(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

Protected Cell Annual Statement

1

0

N/A

3/1

NAIC

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

4

Combined Annual Statement (8½ "x14")

1

EO

N/A

5/1

NAIC

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

II.  NAIC SUPPLEMENTS

10

Accident & Health Policy Experience Exhibit

1

EO

N/A

4/1

NAIC

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

11

Actuarial Opinion

1

EO

N/A

3/1

Company

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

12

Actuarial Opinion Summary

1

N/A

N/A

3/15

Company

A,B,E,F,J,P

13

Bail Bond Supplement

1

EO

N/A

3/1

NAIC

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

14

Combined Insurance Expense Exhibit

1

EO

N/A

5/1

NAIC

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

15

Credit Insurance Experience Exhibit

1

EO

1

4/1

NAIC

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

16

Director and Officer Insurance Coverage Supplement

1

EO

N/A

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

NAIC

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

17

Exceptions to Reinsurance Attestation Supplement

1

N/A

N/A

3/1

NAIC

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

18

Financial Guaranty Insurance Exhibit

1

EO

N/A

3/1

NAIC

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

19

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

1

EO

N/A

4/1

NAIC

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

20

Health Care Exhibit's Allocation Report Supplement

1

EO

N/A

4/1

NAIC

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

21

Investment Risks Interrogatories

1

EO

N/A

4/1

NAIC

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

22

Insurance Expense Exhibit

1

EO

N/A

4/1

NAIC

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

23

Long Term Care Experience Reporting Forms

1

EO

N/A

4/1

NAIC

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

24

Management Discussion & Analysis

1

EO

N/A

4/1

Company

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

25

Medicare Supplement Insurance Experience Exhibit

1

EO

N/A

3/1

NAIC

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

26

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,P

27

Premiums Attributed to Protected Cells Exhibit

1

EO

N/A

3/1

NAIC

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

28

Reinsurance Attestation Supplement

1

EO

N/A

3/1

Company

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

29

Reinsurance Summary Supplement

1

EO

N/A

3/1

NAIC

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

30

Risk-Based Capital Report

1

EO

N/A

3/1

NAIC

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

31

Schedule SIS

1

N/A

N/A

3/1

NAIC

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

32

Supplement A to Schedule T

1

EO

N/A

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

NAIC

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

33

Supplemental Compensation Exhibit

1

N/A

N/A

3/1

NAIC

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

34

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,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

Combined Annual Statement Electronic Filing

N/A

1

N/A

5/1

NAIC

55

Combined Annual Statement .PDF Filing

N/A

1

N/A

5/1

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,P

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,N,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,N,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

Request to File Consolidated Audited Financial Statements

1

N/A

1

12/1

Company

A,B,E,J,O

80

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

1

EO

1

3/1

Company

A,B,E,J,O

81

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

1

EO

1

3/1

Company

A,B,E,J,O

82

Relief from the Requirements for Audit Committees

1

EO

1

3/1

Company

A,B,E,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

Filings Checklist (with Column 1 completed)

N/A

N/A

N/A

3/1

State

104

Premium tax /Assessment Filings:

SEPARATE FILING - DIFFERENT ADDRESS

1

N/A

1

3/1

State

See Note D

XXXX

105

State Filing Fees

N/A

N/A

N/A

XXXX

106

Signed Jurat

N/A

N/A

N/A

L

107

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

108

Application for Renewal of License

1

N/A

1

3/1

State

A,B,E,F,J,P

109

Insurance Holding Company System Annual Reg. Stmt.

1

N/A

N/A

4/30

Company

A,B,E,F,J,P

110

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

1

N/A

1

3/1

Company

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

111

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

1

N/A

1

3/1

Company

A,B,E,F,J,O

112

Producer-Controlled Insurer Report

[Link to NAIC list of accredited states]

1

N/A

N/A

3/1

State

A,B,E,F,J,P

113

Related Parties Summary

1

N/A

N/A

4/1

Company

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

114

Report of Assessable Ocean & Inland Marine Premium

SEPARATE FILING - SEE FORM

1

N/A

1

4/1

State

A,E

115

[Report of Assets Pledged, Hypothecated or Encumbered]

1

N/A

N/A

3/1

State

A,B,E,F,J,P

116

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.

The DIRECTOR AND OFFICER SUPPLEMENT is required of domestic property and casualty companies.

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.