(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 (8½ "x14")

1

EO

N/A

3/1

NAIC

A,B,E,F,G,H,I,J,K,M,O

1.1

Printed Investment Schedule detail (Pages E01-E27)

1

EO

N/A

3/1

NAIC

A,B,E,F,J,K,M,O

2

Quarterly Financial Statement (8½ "x14")

1

EO

N/A

5/15, 8/15, 11/15

NAIC

A,B,E,F,G,H,I,J,K,O

3

Separate Accounts Annual Statement (8½ "x14")

1

EO

N/A

3/1

NAIC

A,B,E,F,G,H,I,J,K,M,O,P

II.  NAIC SUPPLEMENTS

10

Accident & Health Policy Experience Exhibit

1

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M,O,P

11

Actuarial Certification Related Annuity Nonforfeiture Ongoing Compliance for Equity Indexed Annuities

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

12

Actuarial Certifications Related to Hedging required by Actuarial Guideline XLIII

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

13

Actuarial Certification Related to Reserves required by Actuarial Guideline XLIII

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

14

Actuarial Certification regarding use 2001 Preferred Class Table

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

15

Actuarial Opinion

1

EO

N/A

3/1

Company

A,B,E,F,G,I,J,K,O,P

16

Actuarial Opinion on X-Factors

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

17

Actuarial Opinion on Separate Accounts Funding Guaranteed Minimum Benefit

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

18

Actuarial Opinion on Synthetic Guaranteed Investment Contracts

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

19

Actuarial Opinion required by Modified Guaranteed Annuity Model Regulation

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

20

Analysis of Annuity Operations by Lines of Business

1

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M,P

21

Analysis of Increase in Annuity Reserves During Year

1

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M,P

22

Credit Insurance Experience Exhibit

1

EO

1

4/1

NAIC

A,B,E,F,J,K,M,O,P
See Administrative Letter AL 2012-1

23

Financial Officer Certification Related to Clearly Defined Hedging Strategy required by Actuarial Guideline XLIII

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

24

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

1

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M,P

25

Health Care Exhibit's Allocation Report Supplement

1

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M,P

26

Interest Sensitive Life Insurance Products Report

1

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M,P

27

Investment Risks Interrogatories

1

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M,O,P

28

Life, Health & Annuity Guaranty Assessment Base

Reconciliation Exhibit

N/A

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M

29

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

N/A

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M

30

Long Term Care Experience Reporting Forms

1

EO

N/A

4/1

NAIC

A,B,E,F,J,K,M,P

31

Management Certification that the Valuation Reflects Management's Intent required by Actuarial Guideline XLIII

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,P

32

Management Discussion & Analysis

1

EO

N/A

4/1

Company

A,B,E,F,J,K,O,P

33

Medicare Supplement Insurance Experience Exhibit

1

EO

N/A

3/1

NAIC

A,B,E,F,J,K,M,P

34

Medicare Part D Coverage Supplement

1

EO

N/A

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

NAIC

A,B,E,F,J,K,M

35

Reasonableness of Assumptions Certification required by Actuarial Guideline XXXV

1

EO

N/A

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

Company

36

Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXV

1

EO

N/A

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

Company

A,B,E,F,J,K,M

37

Reasonableness of Assumptions Certification for Implied Guaranteed Rate Method required by Actuarial Guideline XXXVI

1

EO

N/A

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

Company

A,B,E,F,J,K,M

38

Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXVI(Updated Average Market Value)

1

EO

N/A

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

Company

A,B,E,F,J,K,M

39

Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXVI(Updated Market Value)

1

EO

N/A

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

Company

A,B,E,F,J,K,M

40

Risk-Based Capital Report

1

EO

N/A

3/1

NAIC

A,B,E,F,G,J,K,P

41

RBC Certification Required Under C-3 Phase I

1

EO

N/A

3/1

Company

A,B,E,F,J,K,P

42

RBC Certification Required Under C-3 Phase II

1

EO

N/A

3/1

Company

A,B,E,F,J,K,P

43

Schedule SIS

1

N/A

N/A

3/1

NAIC

A,B,E,F,J,K,M,P

44

Statement on non-guaranteed elements - Exhibit 5 Int. #3

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,O

45

Statement on par/non-par policies - Exhibit 5 Int. 1 & 2

1

EO

N/A

3/1

Company

A,B,E,F,J,K,M,O

46

Supplemental Compensation Exhibit

1

N/A

N/A

3/1

NAIC

A,B,E,F,J,K,P

47

Supplemental Schedule O

1

EO

N/A

3/1

NAIC

A,B,E,F,J,K,M,P

48

Trusteed Surplus Statement

N/A

EO

N/A

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

NAIC

A,B,E,F,I,J,K,M,O

49

Workers' Compensation Carve Out Supplement

1

EO

N/A

3/1

NAIC

A,B,E,F,I,J,K,P

III.  ELECTRONIC FILING REQUIREMENTS

50

Annual Statement Electronic Filing

N/A

1

N/A

3/1

NAIC

51

March .PDF Filing

N/A

1

N/A

3/1

NAIC

52

Risk-Based Capital Electronic Filing

N/A

1

N/A

3/1

NAIC

53

Risk-Based Capital .PDF Filing

N/A

1

N/A

3/1

NAIC

54

Separate Accounts Electronic Filing

N/A

1

N/A

3/1

NAIC

55

Separate Accounts .PDF Filing

N/A

1

N/A

3/1

NAIC

56

Supplemental Electronic Filing

N/A

1

N/A

4/1

NAIC

57

Supplemental .PDF Filing

N/A

1

N/A

4/1

NAIC

58

Quarterly Statement Electronic Filing

N/A

1

N/A

5/15, 8/15, 11/15

NAIC

59

Quarterly .PDF Filing

N/A

1

N/A

5/15, 8/15, 11/15

NAIC

60

June .PDF Filing

N/A

1

N/A

6/1

NAIC

IV.  AUDITED FINANCIAL STATEMENTS

71

Accountants Letter of Qualifications

1

EO

N/A

6/1 or 6/30

Company

A,B,E,F,J,O,P

72

Audited Financial Reports

1

EO

N/A

6/1 or 6/30

Company

A,B,E,F,J,K,O,P

73

Audited Financial Reports Exemption Affidavit

1

N/A

1

3/1

State

A,B,E,F,J,O

74

Communication of Internal Control Related Matters Noted in Audit

1

N/A

1

within 60 days after filing the annual Audited Financial Report

Company

A,B,E,F,J,K,M,O,P

75

Independent CPA (Change)

1

N/A

1

Within 5 business days of change

Company

A,B,E,F,J,O

76

Management's Report of Internal Control Over Financial Reporting

1

N/A

N/A

within 60 days after filing the annual Audited Financial Report

Company

A,B,E,F,J,K,M,O,P

77

Notification of Adverse Financial Condition

1

N/A

1

Within 5 business days of receipt

Company

A,B,E,F,O

78

Request for Exemption to File

See Line 73

N/A

See Line 73

3/1

Company

A,B,E,F,J,O

79

Relief from the five-year rotation requirement for the lead audit partner

1

EO

1

3/1

Company

A,B,E,F,J,O

80

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

1

EO

1

3/1

Company

A,B,E,F,J,O

81

Relief from the Requirements for Audit Committees

1

EO

1

3/1

Company

A,B,E,F,J,O

V.  STATE REQUIRED FILINGS

101

Certificate of Compliance

N/A

N/A

1

3/1

Dom. State

A,B,E,J,O,P

102

Certificate of Deposit

N/A

N/A

1

3/1

Dom. State

A,B,E,J,O,P

103

Certificate of Reserve Valuation

N/A

N/A

1

8/1

Dom. State

A,B,E,J,O

104

Filings Checklist (with Column 1 completed)

N/A

N/A

N/A

3/1

State

105

Premium tax/Assessment Filings:

SEPARATE FILING - DIFFERENT ADDRESS

1

N/A

1

3/1

State

See Note D

 XXXX

106

State Filing Fees

N/A

N/A

N/A

 XXXX

107

Signed Jurat

N/A

N/A

N/A

L

108

Actuarial Opinion Memorandum

1

N/A

N/A

3/1

Company

A,B,E,F,J,P

109

Actuarial Opinion Memorandum Regarding X Factors

1

N/A

N/A

3/1

Company

A,B,E,F,J,P

110

Analysis of Excess Capital & Surplus Investments Report

1

N/A

N/A

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

State

A,B,E,F,J,P

111

Application for Renewal of License

1

N/A

1

3/1

State

A,B,E,F,J,P

112

Insurance Holding Company System Annual Reg. Stmt.

1

N/A

N/A

4/30

Company

A,B,E,F,J,P

113

Managed Care Health Insurance Plan ("MCHIP") Description of Virginia Operations

1

N/A

1

3/1

Company

A,B,E,F,J,O,P

114

Managed Care Health Insurance Plan ("MCHIP") List of Providers

1

N/A

1

3/1

Company

A,B,E,F,J,O

115

Regulatory Asset Adequacy Issues Summary (No form)

1

N/A

1

3/15

Company

A,B,E,F,J,O,P

116

[Report of Assets Pledged, Hypothecated or Encumbered]

1

N/A

N/A

3/1

State

A,B,E,F,J,P

117

Request for Information Regarding RIs

1

N/A

N/A

3/1

State

A,B,E,F,J,P

NOTES AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS)

A

Required Filings Contact Person:

VIRGINIA DOMESTIC COMPANIES:
Karen Traylor: 804-371-9908 Karen.Traylor@scc.virginia.gov

FOREIGN COMPANIES:
Gala Yung: 804-371-9136 Galang.Yung@scc.virginia.gov

B

Annual Renewal and Related Filings Mailing Address:

State Corporation Commission

Bureau of Insurance

Financial Regulation Division

P.O. Box 1157

Richmond, VA  23218

NEW THIS YEAR: We have a portal which will allow the electronic submission of many of these required documents at Annual License Renewal and Financial Filing Submission Portal. Insurers must go to the portal and log in to submit documents electronically.

Annual Renewal and Related Filings Courier Delivery:

State Corporation Commission

Bureau of Insurance, Financial Regulation Division

1^st Floor Mailroom

1300 East Main Street

Richmond, VA  23219

C

Mailing Address for Filing Fees:

N/A

D

Information for Premium Tax/Assessments Filings:

www.scc.virginia.gov/boi/co/tax/filing.aspx

The tax packet is a SEPARATE filing and SHOULD NOT be submitted with the Annual Statement and its related filings.

Premium Tax/Assessment Filings Mailing Address:

Wells Fargo/State Corporation Commission

TAA Insurance 2

P.O. Box 759064

Baltimore, MD  21275-9064

Contact Administrative Tax Division, 804-371-9096 , with any questions.

Premium Tax Packet Courier Delivery:

Wells Fargo/State Corporation Commission

TAA Insurance 2

Lockbox 759064

7175 Columbia Gateway Drive

Columbia, MD  21046

E

Delivery Instructions:

All filings must be postmarked no later than the indicated due date.  If the due date falls on a weekend or holiday, then the postmark deadline is extended to the next business day.

F

Late Filings:

Late filings are subject to penalties pursuant to § 38.2-218 of the Code of Virginia.

G

Original Signatures:

A printer's reproduction of "live" signatures is acceptable.

H

Signature/Notarization/Certification:

Statements must be signed by at least two principal officers of the company.

I

Amended Filings:

Any signature requirements for the original filing must be followed for amendments.

J

Exceptions from normal filings:

Exemptions or extensions are not automatically granted to any company.  Requests must be made prior to the filing due date.

K

Bar Codes (State or NAIC):

NAIC Annual Statement Instructions should be followed.

L

Signed Jurat:

N/A

M

NONE Filings:

NAIC Annual Statement Instructions for Supplemental Interrogatories should be followed.

N

Filings new, discontinued or modified materially since last year:

The CREDIT INSURANCE EXPERIENCE EXHIBIT - see Administrative Letter AL 2012-1 for guidance.

O

Foreign Company Filing Requirements:

All foreign companies and accredited reinsurers, excluding Health Maintenance Organizations (HMOs) and Dental Plan Organizations (DPOs), that file their NAIC annual statement blank, annual audited finanical reports, quarterly financial statements and any supplements related to these documents with the NAIC are exempt from filing a hard copy of these items with this office. These filings should be submitted to the NAIC via electronic media in accordance with the due dates established by the NAIC.

A CERTIFICATE OF COMPLIANCE from the Insurance Commissioner of your domiciliary state is required to be filed. The Certificate must indicate that the company is (i) licensed and in good standing in that state and (ii) in compliance with all applicable laws of that state. The Certificate must also give the classes of business the company is authorized to transact and have been issued within three(3) months of the filing date.

A CERTIFICATE OF DEPOSIT is required from insurers that do not maintain a deposit with the Treasurer of Virginia. The Certificate must be prepared by the Insurance Commissioner, Treasurer, or other officer or official body of the insurer's domicile state and must list the type and amount of securities held on deposit in that state. The Certificate must state that the securities, with a market value of at least $500,000, are held first for protection of the insurer's policyholders.

P

NEW THIS YEAR:

We have a portal which will allow the electronic submission of many of these required documents at Annual License Renewal and Financial Filing Submission Portal. Insurers must go to the portal and log in to submit documents electronically.

Notarization is no longer required for Virginia-specific renewal forms.