Property & Casualty Insurers 401 014 Fin122cklpc
User Manual: 401-014
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FIN122 | 0118 PROPERTY & CASUALTY INSURERS COMPANY NAME: NAIC Company Code: Contact: Telephone: TEXAS REQUIRED FILINGS IN THE STATE OF: (1) (2) (3) Checklist Line # REQUIRED FILINGS FOR THE ABOVE STATE 1 1.1 2 3 4 I. NAIC FINANCIAL STATEMENTS Annual Statement (8 ½” x 14”) Printed Investment Schedule detail (Pages E01-E27) Quarterly Financial Statement (8 ½” x 14”) Protected Cell Annual Statement Combined Annual Statement (8 ½” x 14”) 37 II. NAIC SUPPLEMENTS Accident & Health Policy Experience Exhibit Actuarial Opinion Actuarial Opinion Summary – Confidential filing. Submit to Actuarial Office. + Bail Bond Supplement Combined Insurance Expense Exhibit Credit Insurance Experience Exhibit Cybersecurity and Identity Theft Insurance Coverage Supplement Director and Officer Insurance Coverage Supplement Financial Guaranty Insurance Exhibit Insurance Expense Exhibit Long-Term Care Experience Reporting Forms Management Discussion & Analysis Medicare Part D Coverage Supplement Medicare Supplement Insurance Experience Exhibit Premiums Attributed to Protected Cells Exhibit Reinsurance Attestation Supplement Exceptions to Reinsurance Attestation Supplement Reinsurance Summary Supplemental Risk-Based Capital Report Schedule SIS Supplement A to Schedule T Supplemental Compensation Exhibit Supplemental Health Care Exhibit (Parts 1, 2 and 3) Supplemental Health Care Exhibit’s Allocation Report Supplement Supplemental Investment Risk Interrogatories Supplemental Schedule for Reinsurance Counterparty Reporting Exception – Asbestos and Pollution Contracts Trusteed Surplus Statement 61 62 63 64 65 66 67 68 69 70 71 III. ELECTRONIC FILING REQUIREMENTS Annual Statement Electronic Filing March .PDF Filing Risk-Based Capital Electronic Filing Risk-Based Capital .PDF Filing Combined Annual Statement Electronic Filing Combined Annual Statement .PDF Filing Supplemental Electronic Filing Supplemental .PDF Filing Quarterly Statement Electronic Filing Quarterly .PDF Filing June .PDF Filing 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Texas Department of Insurance | www.tdi.texas.gov Filings Made During the Year 2018 (4) NUMBER OF COPIES* Domestic Foreig n State NAIC State (5) DUE DATE (6) FORM SOURCE** (7) APPLICAB LE NOTES 1 1 1 xxx 1 EO EO EO 0 EO xxx xxx xxx xxx xxx 3/1 3/1 5/15, 8/15, 11/15 3/1 5/1 NAIC NAIC NAIC NAIC NAIC Q, Z, AA Q, Z, AA Q, Z, AA U Q, Z, AA 1 1 EO EO xxx xxx 4/1 3/1 NAIC Company Q, Z Q, Z 1 1 1 1 N/A EO EO EO xxx xxx xxx xxx 3/15 3/1 5/1 4/1 Company NAIC NAIC NAIC R, AK O, Z, AS Q, Z Q, Z 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 EO EO EO EO EO EO EO EO EO EO N/A EO EO N/A EO N/A EO xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx N/A N/A xxx 4/1 3/1, 5/15, 8/15, 11/15 3/1 4/1 4/1 4/1 3/1, 5/15, 8/15, 11/15 3/1 3/1 3/1 3/1 3/1 3/1 3/1 3/1, 5/15, 8/15, 11/15 3/1 4/1 NAIC NAIC NAIC NAIC NAIC Company NAIC NAIC NAIC Company Company NAIC NAIC NAIC NAIC NAIC NAIC Q, Z Q, Z, AW Q, Z Q, Z Q, Z Q, Z Q, Z Q, Z Q, Z Q, Z R Q, Z O, Y, Z P, R Q, Z P, R O, Z, AV 1 1 EO EO xxx xxx 4/1 4/1 NAIC NAIC O, Z, AV Q, Z 0 1 EO EO xxx xxx 3/1 3/1, 5/15, 8/15, 11/15 NAIC NAIC N, Z Q, Z xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx EO EO EO EO EO EO EO EO EO EO EO xxx xxx N/A N/A xxx xxx xxx xxx xxx xxx xxx 3/1 3/1 3/1 3/1 5/1 5/1 4/1 4/1 5/15, 8/15, 11/15 5/15, 8/15, 11/15 6/1 NAIC NAIC NAIC NAIC NAIC NAIC NAIC NAIC NAIC NAIC NAIC O, Z O, Z O, Z O, Z O, Z O, Z O, Z O, Z O, Z O, Z O, Z, AD 1/9 FIN122 | 0118 (1) (2) (3) Checklist Line # REQUIRED FILINGS FOR THE ABOVE STATE 81 82 83 84 85 86 87 88 89 90 91 92 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 IV. AUDIT/INTERNAL CONTROL RELATED REPORTS Accountants Letter of Qualifications (TIC § 401.013 and 28 TAC §7.88(I)) Audited Financial Reports (TIC Chapter 401 Subchapter B, and 28 TAC §§7.18, 7.85 and 7.88) Audited Financial Reports Exemption Affidavit for Certain Small Insurers and HMO’s (TIC §401.006) Communication of Internal Control Related Matters Noted in Audit (28 TAC 7.88(j)) Independent CPA (change) (Designation of Accountant) (TIC §401.014) Management’s Report of Internal Control Over Financial Reporting (28 TAC §7.88(m) and (n)(2) and (3)) Notification of Adverse Financial Condition or Misstatement of Financial Condition (TIC § 401.017) Relief from the five-year rotation requirement for lead audit partner (28 TAC §7.88 (h)(1) and (2)) Relief from the one-year cooling off period for independent CPA (28 TAC §7.88 (h)(10) and (12)) Relief from the Requirements for Audit Committees (28 TAC §7.88 (k)(4)) Request to File Consolidated Audited Annual Statements Request for Exemption to File Management’s Report of Internal Control Over Financial Reporting (28 TAC §7.88 (j)(4)) V. STATE REQUIRED FILINGS*** Registration of Accountant (TIC §401.014) Form B - Annual Holding Company Registration Statement Biographical Affidavit Certificate of Compliance – Advertising Filings Checklist (with Column 1 completed) Premium Taxes – file with the Texas Comptroller of Public Accounts + Signed Jurat page - ONLY. Foreign companies are not required to file annual/quarterly statements with TDI but must submit a signed Jurat page. Foreign HMOs – see note AA. State Filing Fees (Annual Statements) - File with the Texas Comptroller of Public Accounts. + Texas Officers and Directors Page Texas Overhead Assessment Exemption Form (PDF) Request for Permitted Accounting Practices Texas Negotiated Deductible Workers’ Compensation Form. CONFIDENTIAL filing. File upon request of TDI. Do NOT include with Annual or Quarterly statement filings. + Texas Supplemental A For County Mutuals (PDF) (County Mutuals Only) Texas Supplement For County Mutuals (PDF) (County Mutuals Only) Policy Count Exhibit – Form; Instructions (TIC §521.052 (1)) Corporate Governance Annual Disclosure*** Form F – Holding Company Enterprise Risk Report **** file with TDI if Texas is the lead state ORSA (Own Risk and Solvency Assessment) ***** file with TDI if Texas is the lead state Texas Department of Insurance | www.tdi.texas.gov (4) NUMBER OF COPIES* Domestic Foreig n State NAIC State (5) DUE DATE (6) FORM SOURCE** (7) APPLICAB LE NOTES 1 EO N/A 6/1 or 6/30 Company Q, Z 1 EO N/A 6/1 or 6/30 Company Q, Z, AD 1 N/A N/A 6/1 or 6/30 Company R, AG 1 EO N/A 8/1 or 8/31 Company P, AX 1 N/A N/A 12/31 Company R, AF 1 N/A N/A 8/1 or 8/31 Company P, AX Company P, AD 1 N/A N/A <5th business day after notice received 1 EO N/A 3/1 Company Q, Z, AZ 1 EO N/A 3/1 Company Q, Z, AZ 1 1 EO N/A N/A N/A 3/1 12/31 Company Company Q, Z, AZ P, AH 1 N/A N/A 8/1 or 8/31 Company P, AX 1 1 1 EO 0 0 0 0 0 0 N/A N/A 1 EO 0 12/31 4/30 As change occurs 3/1 Accountant State State Company State R, AF R, AE P, X 1 0 1 Varies State P, V xxx 0 1 3/1, 5/15, 8/15, 11/15 NAIC L, P, AA 1 1 1 1 0 0 0 0 1 N/A N/A N/A Varies As change occurs 3/1 As needed State State State Company P, V P, R, W P, R R, AI 1 0 N/A As needed State P, R, AO 1 0 N/A 3/1 State P, R 1 0 N/A 3/1 State P, R EO 1 0 0 EO N/A 3/1 State Company N, BD AE 1 0 N/A 4/30 State BB 1 0 N/A Varies Company BC U 2/9 FIN122 | 0118 *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. ***For those states that have adopted the NAIC Corporate Governance Annual Disclosure Model Act, an annual disclosure is required of all insurers or insurance groups by June 1. The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by the company to the NAIC. Note however that this filing is intended to be submitted to the lead state if filed at the insurance group level. For more information on lead states, see the following NAIC URL: http://www.naic.org/public_lead_state_report.htm. ****For those states that have adopted the NAIC updated Holding Company Model Act, a Form F filing is required annually by holding company groups. Consistent with the Form B filing requirements, the Form F is a state filing only and should not be submitted by the company to the NAIC. Note however that this filing is intended to be submitted to the lead state. For more information on lead states, see the following NAIC URL: http://www.naic.org/public_lead_state_report.htm. *****For those states that have adopted the NAIC Risk Management and Own Risk and Solvency Assessment Model Act, a summary report is required annually by insurers and insurance groups above a specified premium threshold. The ORSA Summary Report is a state filing only and should not be submitted by the company to the NAIC. Note however that this filing is intended to be submitted to the lead state if filed at the insurance group level. For more information on lead states, see the following NAIC URL: http://www.naic.org/public_lead_state_report.htm. Texas Department of Insurance | www.tdi.texas.gov 3/9 FIN122 | 0118 + This symbol along with the yellow highlighting are provided for emphasis only. NOTES AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS) A For questions regarding required filings, contact: FinancialAnalysis@tdi.texas.gov B Mailing Address: Texas Department of Insurance Financial Analysis MC 303-1A PO Box 149104 Austin TX 78714-9104 Street Address (carrier delivery, overnight mail, etc.): Texas Department of Insurance Financial Analysis MC 303-1A 333 Guadalupe St Austin, TX 78701 Mailing Address for Annual Statement Filing Fees: Texas Comptroller of Public Accounts P.O. Box 149356 Austin, TX 78714-9356 (800) 252-1387 C Refer to Annual Statement Filing Fee (Item 23) for amounts: http://www.comptroller.texas.gov/forms/25-300.pdf http://www.comptroller.texas.gov/ D Mailing Address for Premium Tax Payments: Refer to Texas Insurance Tax Forms at: http://www.comptroller.texas.gov/taxes/insurance/ Texas Comptroller of Public Accounts P.O. Box 149356 Austin, TX 78714-9356 (800) 252-1387 http://www.comptroller.texas.gov/ E Delivery Instructions: Filings must be postmarked by due date. If the due date falls on a weekend or holiday, the due date is extended to the next business day. F Late Filings: Penalties and fines for late filings are provided for by the Texas Insurance Code. G Original Signatures: Original signatures are required on all filings from domestic companies. Foreign/Alien insurers may submit a photocopy of the original signed filing. H Signature/Notarization/Certification: The following officers are required to sign annual/quarterly statements: the President and two principal officers. I Amended Filings: To be submitted with cover letter and Jurat page signed by the President and two principal officers. If more than five pages are amended, submit an entire statement including Jurat page with appropriate signatures. J Exceptions from normal filings: None. K Bar Codes (State or NAIC): NAIC Bar Codes are required and should be generated according to NAIC instructions. L Signed Jurat: Domestic+: original signatures Foreign/Alien+: photo-copied signatures are accepted Signed by the President and two principal officers. M NONE Filings: “NONE” bar codes are allowed. Texas Department of Insurance | www.tdi.texas.gov 4/9 FIN122 | 0118 + N This symbol along with the yellow highlighting are provided for emphasis only. Filings new, discontinued or modified materially since last year: New: Fraternal/Life Blanks - Variable Annuities Supplement, VM 20 Reserves Supplement, Life PBR Exemption, PBR Actuarial Report Executive Summary; All Blanks - Corporate Governance Annual Disclosure Discontinued: Health Blank - Property/Casualty Supplements due 03/01 and 04/01 Modified: N/A O P Q R S T U V Filed with the NAIC only. Filed hard copy with Texas only. Filed with the NAIC and Texas. Required of Texas domestic companies only. Required of foreign companies only. Required of Texas domestic and foreign companies. Not required to be filed. To be filed with the State of Texas Comptroller of Public Accounts. Questions? Call the Comptroller at 800-252-1387. Texas Comptroller of Public Accounts P.O. Box 149356 Austin, TX 78714-9356 (512) 463-4600 http://www.comptroller.texas.gov/ W Texas Officers and Directors TDI form FIN306 (Officers and Directors Page) X Biographical Affidavit Biographical affidavits must be submitted when a change occurs to a company’s officers or directors. FIN353 (Biographical Affidavit Instructions and Fingerprint Requirements for Texas-Domestic Insurers) NAIC UCAA, Form 11 (Biographical Affidavit) Required of Texas domestics when change occurs to an executive officer/director, along with the Biographical Affidavit. Domestic insurers are required to submit Biographical Affidavits and fingerprint receipts for all Directors and only the following officers: CEO, President, Executive Director, Secretary, Treasurer, CFO/Controller, COO and Medical Director (if applicable). TDI does NOT require biographical affidavits for Vice Presidents or Assistantofficers. Foreign insurers submit Bios for President, Secretary and Treasurer only when changes occur. Y Risk-Based Capital Report Z To be filed electronically with the NAIC. AA Foreign companies Foreign companies shall file a Signed Jurat page with TDI. Foreign HMOs must file a complete statement. AB Analysis of Surplus Discontinued (2014) AC Recommended, not required. AD Audited Financial Statements Companies receiving a Notification of Adverse Financial Condition or a Report of Significant Deficiencies in Internal Control must provide a copy of the notice to the Department not later than the 5th business day after the date the insurer or HMO receives the notice (TIC § 401.017). Instructions for Filing CPA Audited Financial Report and Related Filings for the Year 2017 AE Annual Holding Company Registration Statement (Form B) For Form B and other Holding Company filing fees, refer to Transaction Cash Receipts Transmittal Form. AF CPA Audited Financial Statement – Intent Form. Texas Domestic Companies Only+ Texas Department of Insurance | www.tdi.texas.gov Required to be filed with TDI upon request. Domestic Insurers: File hard copy with TDI by June 1 (or June 30 if the insurer and its affiliate insurer(s) conduct business only in Texas). See 28 TAC §7.88(d)(2). Foreign Insurers: TDI will accept Annual Audited Financial Statements filed with the NAIC in accordance with the NAIC Electronic Filing Submission Directive in lieu of filing a hard copy with TDI. Notification of Adverse Financial Condition or a Report of Significant Deficiencies in Internal Control must be filed with TDI. Applies to all Texas domestic and Commercially domiciled insurers that are subject to the Insurance Holding Company System Regulatory Act (Chapter 823). Complete this Texas supplemental form (Domestics Only). 5/9 FIN122 | 0118 + This symbol along with the yellow highlighting are provided for emphasis only. AG CPA Audited Financial Statement – Affidavit for Exemption from Generally, an insurer may qualify for an exemption to file Filing CPA Report a CPA report if direct written premiums in Texas were less than $1 million. Insurers that have more than $1 million in assumed premiums are not exempt (TIC § 401.006). AH Request to file Consolidated Audited Annual Statement Refer to TIC § 401.016. AI Request for Permitted Accounting Practices, submit to: Include the requested practice, the referenced SSAP number, the reason for the request, and the financial impact of the request. Jeff Hunt, Director Texas Department of Insurance Company Licensing & Registration MC 305-2C PO Box 149104 Austin TX 78714-9104 AJ Holding Company Filings File Holding Company documents with TDI if any insurer in the group is a Texas Domestic or is Commercially Domiciled. Filings (not including Registration Statement) are not required by Commercially Domiciled insurers, if an exemption is in place. Foreign insurers file with their Domestic state. AK Actuarial Opinion Summary – Confidential Filing. Property and Casualty Actuarial Opinion Summary (28 TAC §7.9). Confidential filing – file separately per Rule. Submit electronically+ to: ActuarialDivision@tdi.texas.gov AL Regulatory Asset Adequacy Issues Summary – Confidential Filing. Submit electronically+ to: ActuarialDivision@tdi.texas.gov All Domestic companies licensed as life, accident, & health insurers must submit a RAAIS, unless exempt according to 28 TAC §3.9902. NOTE: Foreign companies must file upon request. AM AN Reasonableness of Assumptions Certification Reasonableness & Consistency of Assumptions Certification AO AP Reasonableness of Assumptions Certification for Implied Guaranteed Rate Method Reasonableness & Consistency of Assumptions Certification (Updated Average Market Value) Reasonableness & Consistency of Assumptions Certification (Updated Market Value) Texas Negotiated Deductible Workers’ Compensation Form - place in separate envelope clearly marked “Confidential – Texas Negotiated Deductible Workers’ Comp Form”.+ Actuarial certifications required for equity indexed annuities as found in Actuarial Guideline XXXV, Appendix C of the Accounting Practices and Procedures Manual. Actuarial certifications required for equity indexed life insurance policies as found in Actuarial Guideline XXXVI, Appendix C of the Accounting Practices and Procedures Manual. Pursuant to 28 TAC 8.4. Required upon request, only for companies writing this line of business. Actuarial Certification Related to Annuity Non-forfeiture Compliance Actuarial Opinion on Separate Accounts Funding Actuarial Opinion on Synthetic Guaranteed Investment Contracts Actuarial Opinion required by Modified Guaranteed Annuity Model Regulation These filings should be completed in accordance with the NAIC Model Regulations. Required upon request. AQ Actuarial Opinion on X-Factors Actuarial Opinion required by APPM A-830. AR RBC Certification required under C-3 Phase I RBC Certification required under C-3 Phase II Required to be filed with TDI upon request. AS Bail Bond Supplement Texas Department of Insurance | www.tdi.texas.gov Only reporting entities writing bail bond coverage are required to complete this supplement. This supplement must be filed with the NAIC by March 1 each year. 6/9 FIN122 | 0118 + This symbol along with the yellow highlighting are provided for emphasis only. AT Required by Actuarial Guideline XLIII Certifications required for variable annuities as found in Actuarial Guideline XLIII, Appendix C of the Accounting Actuarial Certification Related to Hedging Practices and Procedures Manual. Actuarial Certification Related to Reserves Financial Officer Certification Related to Clearly Defined Hedging Strategy Management Certification that the Valuation Reflects Management’s Intent AU Supplemental Annuity Exhibits Only reporting entities writing annuity products are required to complete these exhibits. AV Supplemental Health Care Exhibits Only reporting entities writing comprehensive major medical insurance business for large group employer, small group employer, and individual, are required to complete these exhibits. AW Director and Officer Supplement Only reporting entities providing director and officer (D&O) liability coverage in a monoline policy or as part of a commercial multiple peril (CMP) policy are required to complete this supplement. AX Communication of Internal Control Matters Noted in Audit and Report of Internal Control over Financial Reporting Required to be filed no later than the 60th day after the date of the audited financial report is filed (28 TAC §§7.88(j)(1) and (m)(1)). AY Actuarial Certification Related to the Use of the 2001 Preferred Class Mortality Tables For all reporting entities that use the 2001 Preferred Class Mortality Tables permitted by 28 TAC §§3.94013.9404. This certification is required by §3.9404(a) and (b). AZ Relief from Rotation, Cooling-Off, and Audit Committee Requirements Also see the Model Audit Rule Implementation Guide in the NAIC’s Accounting Practices and Procedures Manual - Appendix G (adopted by reference in 28 TAC §7.18). BA Actuarial Memorandum Related to Universal Life with Secondary Guarantee Policies required by Actuarial Guideline XXXVIII – Section 8D – Confidential Filing. Requirements and guidance are found in AG38 Section 8D(c) Documentation and Reporting. Applies to Texas domestic companies that have ULSG business subject to AG38 Section 8D. Submit electronically+ to: ActuarialDivision@tdi.texas.gov BB Enterprise Risk Report – Form F File if insurer meets the requirements of TIC §823.0595(b)(1) and (2), and if Texas is the Lead State Regulator of the holding company group (see Lead State Report located at http://www.naic.org/public_lead_state_report.htm). BC Own Risk and Solvency Assessment (ORSA) Insurers or insurance groups subject to TIC Chapter 830 must file with the lead state commissioner an ORSA Summary Report unless qualifying for an exemption pursuant to §830.006. BD Policy Count Exhibit – Form Submittal Instructions and Definitions Annual filing used to determine complaint ratios. Due date coincides with the annual statement filing. Read the instructions thoroughly before completing the Policy Count Exhibit form. Foreign Risk Retention Groups are not required to submit this form. BE Principles Based Reserves (PBR) Filings This filing is not required for those companies that have elected to defer PBR during the 3-year transition period (1/1/2017 to 12/31/2019) as permitted in VM Sec. II – Life Products – C. No filing is anticipated for such companies until 2020. Texas Department of Insurance | www.tdi.texas.gov 7/9 FIN122 | 0118 General Instructions 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 be filing(s) submitted to the NAIC via the NAIC Internet Filing Site which eliminates the need for a company to submit diskettes or CD-ROM 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. 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 annual statement data, detail for investment schedules and supplements due March 1. The Risk-Based Capital Electronic Filing includes all risk-based capital data. The Risk-Based Capital.PDF Filing is the .pdf file for risk-based capital data. 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 supplemental schedules and exhibits due April 1. The Quarterly Statement Electronic Filing includes the complete quarterly statement data. The Quarterly Statement.PDF Filing is the .pdf file for quarterly statement data. The Combined Annual Statement Electronic Filing includes the required pages of the combined annual statement and the combined Insurance Expense Exhibit. The Combined Annual Statement.PDF Filing is the .pdf file for the Combined annual statement data and the combined Insurance Expense Exhibit. 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 (EX) 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 (EX) 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. Texas Department of Insurance | www.tdi.texas.gov 8/9 FIN122 | 0118 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. 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. w:\qa\blanks\checklists\2017 filings made in 2018\4 propcklist_2017_filingsmade2018.docx Texas Department of Insurance | www.tdi.texas.gov 9/9
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