L . The department will invoice approved surplus lines insurers for the $1,000 annual fee. to the due date. 1.1 Printed Investment Schedule detail (Pages E01-E29) 0 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 0 EO xxx 5/16, 8/15 , 11/15 NAIC 3 Protected Cell Annual Statement 0 0 xxx 3/1 NAIC 4 Combined Annual Statement (8 " x 14") 0 EO xxx 5/2 NAIC To download the latest New York Statement and Supplement blank forms, use the links below. 2021 National Association of Insurance Commissioners Revised 1/05/2022 5 Quarterly Financial Statement exam fee - $100 audit and examination fee required by ALDOI pursuant to Bulletin No. Foreign companies: file .

Foreign companies should follow the instructions in the NAIC's Annual . Refunds are issued accordingly: Registration fees are NOT transferable to future meetings however substitutions are accepted.

The XXX in this column might signify that the state has waived the paper filing of the annual statement and all supplements. REQUIRED FILINGS IN VIRGINIA Filings Made During the Year 2022.

NAIC . returns and payments must be received no later than March 1st and Installment Reporting Statement due on or before June 1.

Up to $25.00 per day -Annual Statement, Annual Fees, Actuarial Opinion, Management Discussion and Analysis or Audited Financial Report. The interest penalty for late filing is 1% of the payment due for each month or part of a month. Domestic. Filings Made During the Year 2022 (1) Checklist (2) Line # (3) REQUIRED FILINGS FOR THE ABOVE STATE (4) NUMBER OF COPIES* (5) DUE DATE (6) FORM SOURCE** (7) APPLICABLE NOTES. 1 Annual Statement (8 " x 14") EO EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) EO EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") EO EO xxx 5/16, 8/1 5,

and filing fees. 2021 National Association of Insurance Commissioners 1 Life . . Premium tax Foreign. DUE DATE (6) FORM SOURCE**Domestic (7) APPLICABLE Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 " x 14") 2 EO xxx 3/1 NAIC G,H,J,K,L,O, BB 1.1 Printed Investment Schedule detail (Pages E01-E29) 2 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 2 EO 5/15, 8/15, 11/15 2021 Combined Annual Statement - due May 2, 2022 . The Combined Statement filing fee is due May 1, 2022. . ****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. I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 "x14") 1 EO xxx 3/1 NAIC Note G, H & L 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC 3 Separate Accounts Annual Statement (8 "x14") 1 EO xxx 3/1 NAIC II. L. NONE Filings: . Annual Statement Filing Requirements.

State NAIC State . 2022 NAIC Quarter 2 Filings/New York Quarter 2 Supplemental filings : Site Availability: Monday, Thursday and Friday: 6:00am to 12:00am and 1:30am to 6:00am CT. . Mar. DUE DATE (6) FORM SOURCE** (7) APPLICABLE stic Foreign NOTESDome. DUE DATE (6) FORM SOURCE** (7) APPLICABLE . Since the NAIC's electronic . There is no separate regulation in PA. See 40 Pa. CS 3901, et al.

All companies licensed to write automobile insurance in Massachusetts must submit electronic copies of the 2021 Annual Statement documents to the AIB on or before the due dates shown below. 1 . I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 "X14") 1 EO xxx 3/1 NAIC B . Created Date: 02/14/2022 07:43:00 Title: LIFE, ACCIDENT AND HEALTH INSURERS Last modified by: Diep, Christine Company: I. NAIC FINANCIAL STATEMENTS . . LIFE, ACCIDENT AND HEALTH/FRATERNAL INSURERS . EO : xxx . The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by the company to the NAIC.

you may complete the NAIC Annual Statement page entitled "Supplemental Exhibits and Schedules Interrogatories" INSTEAD OF filing duplicate reports . Annual Calls . Due January 15, 2022.

DUE DATE (6) FORM SOURCE** (7) APPLICABLE . 3/1 PPD, Foreign CI, DI, LD, PC 3/31 HCSO, HMDO : 3/31 Domestic CI, DI, LD, PC .

G Original Signatures: Original Signatures required on all filings from domestic companies. 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. (State or NAIC): Please follow the instructions in the NAIC Annual Statement Instructions. Members of the North Carolina Insurance . These are available in PDF format unless otherwise specified. Annual Statement: Per IC 27-1-20-21.2, a $500 late fee may be assessed if the Annual Statement is not received in our office on or before the indicated due date.

Filing Date 2022-02-24 Filing Number 6291430 Filing Type Annual Report (Due: 4/15/2022) Last updated March 15 2022, 3.43PM (4 months ago) License applications. L Signed Jurat The following statutes govern the individuals who are authorized to sign the Jurat. The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by the company to 18. DUE DATE (6) FORM SOURCE ** (7) APPLICABLE NOTES Domestic Foreign State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 1/2" X 14") 1 EO XXX 3/1 NAIC 1.1 Investment Schedule detail (pages E01-E29) 1 EO XXX 3/1 NAIC 2 Quarterly Financial Statement (8 1/2" X 14") 1 EO XXX 5/15, 8/15, 11/15 NAIC . you may complete the NAIC Annual Statement page entitled "Supplemental Exhibits and Schedules Interrogatories" INSTEAD OF filing reports marked "None". See also NAIC website. . DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 " x 14") 1 EO xxx 3/1 NAIC G, H 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC If the filing due date falls on a weekend, you must consult your state of domicile on whether filings are due the Friday before the due date or the Monday after the due date. ** For those states that have adopted the NAIC Corporate Governance Annual Disclosure Model Act, an annual . 1992 - 2020 National Association of Insurance Commissioners 1 Title 2020 INSTRUCTIONS For Completing Title Annual Statement Blank FOREWORD Line titles and columnar headings of the various statement items and lines are in general self-explanatory and as such constitute instructions. State NAIC State ; I. NAIC FINANCIAL STATEMENTS ; 1 Annual Statement (8 "x1 4") EO EO xx x 3/ 1 NAIC A-K, M 1.1 Printed Investment Schedule detail (Pages E01-E29) @ EO EO xxx 3/1 NAIC A-K, M . This waiver could include supplemental annual statement filings. supplements due March 1, per the Annual Statement Instructions.

Statements are due 45 days subsequent to the end of each quarter: Quarter Ending Due Date March 31, 2022 May 15, 2022 June 30, 2022 August 15, 2022 Puerto Rico is now a participating MCAS jurisdiction. Financial Statement Filings due March 31 st and beyond, please consult your domiciliary state for any information on obtaining a waiver or extension. DUE DATE (6) FORM SOURCE ** (7) APPLICABLE ; Foreign NOTES. K Bar Codes (State or NAIC): Follow the instructions in the NAIC . Filings Made During the Year 2022 (1) Check- List (2) Line # (3) REQUIRED FILING FOR THE ABOVE STATE (4) NUMBER OF COPIES* (5) DUE DATE (6) FORM SOURCE** (7) APPLICABLE NOTES; Domestic Foreign; . Domestic companies should apply at least 30 days prior to the due date and, for extensions, must submit a written request explaining the reason for the delay and detailed "time-line" of any expected component completion dates and contingencies. 1 Annual Statement (8 " x 14") 2 EO xxx 3/1 NAIC A-O 1.1 Printed Investment Schedule detail (Pages E01-E29 ) 2 EO xxx 3/1 NAIC A-O 2 Quarterly Financial Statement (8 " x 14") 2 EO xxx 5/15, 8/15, 11/15 NAIC A-O 3 Protected Cell Annual Statement 2 0 xxx 3/1 NAIC A-O Cancellation refund checks will be processed after August 22, 2022. State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 " x 14") 1 EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 . A.

DATE: February 9, 2022 TO: Property & Casualty Insurers - Financial Statement Contact Person . . State NAIC State ; I. NAIC FINANCIAL STATEMENTS ; 1 Annual Statement (8 "x1 4") EO EO xx x 3/ 1 NAIC A-K, M 1.1 Printed Investment Schedule detail (Pages E01-E29) @ EO EO xxx 3/1 NAIC A-K, M . must be physically received at the address in Note C no later than April 30th. Pet Insurance Model Act Not Yet Adopted by NAIC.

NAIC SUPPLEMENTS Payments are due on or before March 1, 2022.

Electronic filings, in the form of a zip file in accordance with the NAIC Filing Instructions, should be sent to annstat@aib.org as an email attachment. HCS & HMO - 354.435 Prepaid Dental - 354.720 ***** Effective July 1, 2017, North Carolina adopted the NAIC updated 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. If your company writes business in Puerto Rico for any of the MCAS lines of business, you . 66 Supplemental .PDF Filing xxx EO xxx 4/1 NAIC 67 Quarterly Statement Electronic Filing xxx EO . . DUE DATE (6) APPLICABLE : Domestic. K Bar Codes (State or NAIC): Follow the instructions in the NAIC Annual Statement Instructions. indicated due date.

If this column contains "State," the state will provide the forms with the filing instructions. only. Part 4- NAIC Annual Statement and Insurance Expense Exhibit Data Submission .

Fax to 816-460-7666 or email, meetingsmail@naic.org. statement. for Supplemental Interrogatories should be . 110 Annual Statement Filing Fee The Company Licensing Bureau will process the 2022 Annual Statement File Fee. 5/15, 8/15, 11/15 NAIC Annual Filing Instructions. If your company is granted a waiver or extension, please provide that documentation to FDRadmin@naic.org . 2021 Year-end and 2022 Quarterly Filings Page 3 of 5 The request for an exemption or extension must be submitted in writing not less than ten days prior to the due date in sufficient detail to permit the Director to make an informed . If the due date falls on a weekend or holiday, then the postmark deadline is extended to the . 2020 National Association of Insurance Commissioners 5 Health . There is no due date for CY 2022. ***For those states that have adopted the NAIC Corporate Governance Annual Disclosure . The Annual Statement filing fee is due March 1, 2022. Premium Tax: The penalty for non-filing is $100 per day. 61 Annual Statement Electronic Filing xxx EO xxx 3/1 NAIC E . 1, 2022 Annual Statement Filing (Property, Life, Health, Title) Merger/history form, if applicable (Property, Life, Health, Title) (electronic txt file only) Bail Bond Supplement (Property) F Late Filings: Companies will be fined $100 per day for a late filing. State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 "x14") 1 EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC NAIC. Premium tax . for Nevada required filings - supply a written copy of any exemption or extension received from your state of domicile at least 10 days prior to the filing due date. License applications and filing fees. Invoices will be available January 2022, on the Examinations Bureau webpage and the Company Licensing Bureau webpage, which can be found at Up to $100.00 per day - Quarterly Statements. . 2021 National Association of Insurance Commissioners 1 Life .

We use the NAIC filing date or the USPS postmark or courier pick-up date as the date filed. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 " x 14") 2 EO 0 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 2 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 2 EO 0 5/15, 8/15, 11/15 NAIC Quarterly Statement Filing as of March 31, 20189 (Property, Life, Health, Title) Trusteed Surplus Statement - Quarter Ending March 31, 2019 (Property, Life) Supplement A to Schedule T (Medical Professional Liability Supplement . The format to be used is the 2021 edition of the quarterly blank adopted by the NAIC for the 2022 reporting year. Forms & Endorsements. A summary of all changes can be found in the Summary of 2022 Changes document. The first annual PA CGAD filing due date was June 1, 2020. 2021-2022 New York Annual Statement and Supplement Filing Blanks. All annual financial statement filings must be postmarked no later than March 1st. must be physically received at the address in Note C no later than April 30th.

Annual Statement Instructions. The National Association of Insurance Commissioners (NAIC) held its 2022 Spring National Meeting from March 4 to 8 in Kansas City, Missouri. Payments can be made via Check, ACH or Wire. Signed Jurat pages are not required for foreign insurers. This Sidley Update summarizes the highlights from this . Although the meeting was held in a hybrid in-person and . Michigan has adopted the NAIC Corporate Governance Annual Disclosure Model Act . Although the meeting was held in a hybrid in-person and . If the due date falls on a weekend or holiday, the deadline is extended to the next business day. Information on Annual Report (Due: 4/15/2022) filing for Dusty Kautz Trucking, LLC (Montana (US)) Learn how to leverage transparent company data at scale. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 "x14") 2 EO 0 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 2 EO xxx 3/1 NAIC . Annual Statement Verification and Acknowledgement Form. K Bar Codes (State or NAIC): Bar codes are not required by Missouri. Internet Filing will be available starting February 4, 2022 for submission of the 2021 Annual Financial Statement Filings and conclude on January 31, 2023. . The NAIC is using a streamlined formulaic approach for the calculation of the 2021 annual financial filing . Other financial filings must be postmarked no later than the indicated due date. Company's license may be suspended if the annual statement is received more than 30 days late G Original Signatures: Column (7) (Applicable Notes)

> The REFS filings must be received by the Office no later than 5:00 PM on the applicable due date. submit quarterly statements to the NAIC electronically. Due Dates . NAIC Report: 2022 Spring National Meeting. DUE DATE (6) FORM SOURCE ** (7) APPLICABLE NOTES Domestic Foreign State NAIC State I. NAIC FINANCIAL STATEMENTS . 2021-08 DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 "X14") KY EO** EO KY EO* 3/1** NAIC *Jurat page for Foreign only **See Letter E and F 1.1 Printed Investment Schedule detail (Pages E01-E29) KY EO EO 0 3/1* NAIC *See Letter E 2 Quarterly Financial Statement . NAIC Annual Statement Instructions. Note M - NONE Filings See NAIC . Filings Made During the Year 2022 (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; . LIFE, ACCIDENT AND HEALTH/FRATERNAL INSURERS . . you may complete the NAIC Annual Statement page entitled "Supplemental Exhibits and Schedules Interrogatories" INSTEAD OF filing reports marked . ***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. Annual Statement Instructions . Up to $25.00 per day -Certificate of Disclosure Form E-178. The National Association of Insurance Commissioners (NAIC) held its 2022 Spring National Meeting from March 4 to 8 in Kansas City, Missouri. Foreign NOTES . NAIC SUPPLEMENTS Puerto Rico will begin collecting MCAS filings beginning with the 2022 data to be reported on the filing due dates in 2023. Filings Made During the Year 2022: FRATERNAL COMPANIES BEGIN FILING LIFE/FRATERNAL STATEMENT EFFECTIVE WITH FIRST QUARTER, 2019 . Filings for the respective quarters have deadlines of May 15, August 15, and November 15, 2022. 1 Annual Statement (8 " x 14") EO EO N/A 3/1 NAIC A, E 1.1 Printed Investment Schedule detail (Pages E01-E29) EO EO xxx 3/1 NAIC E 2 Quarterly Financial Statement (8 " x 14") EO EO N/A 5/15, 8/15, 11/15 NAIC E 3 Protected Cell Annual Statement EO 0 xxx 3/1 NAIC E Date, Sunday Due Date requires next day receipt. you may complete the NAIC Annual Statement page entitled . The Pet Insurance Model Act, which provides a comprehensive legal framework in which pet . B. DUE DATE (6) FORM SOURCE**Domestic (7) APPLICABLE Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 "X14") 1 EO xxx 3/1 NAIC G, H 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC G, H DUE DATE (6) FORM SOURCE* * (7) APPLICABLE Domestic ForeigNOTES n State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 " x 14") 1 EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC II. waive printed quarterly and annual statements from their foreign insurers and to rely upon the NAIC database for these filings. . 2021-22 Annual Statements and New York Supplement Filing Instructions & Forms. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 "X14") 1 EO xxx 3/1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 1 EO xxx 5/15, 8/15, 11/15 NAIC II. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 " x 14") 1 EO xxx 3/1 NAIC Note G, H & L 1.1 Printed Investment Schedule detail (Pages E01-E29) 1 EO xxx 3/1 NAIC 2 Quarterly Financial Statement (8 " x 14") 1 EO xxx 5/15, 8/15, 11/15 The State of Ohio does not require annual filings or Annual Statements as long as the filings required by the National Association of Insurance Commissioners (NAIC) are filed with the NAIC by their due dates. Foreign NOTES . Annual Calls and Due Dates .

during 2022, to this Department in the same manner as noted above. Financial Statement Filing. the due dates listed above for the following companies licensed to write automobile insurance in Massachusetts in 2021. May 15, 2019. . later than the indicated due date. submit their NAIC Annual Statement, Installment Premium charges, and Automobile and Property Expens e Experience data. 2021 National Association of Insurance Commissioners 1 Life LIFE, ACCIDENT AND HEALTH/FRATERNAL INSURERS . Foreign NOTES ; State NAIC State ; I. NAIC FINANCIAL STATEMENTS ; 1 Annual Statement (8 " x 14") 2 EO xxx 3/1 A-R,T-V,X,Y,Z 1.1 Printed Investment Schedule detail (E01-E25) 2 EO xxx 3/1 O . EO : xxx . filing due date. DUE DATE (6) FORM SOURCE ** (7) APPLICABLE NOTES Domestic Foreign State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 1/2" X 14") 1 EO XXX 3/1 NAIC 1.1 Investment Schedule detail (pages E01-E29) 1 EO XXX 3/1 NAIC 2 Quarterly Financial Statement (8 1/2" X 14") 1 EO XXX 5/15, 8/15, 11/15 NAIC NE EO 0 EO 3/1 NAIC V 111 Annual Statement Schedule T Page (Page 49-50) EO 0 EO 3/1 NAIC V . P & C Annual Statement March 1, 2022 Insurance Expense Exhibit April 4, 2022 Automobile Expense Experience April 21, 2022 Installment Premium Charges May 5, 2022 . DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 " x 14") EO EO XXX 3/1 NAIC B(c), G, H(a), I, L, N(a) 1.1 Printed Investment Schedule detail (Pages E01-E29) EO EO XXX 3/1 NAIC B(c), I, N(a)

. 1 Annual Statement (8 " x 14") EO EO xxx 3/ 1 NAIC 1.1 Printed Investment Schedule detail (Pages E01-E29 ) @ EO EO xxx 3/1 NAIC A-K , M . NOTICE: THE FOLLOWING REPRESENTS, IN GENERAL, THE ANNUAL RENEWAL AND RELATED . The National Association of Insurance Commissioners (NAIC) held its Spring 2022 National Meeting (Spring Meeting) from April 4-8, 2022. For 2022, North Dakota is . Other financial filings must be postmarked no later than the indicated due date.

Please follow the NAIC Annual Statement Instructions for NAIC bar codes.

***For those states that have adopted the NAIC Corporate Governance Annual Disclosure . DUE DATE (6) FORM SOURCE** (7) APPLICABLE ; Domestic Foreign NOTES . 1 Annual Statement (8 " x 14") 2 EO xxx 3/1 NAIC A-O 1.1 Printed Investment Schedule detail (Pages E01-E29 ) 2 EO xxx 3/1 NAIC A-O 2 Quarterly Financial Statement (8 " x 14") 2 EO xxx 5/15, 8/15, 11/15 NAIC A-O 3 Protected Cell Annual Statement 2 0 xxx 3/1 NAIC A-O P & C Annual Statement March 1, 2022 Insurance Expense Exhibit April 4, 2022 Automobile Expense Experience April 21, 2022 . F Late Filings: $500 and for the annual statement if after 10 days notice, failure to file penalty will accrue at $100 per day. Foreign companies: follow NAIC Annual Statement Instructions. Not applicable Note L - Signed Jurat See NAIC Annual Statement Instructions.

The NAIC filing deadlines and requirements for the 2019 quarterly electronic filings are as follows. DUE DATE (6) FORM SOURCE** (7) APPLICABLE Domestic Foreign NOTES State NAIC State I. NAIC FINANCIAL STATEMENTS 1 Annual Statement (8 " x 14") KY EO EO KY EO* 3/1** NAIC *Jurat page for Foreign only **See Letter E and F 1.1 Printed Investment Schedule detail (Pages E01-E29) KY EO EO 0 3/1* NAIC *See Letter E