REQUIRED FILINGS IN THE STATE OF: North Carolina
DOMESTIC TOWN AND COUNTRY MUTUAL INSURERSCOMPANY NAME:NAIC Company Code:Contact:Telephone:North CarolinaREQUIRED FILINGS IN THE STATE OF:(1)(2)(3)ChecklistLine#REQUIRED FILINGS FOR THE ABOVE STATEFilings Made During the Year 2021(4)NUMBEROFCOPIES *(5)DUE DATE(6)FORMSOURCE**(7)APPLICABLENOTES12I. NAIC FINANCIAL STATEMENTSAnnual Statement (8 ½” x 14”)Quarterly Financial Statement (8 ½” x 14”)223/15/15, 8/15, 11/153456789101112II. NAIC SUPPLEMENTSSupplemental Investment Risk InterrogatoriesInsurance Expense ExhibitManagement Discussion & AnalysisStatement of Actuarial OpinionActuarial Opinion SummarySupplemental Compensation ExhibitReinsurance Attestation SupplementExceptions to Reinsurance Attestation SupplementReinsurance Summary Supplement for GI 9Director and Officer 1, 5/15, 8/15, ,N,P28/1CompanyA,B,E,F,J,N,P2Within 5 days ofreceipt from CPACompanyA,B,E,F,N12212113/153/1, 5/15, 8/15, 23IV. AUDIT/INTERNAL CONTROLRELATED REPORTSDesignation of CPA and Accountant’s AppointmentLetter (“AAL”)Notice or Request for ExemptionRequest for an Exemption Annual Financial ReportingLaw’s Independence of ServicesRequest for Relief from Lead Partner RotationRequirementDesignation of Audit CommitteeRequest for Extension to File Annual Audited FinancialReportAudited Financial ReportsAccountants Letter of QualificationsCommunication of Internal Control Related MattersNoted in AuditManagement’s Report of Internal Control Over FinancialReportingNotification of Adverse Financial Condition24252627282930V. STATE REQUIRED FILINGSPremium TaxPledged Asset Supplement (NCGS 58-13-25(b))Certificate of Intent (NCGS 58-2-165(a1))Certificate of Compliance (NCGS 58-2-165(a1))Management Agreement Supplement (G.S. 58-34-10(d))License Update Form and Fee ScheduleCorporate Governance Annual ,F,J,K,O,QA,B,E,FA,B,E,G*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 electronicallywith 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.*** Effective July 1, 2019, North Carolina adopted the NAIC Corporate Governance Annual Disclosure Model Act, an annual disclosure is requiredof all insurers or insurance groups by June 1. The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by thecompany 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 moreinformation on lead states, see the following NAIC URL: http://www.naic.org/public lead state report.htm. A copy of the group level CorporateGovernance Annual Disclosure is to be filed with North Carolina. 2020 National Association of Insurance Commissioners1CFM
NOTES AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS)ALICENSE UPDATE FORM AND FEESCHEDULE, AND ANNUAL LICENSECONTINUATION FEES:Ms. Sue Ann Webster (919) 807-6164SueAnn.Webster@ncdoi.govRequired Filings Contact Person:DOMESTIC COMPANY FILINGS:Ms. Sue Ann Webster (919) 807-6164SueAnn.Webster@ncdoi.govDOMESTIC AUDITED FINANCIALSTATEMENTS AND RELATEDSUPPLEMENTAL FILINGS:Ms. Sue Ann Webster (919) 807-6164SueAnn.Webster@ncdoi.govPREMIUM TAX FILINGS:North Carolina Department of RevenueMs. Latoya Parmele (919) 754-2600Latoya.Parmele@ncdor.govBFor U. S. Postal DeliveryNorth Carolina Department of InsuranceCompany Services GroupFinancial Analysis Section1203 Mail Service CenterRaleigh, NC 27699-1203Mailing Address:For Other Than U. S. Postal Service DeliveryNorth Carolina Department of InsuranceCompany Services GroupFinancial Analysis Section325 North Salisbury StreetRaleigh, NC 27603CANNUAL LICENSE CONTINUATION FEES:Detailed for your reference at the bottom of theLicense Update Form and Fee Schedule.Mailing Address for Filing Fees:CHECKS FOR FEES: Must include the CompanyName if different than the payor on the checkChecks should be sent under separate coveralong with the License Update Form and FeeSchedule to the attention of Ms. Sue Ann Websterat:For U. S. Postal DeliveryNorth Carolina Department of InsuranceCompany Services GroupFinancial Analysis Section1203 Mail Service CenterRaleigh, NC 27699-1203For Other than US Postal Service DeliveryNorth Carolina Department of InsuranceCompany Services GroupFinancial Analysis Section325 North Salisbury StreetRaleigh, NC 27603ELECTRONIC PAYMENTS: For informationregarding electronic payment options ations 2020 National Association of Insurance Commissioners2CFM
DFor U. S. Postal DeliveryMs. Latoya ParmeleNorth Carolina Department of RevenueInsurance Premium Tax UnitP.O. Box 25000Raleigh, NC 27640-0300Mailing Address for Premium Tax Payments:For Other than US Postal Service DeliveryNorth Carolina Department of RevenueInsurance Premium Tax Unit501 North Wilmington StreetRaleigh, NC 27640EAll filings must be RECEIVED at the appropriateaddress provided in Note B no later than theindicated due date. If the due date falls on aweekend or holiday, then the deadline is extended tothe next business day.Delivery Instructions:Hand deliveries are NOT accepted.FLate Filings:Penalties under G.S.58-2-70 may apply.GOriginal Signatures:Original signatures are required on all filings.See Note H for Temporary COVID-19 Signatureand Notarization Requirements.HThe following officers are required to sign theannual and quarterly statements: President, CEO,or COO; Secretary; and Treasurer or CFO.Signature/Notarization/Certification:The President is required to sign the Certificate ofIntent (see Attachment A) and the Certificate ofCompliance (see Attachment B). These documentsmust be on the insurer’s letterhead.All signatures must be notarized, and the corporateseal, if any, affixed.TEMPORARY COVID-19 FILINGREQUIREMENTS: Annual statements arerequired to be filed in hardcopy. However, forthe Jurat Page and other specific pages requiringa signature or notarization, electronic signaturesand notarizations will be permitted during thepandemic. Please note that the Jurat Page andother specific pages submitted with an electronicsignature and notarization will be required to beresubmitted with a wet signature andnotarization in hardcopy after the pandemic.Electronic signatures and notarizations should besent to:FinancialAnalysisSubmissions@ncdoi.govIAny amended pages must be accompanied by aproperly executed Jurat Page and filed within 10days of the amendment.Amended Filings:The Jurat page accompanying the amended filingmust include the amendment number, theamendment date, and the number of pages amended.See Note H for COVID-19 Signature andNotarization Requirements.JRequests for exemptions or extensions must besubmitted in writing at least 10 days prior to theindicated due date.Exceptions from normal filings: 2020 National Association of Insurance Commissioners3CFM
For additional filing instructions regarding theaudited financial statement and supplements, refer al-analysis/annual-financial-reporting-lawRequests for the exemption from filing an actuarialopinion are due 10/1.KNONE Filings:Follow NAIC Annual Statement Instructions.LStatement of Actuarial Opinion:One (1) original and two (2) copies of the actuarialopinion must be filed with this Department.MSupplemental Exhibits and Schedules Interrogatories:These interrogatories included in the AnnualStatement must be completed to indicate if any ofthese supplements are not applicable.NElection to file either the NAIC Annual Statement or audited financialstatements:If for the preceding year the insurer had directwritten premiums of less than one hundred fiftythousand dollars ( 150,000) and fewer than 400policyholders, it may elect to file an auditedfinancial statement prepared by a certified publicaccountant as a representation of its financialcondition at December 31st, in lieu of an annualstatement.Insurers qualifying must complete a Certificate ofIntent on the insurer’s letterhead signed by thePresident, with such signature notarized and withthe Corporate Seal affixed.Such Certificate of Intent must be filed by January31st.OIf for the preceding year the insurer had directwritten premiums of less than one hundred fiftythousand dollars ( 150,000) and fewer than 400policyholders, no quarterly statement is required tobe filed.Statutory Exemption from filing Quarterly Statements:Insurers qualifying must complete a Certification ofCompliance per on the insurer’s letterhead signed bythe President, with such signature notarized andwith the Corporate Seal affixed.Such Certificate of Compliance must be filed byJanuary 31st.PFor information concerning exemption from theCPA Audit Rule refer toExemption from CPA Audit rterly Statement Exemption Requests (Per Attached Guidelines):In accordance with the attached guidelines,companies may request an exemption from thequarterly statement filing requirements. Suchrequests and required information must be filed byMarch 1st.RFilings new, discontinued or modified materially since last year:None 2020 National Association of Insurance Commissioners4CFM
General InstructionsFor Companies to Use ChecklistPlease Note:This state’s instructions for companies to file with the NAIC are included in this Checklist. The NAICwill 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 Sitewhich eliminates the need for a company to submit diskettes or CD-ROM to the NAIC. Companies arenot 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 placean “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 AnnualStatement Instructions. This includes all detail investment schedules and other supplements for which the Annual StatementInstructions exempt printed detail.The March .PDF Filing is the .pdf file for annual statement data, detail for investment schedules and supplements due March1.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 thecombined Insurance Expense Exhibit.The Combined Annual Statement .PDF Filing is the .pdf file for the combined annual statement data and the combinedInsurance 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 andcertain investment schedule detail, if such investment schedule data is available to the states via the NAIC database. Thechecklists reflect this action taken by the Blanks (EX) Task Force. XXX appears in the “Number of Copies” “Foreign” columnfor the appropriate schedules and exhibits. Some states have chosen to waive printed quarterly and annual statements fromtheir foreign insurers and to rely upon the NAIC database for these filings. This waiver could include supplemental annualstatement filings. The XXX in this column might signify that the state has waived the paper filing of the annual statementand all supplements. 2020 National Association of Insurance Commissioners5CFM
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 mustobtain the forms from the appropriate vendor. If this column contains “State,” the state will provide the forms with the filinginstructions. If this column contains “Company,” the company, or its representative (e.g., its CPA firm), is expected to providethe 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 companyshould carefully read these notes before submitting a filing. 2020 National Association of Insurance Commissioners6CFM
*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 c
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
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This package is designed to assist Property and Casualty insurers in preparing their filings with the Florida Office of Insurance Regulation (Office). . NAIC Company Code: Contact: Telephone: REQUIRED FILINGS IN THE STATE OF: Filings Made During the Year 2022 (1) Check-list (2) Line # (3) REQUIRED FILINGS FOR THE ABOVE STATE Domestic .
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.
