ins commissioners memorandum 14c

LINDA LINGLE MARK E. RECKTENWALD GOVERNOR DIRECTOR J. P. SCHMIDT JAMES AIONA INSURANCE COMMISSIONER LT. GOVERNOR S T A T E OF HA WA I I INSURANCE DIVISION DEPARTMENT OF COMMERCE & CONSUMER AFFAIRS P. O. BOX 3614 HONOLULU, HAWAII 96811-3614 335 Merchant Street, Room 213 HONOLULU, HAWAII 96813 December 22, 2004 Memorandum 2004 – 14C TO: CAPTIVE INSURERS AUTHORIZED IN HAWAII SUBJECT: Annual Filing Requirements in 2005 I. GENERAL INFORMATION A. File all documents directly with the Insurance Division. B. Required filings for risk retention captive insurance companies (RRG) are administered directly by the Financial Surveillance and Examination Branch of the Hawaii Insurance Division. Please refer to Memorandum 2004 – 10E for detailed filing requirements, or contact Susan Hansen at (808)586-7381. C. For due dates that fall on a weekend or State holiday, filing on the first working day following that weekend or State holiday will be accepted. D. Postmark dates will be recognized in determining filing deadlines. E. Fine for late filing of the audited financial statement, statutory annual statement, quarterly statements, and other required filings. All captives are subject to a fine for filing after the due date of not more than $500 per day (HRS 431:19-107). F. Make all checks payable to the “DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS”. A service charge of $15 will be due for each dishonored check, and replacement checks must be certified. G. Reproductions of Insurance Division forms are acceptable, as long as, same size of paper is used. H. Contact Craig Watanabe of Judy Nako at (808)586-0981 or fax at (808)586-0987. Memorandum 2004-14C 1 Annual Filing Requirements 2005 December 22, 2004 II. DOCUMENTS AND FILING DEADLINES Document / Description # of Copies 2005 Filing Deadline STATEMENT OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Includes at a minimum: audit of Balance Sheet, Income Statement and Statement of Cash Flows) Prepared according to GAAP or other comprehensive basis of accounting for Class 1, 2, 4 and 5 captives, and SAP for Class 3 captives, all audited by an approved independent certified public accountant, is due as follows: Class 1, 2, 4 and 5 Captives due on or before the last day of the sixth month following the end of the company’s fiscal year end. 2 As Due Class 3 Captives. 2 June 1 Branch Captives 2 Due 30 days after filed in Parent’s Home Domicile ANNUAL STATEMENT Prepared for Class 3 captives only, (unless otherwise specified by the 2 Hardcopies March 1 Insurance Commissioner for Class 1, 2, 4 and 5 captives), on 8.5”x14” form as required by the NAIC for the year 2004. Verified by oaths of at least two principal officers and properly notarized signatures. TAX STATEMENT <Annual Statement of Premiums Received for Taxation Purposes; CAP-001> Prepared for the 2004 year attested by notarized signature of captive’s duly 1 March 1 authorized representative, and accompanied by appropriate payment. ACTUARIAL OPINION / CERTIFICATION OF RESERVE FOR LOSSES Prepared by a member of the American Academy of Actuaries or other Memorandum 2004-14C 2 Annual Filing Requirements 2005 December 22, 2004 Document / Description # of Copies 2005 Filing Deadline qualified loss reserve specialist as defined in the annual statement adopted by the NAIC, alternatively, each Class 1, 2, 4, and 5 captive may utilize an actuarial opinion prepared by a loss reserve specialist deemed appropriate by the Commissioner. Class 1, 2, 4 and 5 Captives Class 3 Captives Branch Captives 2 2 2 Last day of sixth month following fiscal year end March 1 Due 30 days after filed in Parent’s Home Domicile AMENDMENTS TO CHARTER, BY-LAWS, ETC. Any changes made in 2004 (if not previously filed) must be submitted 1 March 1 bearing an original certification by the proper officer of the state or country or domicile. CASH AND INVESTED ASSETS HELD IN HAWAII <CAP-004> Reported for the calendar year 2004 at market value. 1 March 1 CAPTIVE QUESTIONNAIRE <CAP-002> Reported for the fiscal year ending in 2004. Class 1, 2, 4 and 5 Captives 1 Last day of sixth month following fiscal year end Class 3 Captives 1 March 1 Branch Captives 1 Due 30 days after filed in Parent’s Home Domicile Memorandum 2004-14C 3 Annual Filing Requirements 2005 December 22, 2004 Document / Description # of Copies 2005 Filing Deadline CERTIFICATE OF COMPLIANCE 1 March 1 Each Branch Captive shall file a Certificate of Compliance issued by the insurance regulatory authority of the Parent’s Home Domicile along with a certified copy of the Parent’s most recent examination report conducted by its Home Domicile. ECONOMIC IMPACT REPORT <CAP-003> Expenses reported on an accrual basis for calendar year 2004 1 March 1 INACTIVE STATUS REPORT <CAP-005> Reporting of captives that are not actively writing business 1 March 1 INSURED VEHICLE CENSUS REPORT <Form MVID14-2(1) 9/74> Required by captives authorized to write direct motor vehicle insurance. 1 February 15 Captive with no underwriting risk in Hawaii should submit “nil” report. Only Columns 3 and 4 of Census Report should be completed. Report as of December 31, 2004. DRIVERS’ EDUCATION FUND UNDERWRITERS’ FEE Applicable to only to captives writing direct motor vehicle insurance in 1 February 15 Hawaii. See Memorandum No. 2002-9R for payment instructions. For Quarter/Year ending December 31, 2004. ANNUAL LICENSE RENEWAL FEE Required for renewal of Certificate of Authority. (ref. HAR §16-17-6(a)) 1 April 1 Memorandum 2004-14C 4 Annual Filing Requirements 2005 December 22, 2004 Document / Description # of Copies 2005 Filing Deadline ANNUAL ASSESSMENT FOR WORKERS’ COMPENSATION INSURANCE SPECIAL COMPENSATION FUND (ref. HRS §386:151 & HRS §386:152) 1 March 15 Form 315 is required for captives writing workers compensation risks on a direct basis in Hawaii only. Memorandum 2004-14C 5