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Property & Casualty Insurers

Click here for a printable table form of the checklist for Property & Casualty Insurers in Word or Adobe PDF format.

Company Name:_______________________   NAIC Company Code: _________
Contact:_____________________________   Telephone: _________________
REQUIRED FILINGS IN THE STATE OF: Maine   Filings Made During the Year 2015

 (1)

Checklist

(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” x 14”)

2

EO

xxx

3/1

NAIC

 

 

1.1

Printed Investment Schedule detail (Pages E01-E27)

1

EO

xxx

3/1

NAIC

 

 

2

Quarterly Financial Statement (8 ½” x 14”)

 1

EO

xxx

5/15, 8/15, 11/15

NAIC

 

 

3

Protected Cell Annual Statement

1

0

xxx

3/1

NAIC

 

 

4

Combined Annual Statement (8 ½” x 14”)

2

EO

xxx

5/1

NAIC

 

 

 

 

 

 

 

 

 

 

 

 

II.  NAIC SUPPLEMENTS

 

 

10

Accident & Health Policy Experience Exhibit

1

EO

xxx

4/1

NAIC

 

 

11

Actuarial Opinion

1

EO

xxx

3/1

Company

 

 

12

Actuarial Opinion  Summary

1

N/A

xxx

3/15

Company

 

 

13

Bail Bond Supplement

1

EO

xxx

3/1

NAIC

 

 

14

Combined Insurance Expense Exhibit

1

EO

xxx

5/1

NAIC

 

 

15

Credit Insurance Experience Exhibit

1

EO

xxx

4/1

NAIC

 

 

16

Director and Officer  Insurance Coverage Supplement

1

EO

xxx

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

NAIC

 

 

17

Exceptions to Reinsurance Attestation Supplement

1

N/A

xxx

3/1

Company

 

 

18

Financial Guaranty Insurance Exhibit

1

EO

xxx

3/1

NAIC

 

 

19

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

1

EO

xxx

4/1

NAIC

 

 

20

Health Care Exhibit’s Allocation Report Supplement

1

EO

xxx

4/1

NAIC

 

 

21

Investment Risk Interrogatories

1

EO

xxx

4/1

NAIC

 

 

22

Insurance Expense Exhibit

1

EO

xxx

4/1

NAIC

 

 

23

Long-Term Care Experience Reporting Forms

1

EO

xxx

4/1

NAIC

 

 

24

Management Discussion & Analysis

1

EO

xxx

4/1

Company

 

 

25

Medicare Supplement Insurance Experience Exhibit

1

EO

xxx

3/1

NAIC

 

 

26

Medicare Part D Coverage Supplement

1

EO

 

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

NAIC

 

 

27

Premiums Attributed to Protected Cells Exhibit

1

EO

xxx

3/1

NAIC

 

 

28

Reinsurance Attestation Supplement

1

EO

xxx

3/1

Company

 

 

29

Reinsurance Summary Supplemental

1

EO

xxx

3/1

NAIC

 

 

30

Risk-Based Capital Report

1

EO

xxx

3/1

NAIC

 

 

31

Schedule SIS

1

N/A

xxx

3/1

NAIC

 

 

32

Supplement A to Schedule T

1

EO

xxx

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

NAIC

 

 

33

Supplemental Compensation Exhibit

1

N/A

N/A

3/1

NAIC

 

 

34

Trusteed Surplus Statement

1

EO

xxx

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

NAIC

 

 

 

 

 

 

 

 

 

 

 

 

III. ELECTRONIC FILING REQUIREMENTS

 

 

60

Annual Statement Electronic Filing

xxx

EO

xxx

3/1

NAIC

 

 

61

March .PDF Filing

xxx

EO

xxx

3/1

NAIC

 

 

62

Risk-Based Capital Electronic Filing

xxx

EO

N/A

3/1

NAIC

 

 

63

Risk-Based Capital .PDF Filing

xxx

EO

N/A

3/1

NAIC

 

 

64

Combined Annual Statement Electronic Filing

xxx

EO

xxx

5/1

NAIC

 

 

65

Combined Annual Statement .PDF Filing

xxx

EO

xxx

5/1

NAIC

 

 

66

Supplemental Electronic Filing

xxx

EO

xxx

4/1

NAIC

 

 

67

Supplemental .PDF Filing

xxx

EO

xxx

4/1

NAIC

 

 

68

Quarterly Statement Electronic Filing

xxx

EO

xxx

5/15, 8/15, 11/15

NAIC

 

 

69

Quarterly .PDF Filing

xxx

EO

xxx

5/15, 8/15, 11/15

NAIC

 

 

70

June .PDF Filing

xxx

EO

xxx

6/1

NAIC

 

 

 

 

 

 

 

 

 

 

 

 

IV.  AUDIT/INTERNAL CONTROL
RELATED REPORTS

 

 

81

Accountants Letter of Qualifications

1

EO

N/A

6/1

Company

 

 

82

Audited Financial Reports

1

EO

N/A

6/1

Company

 

 

83

Audited Financial Reports Exemption Affidavit

1

N/A

N/A

 

Company

 

 

84

Communication of Internal Control Related Matters Noted in Audit

1

N/A

N/A

8/1

Company

 

 

85

Independent CPA (change)

1

N/A

N/A

 

Company

 

 

86

Management’s Report of  Internal Control Over Financial Reporting

1

N/A

N/A

8/1

Company

 

 

87

Notification of Adverse Financial Condition

1

N/A

N/A

6/1

Company

 

 

88

Request for Exemption to File

1

N/A

N/A

6/1

Company

 

 

89

Request to File Consolidated Audited Annual Statements

1

N/A

N/A

6/1

Company

 

 

90

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

1

EO

N/A

3/1

Company

 

 

91

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

1

EO

N/A

3/1

Company

 

 

92

Relief from the Requirements for Audit Committees

1

EO

N/A

3/1

Company

 

 

 

 

 

 

 

 

 

 

 

 

V.  STATE REQUIRED FILINGS***

 

 

101

Annual Report Supplement

1

0

xxx

3/1

State

P

 

102

Carrier Reporting Form

1

0

xxx

2/1

State

P

 

103

Certificate of Compliance

1

0

   xxx

3/1

State

 

 

104

Certificate of Deposit

1

0

xxx

3/1

State

P

 

105

Consumer Complaint Contact Update

1

0

xxx

3/1

State

P

 

106

Exam Assessment Fee

1

0

xxx

3/1

State

C, D

 

107

Filings Checklist (with Column 1 completed)

1

0

xxx

3/1

State

 

 

108

Form B Holding Company Registration Statement

1

0

xxx

5/1

Company

H, J

 

109

Health Insurance Annual Data Report

1

0

xxx

4/30

State

P

 

110

Liquor Liability Report

1

0

xxx

3/1

State

P

 

111

Maine Fraud and Abuse Report

1

0

xxx

3/1

State

P

 

112

Managing General Agent Report

1

0

xxx

3/1

Company

P

 

113

Mandated Benefit Experience Report (Bulletin 292)

1

0

xxx

4/30

State

P

 

114

Premium Tax

1

0

xxx

3/15

State

E

 

115

Signed Jurat

1

0

xxx

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

NAIC

 

 

116

State Filing Fees

1

0

xxx

8/10

State

C, P

 

117

State of Maine Page

1

0

xxx

3/1

Company

 

 

118

Supplemental Health  Insurance Report (Bulletin  286-A)

1

0

xxx

4/1

State

P

 

119

Tick Borne Disease Report

1

0

xxx

2/1

State

P

 

120

Workers Compensation Aggregate Benefits paid Report

1

0

xxx

3/1

State

P

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*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 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

 

 

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

GENERAL INSTRUCTIONS FOR COMPANIES TO USE CHECKLIST

 

Last Updated: November 12, 2014