FRATERNAL SOCIETIES

 

REQUIRED FILINGS IN VIRGINIA                                                                                                Filings Made During the Year 2009

 

NOTICE:  THE FOLLOWING REPRESENTS, IN GENERAL, THE ANNUAL RENEWAL AND RELATED FILINGS  REQUIRED IN VIRGINIA.  EACH LICENSED COMPANY IS SENT SPECIFIC FILING INSTRUCTIONS BY LETTER IN DECEMBER.

 

(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 (8 ½”x14”)

1

EO

1

3/1

NAIC

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

 

1.1

Printed Investment Schedule detail (Pages E01 - E27)

1

EO

See Note O

3/1

NAIC

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

 

2

Quarterly Financial Statement (8 ½” x 14”)

1

EO

N/A

5/15, 8/15, 11/15

NAIC

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

 

3

Separate Accounts Annual Statement (8 ½”x 14”)

1

EO

1

3/1

NAIC

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

 

 

II.  NAIC SUPPLEMENTS

 

 

 

 

 

 

 

10

Accident & Health Policy Experience Exhibit

1

EO

1

4/1

NAIC

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

 

11

Actuarial Certification Related Annuity Nonforfeiture Compliance

1

EO

N/A

3/1

COMPANY

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

 

12

Actuarial Opinion on X-Factors

1

EO

N/A

3/1

COMPANY

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

 

13

Actuarial Opinion on Separate Accounts Funding

1

EO

N/A

3/1

COMPANY

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

 

14

Actuarial Opinion on Synthetic Guaranteed Investment Contracts

1

EO

N/A

3/1

COMPANY

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

 

15

Interest Sensitive Life Insurance Products Report

1

EO

N/A

4/1

NAIC

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

 

16

Investment Risks Interrogatories

1

EO

1

4/1

NAIC

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

 

17

Long-Term Care Experience Reporting Forms

1

EO

N/A

4/1

NAIC

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

 

18

Management Discussion & Analysis

1

EO

1

4/1

Company

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

 

19

Medicare Supplement Insurance Experience Exhibit

1

EO

N/A

3/1

NAIC

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

 

20

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

 

21

Reasonableness of Assumptions Certificate

N/A

EO

N/A

5/15, 8/15, 11/15

Company

 

22

Reasonableness & Consistency of Assumptions Certificate

N/A

EO

N/A

5/15, 8/15, 11/15

Company

 

23

Reasonableness of Assumptions Certificate for Implied Guaranteed Rate Method

N/A

EO

N/A

5/15, 8/15, 11/15

Company

 

24

Reasonableness & Consistency of Assumptions Certificate (Updated Average Market Value)

N/A

EO

N/A

5/15, 8/15, 11/15

Company

 

25

Reasonableness & Consistency of Assumptions Certificate (Updated Market Value)

N/A

EO

N/A

5/15, 8/15, 11/15

Company

 

26

Risk-Based Capital Report

1

EO

N/A

3/1

NAIC

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

 

27

RBC Certification Required Under C-3 Phase I

1

N/A

N/A

3/1

COMPANY

A,B,E,F,J,K

 

28

RBC Certification Required Under C-3 Phase II

1

N/A

N/A

3/1

COMPANY

A,B,E,F,J,K

 

29

Statement of Actuarial Opinion

1

EO

1

3/1

Company

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

 

30

Statement on non-guaranteed elements – Exhibit 5 Interr. #3

1

EO

1

3/1

Company

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

 

31

Statement on participating/non-participating policies—Exhibit 5, Interr. # 1.

1

EO

1

3/1

Company

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

 

32

Supplemental Compensation Exhibit

1

N/A

N/A

3/1

NAIC

A,B,E,F,J,K

 

33

Trusteed Surplus Statement

N/A

EO

1

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

NAIC

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

 

 

III  ELECTRONIC FILING REQUIREMENTS

 

 

 

 

 

 

 

40

Annual Statement Electronic Filing

N/A

1

N/A

3/1

NAIC

 

 

41

March .PDF Filing

N/A

1

N/A

3/1

NAIC

 

 

42

Separate Accounts Electronic Filing

N/A

1

N/A

3/1

NAIC

 

 

43

Separate Accounts .PDF Filing

N./A

1

N/A

3/1

NAIC

 

 

44

Supplemental Electronic Filing

N/A

1

N/A

4/1

NAIC

 

 

45

Supplemental .PDF Filing

N/A

1

N/A

4/1

NAIC

 

 

46

Quarterly Statement Electronic Filing

N/A

1

N/A

5/15, 8/15, 11/15

NAIC

 

 

47

Quarterly .PDF Filing

N/A

1

N/A

5/15, 8/15, 11/15

NAIC

 

 

48

June .PDF Filing

N/A

1

N/A

6/1

NAIC

 

 

 

IV.  AUDITED FINANCIAL STATEMENTS

 

 

 

 

 

 

 

61

Accountants Letter of Qualifications

1

N/A

1

6/1 or 6/30

Company

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

 

62

Audited Financial Statements

1

EO

N/A

6/1 or 6/30

Company

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

 

63

Audited Financial Statements Exemption Affidavit

1

N/A

1

3/1

Company

A,B,E,F,J,O

 

64

Independent CPA Designation

1

N/A

1

Within 5 business days of change

Company

A,B,E,F,J,O

 

65

Notification of Adverse Financial Condition

1

N/A

1

Within 5 business days of receipt

Company

A,B,E,F,O

 

66

Report of Significant Deficiencies in Internal Controls

1

N/A

1

Within 60 days after the filing of audited statements

Company

A,B,E,F,O

 

67

Request for Exemption to File

1

N/A

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

 

102

Certificate of Deposit

N/A

N/A

1

3/1

Dom.

State

A,B,E,J,O

 

103

Certificate of Valuation

N/A

N/A

1

3/1

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

Analysis of Excess Capital and Surplus Investments Report

1

N/A

N/A

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

State

A,B,E,F,J

 

109

Application for Renewal of License

1

N/A

1

3/1

State

A,B,E,F,J

 

110

Certificate of Advertising Compliance

1

N/A

1

3/1

State

A,B,E,F,J

 

111

Insurance Holding Company System Annual Reg. Stmt.

1

N/A

N/A

4/30

Company

A,B,E,F,J

 

112

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

1

N/A

1

3/1

Company

A,B,E,F,J,O

 

113

Managed Care Health Insurance Plan (“MCHIP”) List of Providers

1

N/A

1

3/1

Company

A,B,E,F,J,O

 

114

Regulatory Asset Adequacy Issues Summary (No Form)

1

N/A

1

3/15

Company

A,B,E,F,J,O

 

115

Report of Assets Pledged, Hypothecated or Encumbered

[Form R10] [Form R11]

1

N/A

N/A

3/1

State

A,B,E,F,J

 

116

Request for Information Regarding RIs

1

N/A

N/A

3/1

State

A,B,E,F,J

 

117

Virginia Business Page (Annual Statement Page 23)

1

N/A

1

3/1

NAIC

A,B,E,F

 

 

 

 

 

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

 

 

A

Required Filings Contact Person:

 

Karen Traylor: 804-371-9908; karen.traylor@scc.virginia.gov

 

B

Annual Statement and Related Filings Mailing Address:

State Corporation Commission

Bureau of Insurance

Financial Regulation Division

P.O. Box 1157

Richmond, VA  23218

Annual Statement and Related Filings Courier Delivery:

State Corporation Commission

Bureau of Insurance, Financial Regulation Division

1st 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/division/boi/webpages/boiinstaxinsurancecoinfo.htm

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:

Wachovia Bank/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:

Wachovia Bank/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:

The Signed Jurat will NOT be accepted in lieu of an Annual Statement from a foreign company.

 

M

NONE Filings:

NAIC Annual Statement Instructions for Supplemental Interrogatories should be followed.

 

N

Filings new, discontinued or modified materially since last year:

 

Beginning in 2009, all foreign companies, excluding HMO's, are required to file their annual audited financial report and quarterly financial statements electronically with the NAIC instead of a hardcopy with the Virginia State Corporation Commission, Bureau of Insurance.

 

O

Foreign Company Filing Requirements:

 

Beginning in 2009, all foreign companies, excluding HMO's, are required to file their annual audited financial report and quarterly financial statements electronically with the NAIC instead of a hardcopy with the Virginia State Corporation Commission, Bureau of Insurance.

All items filed should include the Company’s NAIC Group Number along with the Company Code.

Schedule E-Part 3-Special Deposits is required to be filed by companies filing a certificate of deposit to support a deposit under Section 38.2-1049 of the Code of Virginia.

-------------------------------------------------------------

The Bureau of Insurance does not follow the NAIC Annual Statement Instructions related to certain supplements.  Certain items that are captured on the NAIC database are required to be submitted in hard copy format from foreign insurers even if this information is filed with the domiciliary state and the NAIC.

 

 

General Instructions

For Companies to Use Checklist

VIRGINIA

 

Please Note:         This checklist represents, IN GENERAL, the annual renewal and related filings required in Virginia.  Each licensed company is sent specific filing instructions by letter in December.  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.  Virginia does not request the checklist.

 

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.

 

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 .pdf files for annual statement data, detail for investment schedules and supplements due March 1.

 

The Separate Accounts Electronic Filing includes the separate accounts annual statement and investment schedule detail.

 

The Separate Accounts .PDF Filing is the .pdf file for the separate accounts annual statement and investment schedule detail.

 

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 file for quarterly statement data.

 

The June .PDF Filing is the .pdf file for the Audited Financial Statements.

 

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.  If N/A appears in this column, the filing is not required. "EO" indicates electronic only filing required.

 

Column (5)            (Due Date)

 

Indicates the date on which the company must file the form.

 

Column (6)            (Form Source)

 

If this column contains “NAIC,” the company must obtain the forms from the appropriate vendor. If this column contains “State,” Virginia will provide the forms with the filing instructions (generally on the website).  If this column contains “Dom. State,” the form should be obtained from the state of domicile.  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.