REQUIRED FILINGS IN
NOTICE:
THE FOLLOWING REPRESENTS, IN GENERAL, THE ANNUAL RENEWAL
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(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 |
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Domestic |
Foreign |
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State |
NAIC |
State |
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I. NAIC FINANCIAL STATEMENTS |
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1 |
1 |
EO |
1 |
3/1 |
NAIC |
A,B,E,F,G,H,I,J,K,M |
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1.1 |
Printed Investment Schedule detail (Pages E01-E25) |
1 |
EO |
See Note O |
3/1 |
NAIC |
A,B,E,F,J,K,M,O |
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2 |
Quarterly Financial Statement (8 ˝” x 14”) |
1 |
EO |
1 |
5/15, 8/15, 11/15 |
NAIC |
A,B,E,F,G,H,I,J,K,O |
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3 |
Separate Accounts Annual Statement (8 ˝”x14”) |
1 |
EO |
1 |
3/1 |
NAIC |
A,B,E,F,G,H,I,J,K,M |
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II. NAIC SUPPLEMENTS |
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10 |
Accident & Health Policy Experience Exhibit |
1 |
EO |
1 |
4/1 |
NAIC |
A,B,E,F,J,K,M,O |
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11 |
2 |
EO |
1 |
4/1 |
NAIC |
A,B,E,F,J,K,M,O |
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12 |
Interest Sensitive Life Insurance Products Report |
1 |
EO |
N/A |
4/1 |
NAIC |
A,B,E,F,J,K,M |
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13 |
Investment Risks Interrogatories |
1 |
EO |
1 |
4/1 |
NAIC |
A,B,E,F,J,K,M |
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14 |
Life, Health & Annuity Guaranty Assessment Base Reconciliation Exhibit |
N/A |
EO |
N/A |
4/1 |
NAIC |
A,B,E,F,J,K,M |
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15 |
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 |
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16 |
Long Term Care Experience Reporting Forms |
1 |
EO |
N/A |
4/1 |
NAIC |
A,B,E,F,J,K,M |
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17 |
1 |
EO |
1 |
4/1 |
Company |
A,B,E,F,J,K,O |
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18 |
Medicare Supplement Insurance Experience Exhibit |
1 |
EO |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K,M |
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19 |
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 |
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20 |
Reasonableness of Assumptions Certificate |
N/A |
EO |
N/A |
5/15, 8/15, 11/15 |
Company |
N |
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21 |
Reasonableness and Consistency of Assumptions Certificate |
N/A |
EO |
N/A |
5/15, 8/15, 11/15 |
Company |
N |
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22 |
Reasonableness of Assumptions Certificate for Implied Guaranteed Rate Method |
N/A |
EO |
N/A |
5/15, 8/15, 11/15 |
Company |
N |
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23 |
Reasonableness and Consistency of Assumptions Certificate. (Updated Average Market Value) |
N/A |
EO |
N/A |
5/15, 8/15, 11/15 |
Company |
N |
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24 |
Reasonableness and Consistency of Assumptions Certificate(Updated Market Value) |
N/A |
EO |
N/A |
5/15, 8/15, 11/15 |
Company |
N |
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25 |
1 |
EO |
N/A |
3/1 |
NAIC |
A,B,E,F,G,J,K |
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26 |
Schedule SIS |
1 |
N/A |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K,M |
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27 |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,G,I,J,K,O |
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28 |
Statement on non-guaranteed elements - Exhibit 5 Int. #3 |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,J,K,M,O |
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29 |
Statement on par/non-par policies – Exhibit 5 Int. 1.1 |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,J,K,M,O |
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30 |
Supplemental Compensation Exhibit |
1 |
N/A |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K |
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31 |
Supplemental Schedule O |
1 |
EO |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K,M |
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32 |
N/A |
EO |
1 |
3/1, 5/15, 8/15, 11/15 |
NAIC |
A,B,E,F,I,J,K,M,O |
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33 |
Workers’ Compensation Carve Out Supplement |
1 |
EO |
N/A |
3/1 |
NAIC |
A,B,E,F,I,J,K |
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III. ELECTRONIC FILING REQUIREMENTS |
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40 |
Annual Statement Electronic Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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41 |
March .PDF Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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42 |
Risk-Based Capital
Electronic Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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43 |
Separate Accounts Electronic Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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44 |
Separate Accounts .PDF Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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45 |
Supplemental Electronic Filing |
N/A |
1 |
N/A |
4/1 |
NAIC |
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46 |
Supplemental .PDF Filing |
N/A |
1 |
N/A |
4/1 |
NAIC |
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47 |
Quarterly Electronic Filing |
N/A |
1 |
N/A |
5/15, 8/15, 11/15 |
NAIC |
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48 |
Quarterly .PDF Filing |
N/A |
1 |
N/A |
5/15, 8/15, 11/15 |
NAIC |
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49 |
June .PDF Filing |
N/A |
1 |
N/A |
6/1 |
NAIC |
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IV. AUDITED FINANCIAL STATEMENTS |
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51 |
1 |
N/A |
1 |
6/1 or 6/30 |
Company |
A,B,E,F,J,O |
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52 |
1 |
EO |
1 |
6/1 or 6/30 |
Company |
A,B,E,F,J,K,O |
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53 |
1 |
N/A |
1 |
3/1 |
State |
A,B,E,F,J,O |
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54 |
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