 02/14/2022 07:43:00 Title: LIFE, ACCIDENT AND HEALTH INSURERS Last modified by: Diep, Christine Company: you may complete the NAIC Annual Statement page entitled "Supplemental Exhibits and Schedules Interrogatories" INSTEAD OF filing duplicate reports . ©2021 National Association of Insurance Commissioners 1 Life . Annual Filing Instructions. DUE DATE (6) FORM SOURCE* * (7) APPLICABLE Domestic ForeigNOTES n State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½" x 14") 1 EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC II. submit quarterly statements to the NAIC electronically. The Annual Statement filing fee is due March 1, 2022. Annual Statement Instructions . Michigan has adopted the NAIC Corporate Governance Annual Disclosure Model Act . Filing Date 2022-02-24 Filing Number 6291430 Filing Type Annual Report (Due: 4/15/2022) Last updated March 15 2022, 3.43PM (4 months ago) If your company is granted a waiver or extension, please provide that documentation to FDRadmin@naic.org . ***** Effective July 1, 2017, North Carolina adopted the NAIC updated Risk Management and Own Risk and Solvency Assessment Model Act, a summary report is required annually by insurers and insurance groups above a specified premium threshold. LIFE, ACCIDENT AND HEALTH/FRATERNAL INSURERS . DUE DATE (6) FORM SOURCE ** (7) APPLICABLE NOTES Domestic Foreign State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 1/2" X 14") 1 EO XXX 3/1 NAIC 1.1 Investment Schedule detail (pages E01-E29) 1 EO XXX 3/1 NAIC 2 Quarterly Financial Statement (8 1/2" X 14") 1 EO XXX 5/15, 8/15, 11/15 NAIC If the due date falls on a weekend or holiday, then the postmark deadline is extended to the . Puerto Rico is now a participating MCAS jurisdiction. See also NAIC website. DUE DATE (6) FORM SOURCE** (7) APPLICABLE stic Foreign NOTESDome. Domestic. ©1992 - 2020 National Association of Insurance Commissioners 1 Title 2020 INSTRUCTIONS For Completing Title Annual Statement Blank FOREWORD Line titles and columnar headings of the various statement items and lines are in general self-explanatory and as such constitute instructions. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½" x 14") EO EO XXX 3/1 NAIC B(c), G, H(a), I, L, N(a) 1.1 Printed Investment Schedule detail (Pages E01-E29) EO EO XXX 3/1 NAIC B(c), I, N(a) A summary of all changes can be found in the Summary of 2022 Changes document. NAIC. for Nevada required filings - supply a written copy of any exemption or extension received from your state of domicile at least 10 days prior to the filing due date. Column (7) (Applicable Notes) ***For those states that have adopted the NAIC Corporate Governance Annual Disclosure . . We use the NAIC filing date or the USPS postmark or courier pick-up date as the date filed. For 2022, North Dakota is . Electronic filings, in the form of a zip file in accordance with the NAIC Filing Instructions, should be sent to annstat@aib.org as an email attachment. ©2021 National Association of Insurance Commissioners 1 Life LIFE, ACCIDENT AND HEALTH/FRATERNAL INSURERS . HCS & HMO - §354.435 Prepaid Dental - §354.720 Quarterly Statement Filing as of March 31, 20189 (Property, Life, Health, Title) Trusteed Surplus Statement - Quarter Ending March 31, 2019 (Property, Life) Supplement A to Schedule T (Medical Professional Liability Supplement . Statements are due 45 days subsequent to the end of each quarter: Quarter Ending Due Date March 31, 2022 May 15, 2022 June 30, 2022 August 15, 2022 The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by the company to Payments are due on or before March 1, 2022. If the due date falls on a weekend or holiday, the deadline is extended to the next business day. DUE DATE (6) FORM SOURCE**Domestic (7) APPLICABLE Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 ½" x 14") 2 EO xxx 3/1 NAIC G,H,J,K,L,O, BB 1.1 Printed Investment Schedule detail (Pages E01-E29) 2 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 ½" x 14") 2 EO 5/15, 8/15, 11/15 . Invoices will be available January 2022, on the Examinations Bureau webpage and the Company Licensing Bureau webpage, which can be found at The XXX in this column might signify that the state has waived the paper filing of the annual statement and all supplements. 2021 Year-end and 2022 Quarterly Filings Page 3 of 5 The request for an exemption or extension must be submitted in writing not less than ten days prior to the due date in sufficient detail to permit the Director to make an informed . Although the meeting was held in a hybrid in-person and . Members of the North Carolina Insurance . Premium Tax: The penalty for non-filing is $100 per day. There is no due date for CY 2022. All companies licensed to write automobile insurance in Massachusetts must submit electronic copies of the 2021 Annual Statement documents to the AIB on or before the due dates shown below.
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