AZ Regulatory Bulletin 2001-04: Annual Statement Form Unaffiliated Credit Life and Disability Reinsurers

CC. 2001-4.doc Page 1 of 2 Department of Insurance State of Arizona 05/25/01 Telephone: (602) 912-8400 Telecopier: (602) 912-8453 JANE DEE HULL 2910 North 44th Street, Suite 210 CHARLES R. COHEN Governor Phoenix, Arizona 85018-7258 Director Of Insurance REGULATORY BULLETIN 2001-4 TO: Unaffiliated Credit Life and Disability Reinsurers and Other Interested Parties FROM: Charles R. Cohen Director of Insurance DATE: May 25, 2001 SUBJECT: Annual Statement Form Unaffiliated Credit Life and Disability Reinsurers Effective December 31, 2000, Section 20-1083(B) was amended to provide that the Director of Insurance may prescribe an annual statement form to be filed by unaffiliated credit life and disability reinsurers (“UCLD Reinsurer”). The purpose of this bulletin is to establish the form and content of the UCLD Reinsurer Annual Statement. Effective with the Annual Statements for UCLD Reinsurers due on August 1, 2001, reinsurers may file an abbreviated form of the NAIC Annual Statement Blank for Life and Accident and Health Insurers. Pages required to be filed are listed below, and should comply with the NAIC Annual Statement Instructions. • Jurat Page • Assets • Liabilities, Surplus and Other Funds • Summary of Operations; Capital and Surplus Account • Cash Flow • Summary of Operations by Lines of Business • Schedule E, Part 1, Cash • Schedule E, Part 2, Special Deposits • Schedule S, Part 1, Section 1 (Reinsurance Assumed, Life) • Schedule S, Part 1, Section 2, (Reinsurance Assumed, Disability) • Schedule S, Part 2 (Reinsurance Recoverable on Paid and Unpaid Losses) • Schedule S, Part 3, Section 1 (Reinsurance Ceded, Life) • Schedule S, Part 3, Section 2 (Reinsurance Ceded, Disability) • Schedule Y, Part 1, Organizational Chart May 25, 2001 Page 2 of 2 UCLD reinsurers shall also file the following Notes to Financial Statements: • Basis of Presentation • Information Concerning Parent, Subsidiaries and Affiliates • Contingent Liabilities • Events Subsequent • Other Items Additionally, UCLD Reinsurers must file the following supplemental forms with the Annual Statement. The Supplemental forms and instructions are yet to be updated for the 2000 Annual Statements, but will be made available soon on the Department’s web site at www.state.az.us/id/forms. • E-UCLDR.AS – Annual Statement Filings Worksheet • Form E-UCLDR.CERT (formerly EURCERT) – Annual Certification and Affidavit of Verification • E-178UCLDR – Certificate of Disclosure Finally, the instructions and reporting form required for the remittance of annual fees will also be made available on the Department’s web site under the link to Annual Premium Tax Forms and Instructions. Filers should not send the Annual Fees Report and check with the Annual Statement, as these items must be mailed separately to the attention of the Tax Unit for proper handling upon receipt. Questions regarding any of the filing requirements should be directed to: Rose McNabb, Solvency Support Unit Supervisor Arizona Department of Insurance Financial Affairs Division 2910 North 44th Street, Second Floor Phoenix, AZ 85018-7256 rmcnabb@id.state.az.us Telephone: (602) 912-8420 Fax (602) 912-8421