NAIC Filings Checklist.doc
Published on: Mar 3, 2016
Transcripts - NAIC Filings Checklist.doc
2009 Instructions for Filing
COMPANY NAME: NAIC Company Code:
REQUIRED FILINGS IN THE STATE OF: Wyoming Filings Made During the Year 2010
(1) (2) (3) (4) (5) (6) (7)
Check- Line REQUIRED FILING FOR THE ABOVE STATE NUMBER OF COPIES* DUE DATE FORM APPLICABLE
List # Domestic Foreign SOURCE** NOTES
State NAIC State
I. NAIC FINANCIAL STATEMENTS
1 Annual Statement (8 ½” x 14”) 2 EO xxx 3/1 NAIC A-N
1.1 Printed Investment Schedule detail (Pages E01-E27) 2 EO xxx 3/1 NAIC
2 Quarterly Financial Statement (8 ½” x 14”) 2 EO xxx 5/15, 8/15, NAIC
II. NAIC SUPPLEMENTS
11 Investment Risk Interrogatories 2 EO xxx 4/1 NAIC
12 Management Discussion & Analysis 2 EO xxx 4/1 Company
13 Schedule SIS 2 N/A N/A 3/1 NAIC
14 Statement of Actuarial Opinion 2 EO xxx 3/1 Company
15 Supplemental Compensation Exhibit 2 N/A N/A 3/1 NAIC
16 Supplemental Schedule of Business Written By 2 EO xxx 4/1 NAIC
III. ELECTRONIC FILING REQUIREMENTS
50 Annual Statement Electronic Filing xxx 1 xxx 3/1 NAIC
51 March .PDF Filing xxx 1 xxx 3/1 NAIC
52 Supplemental Electronic Filing xxx 1 xxx 4/1 NAIC
53 Supplemental .PDF Filing xxx 1 xxx 4/1 NAIC
54 Quarterly Statement Electronic Filing xxx 1 xxx 5/15, 8/15, 11/15 NAIC
55 Quarterly .PDF Filing xxx 1 xxx 5/15, 8/15, 11/15 NAIC
56 June .PDF Filing xxx 1 xxx 6/1 NAIC
IV. AUDITED FINANCIAL STATEMENTS
71 Accountants Letter of Qualifications 2 EO N/A 6/1 Company R
72 Audited Financial Statements 2 EO xxx 6/1 Company
73 Audited Financial Statements Exemption Affidavit 0 N/A N/A Company
74 Independent CPA 2 N/A N/A Company S
75 Notification of Adverse Financial Condition 2 N/A N/A Company T
76 Report of Significant Deficiencies in Internal Controls 2 N/A N/A Company U
77 Request for Exemption to File 2 N/A N/A Company V
V. STATE REQUIRED FILINGS
101 Filings Checklist (with Column 1 completed) 1 0 0 3/1 State
102 Premium Tax Return 2 0 1 3/1 State O, P
103 State Filing Fees 1 0 1 3/1 State O, P
104 Estimated Quarterly Premium Tax Return 1 0 1 4/30, 7/31, State Q
105 Holding Company Registration Form B & C 2 0 0 7/1 Company X
106 Notice of Publication 2 0 2 3/1 State
107 Controlled Business Transaction Report 2 0 1 State W
108 Signed Jurat xxx xxx 0 NAIC L
*If XXX appears in this column, this state does not require this filing, if hard 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.
© 2009 National Association of Insurance Commissioners
NOTES AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS)
A Required Filings Contact Person: Mavis Earnshaw, Financial Specialist
Phone No. (307) 777-6884
B Mailing Address: 106 East 6th Avenue
Cheyenne, WY 82002
C Mailing Address for Filing Fees: Same as above
D Mailing Address for Premium Tax Payments: Same as above
E Delivery Instructions: All filings must be postmarked no later
than the indicated due date. If due date
falls on a weekend or holiday then the
deadline is extended to the next business
F Late Filings: Insurer’s certificate of authority may be
suspended or revoked if failing to file its
reports when due.
G Original Signatures: Original signatures required on all filings
which require signatures
H Signature/Notarization/Certification: Statements shall be verified by the oath
of the insurer’s president or vice-
president and secretary or actuary as
I Amended Filings: Follow NAIC Guidelines
J Exceptions from normal filings: Foreign companies must supply a copy
of an exemption or extension by the state
of domicile prior to the due date.
K Bar Codes (State or NAIC): Please follow the NAIC Instructions
L Signed Jurat: Wyoming does not require foreign
companies to file a Signed Jurat page.
M NONE Filings: See NAIC instructions with exceptions
to those noted on the form.
N Filings new, discontinued or modified materially since last year: None
O Premium Tax Return: See instructions attached to the tax
P Payment Instructions: Make checks payable to the Wyoming
If paying under protest, please include an explanation letter. State Treasurer. Each check should
include the company’s NAIC # and make
one copy of the check.
Q Estimated Quarterly Premium Tax Return Instructions on the estimated quarterly
premium tax return form.
R Accountants Letter of Qualifications: W.S.26-3-311
S Designation of Independent CPA: If the CPA is not the CPA who prepared
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the immediately preceding filed audited
financial report for the insurer, due to
dismissal or resignation, the insurer shall
notify the department within 5 business
days of the change. Refer to
T Notification of Adverse Financial Condition: An insurer that has received a report of
adverse financial condition shall forward
a copy of the report to the commissioner
within five (5) business days of receipt
of the report. Refer to W.S.26-3-309
U Report of Significant Deficiencies in Internal Control: An insurer that has received a report
describing significant deficiencies in the
insurer’s internal control structure shall
file the written report with the
department within sixty (60) days after
the filing of the audited financial
statements. Refer to W.S.26-3-310
V Request for Exemption to File: W.S.26-3-313
W Controlled Business Transactions Report Regulations, Chapter 3, Section 6
X Holding Company Registration Form B and C: W.S.26-44-104
All Forms are on the Wyoming Insurance Department’s Website http://insurance.state.wy.us
CONTACT PEOPLE FOR SPECIALIZED AREAS
Direct any questions on the Notice of Publication Form to Tammy Higgins. Phone Number (307) 777-7318; firstname.lastname@example.org
Wyoming requires the UCAA Corporate Amendments application for approval of mergers, name changes, redomestications, etc.
Contact Lou Ann Poutre, Administrative Specialist. Phone Number (307) 777-7401; email@example.com
Direct any questions on updating service of process information to Dee Wilhelm. Phone Number (307) 777-6916;
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 mailing 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.
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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 the annual statement, detail for investment schedules and all supplements due March 1.
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 supplements due April 1.
The Quarterly Electronic Filing includes the quarterly statement data.
The Quarterly .PDF Filing is the .pdf for quarterly statement data.
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.
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