ins commissioners memorandum 16c

STATE OF HAWAII INSURANCE DIVISION DEPARTMENT OF COMMERCE & CONSUMER AFFAIRS P. O. BOX 3614 HONOLULU, HAWAII 96811-3614 250 S. KING ST., 5TH FLOOR HONOLULU, HAWAII 96813 Memorandum 2002-16C 1 December 10, 2002 Memorandum 2002 – 16C TO: CAPTIVE INSURERS AUTHORIZED IN HAWAII SUBJECT: Annual Filing Requirements in 2003 I. GENERAL INFORMATION A. File all documents directly with the Insurance Division. B. Required filings for Risk Retention Group (RRG) captives are administered directly by the Financial Surveillance and Examination Branch of the Hawaii Insurance Division. Please refer to Memorandum 2002 – 15E 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 or Sandy Agena, at (808)586-0981 or fax at (808)586- 0987. LINDA LINGLE GOVERNOR JAMES AIONA LT. GOVERNOR NOE NOE TOM ACTING DIRECTOR GORDON I. ITO ACTING INSURANCE COMMISSIONER Annual Filing Requirements 2003 December 12, 2002 Memorandum 2002-16C 2 II. III. DOCUMENTS AND FILING DEADLINES Document / Description # of Copies 2003 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. Class 3 Captives. Branch Captives 2 2 2 As Due June 1 Due 30 days after filed in Parent’s State of Domicile ANNUAL STATEMENT Prepared for Class 3 captives only, (unless otherwise specified by the Insurance Commissioner for Class 1, 2, 4 and 5 captives), on 8.5”x14” form as required by the NAIC for the year 2002. Verified by oaths of at least two principal officers and properly notarized signatures. 2 Hardcopies 1 Diskette March 1 TAX STATEMENT <Annual Statement of Premiums Received for Taxation Purposes; CAP-001> Prepared for the 2002 year attested by notarized signature of captive’s duly authorized individual, and accompanied by appropriate payment. 1 March 1 ACTUARIAL OPINION / CERTIFICATION OF RESERVE FOR LOSSES Prepared by a member of the American Academy of Actuaries or other Annual Filing Requirements 2003 December 12, 2002 Memorandum 2002-16C 3 Document / Description # of Copies 2003 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 State of Domicile AMENDMENTS TO CHARTER, BY-LAWS, ETC. Any changes made in 2002 (if not previously filed) must be submitted bearing an original certification by the proper officer of the state or country or domicile. 1 March 1 CASH AND INVESTED ASSETS HELD IN HAWAII <CAP-004> Reported for the calendar year 2002 at market value. 1 March 1 CAPTIVE QUESTIONNAIRE <CAP-002> Reported for the fiscal year ending in 2002. Class 1, 2, 4 and 5 Captives Class 3 Captives Branch Captives 1 1 1 Last day of sixth month following fiscal year end March 1 Due 30 days after filed in Parent’s State of Domicile Annual Filing Requirements 2003 December 12, 2002 Memorandum 2002-16C 4 Document / Description # of Copies 2003 Filing Deadline CERTIFICATE OF COMPLIANCE Each Branch Captive shall file a Certificate of Compliance issued by the insurance regulatory authority of the Parent’s State of Domicile along with a certified copy of the Parent’s most recent examination report conducted by the State of Domicile. 1 March 1 ECONOMIC IMPACT REPORT <CAP-003> Expenses reported on an accrual basis for calendar year 2002 1 March 1 INACTIVE STATUS REPORT <CAP-005> Reporting of captives that are in run off. 1 March 1 INSURED VEHICLE CENSUS REPORT <Form MVID14-2(1) 9/74> Required by captives authorized to write direct motor vehicle insurance. 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, 2002. 1 February 15 DRIVERS’ EDUCATION FUND UNDERWRITERS’ FEE Applicable to only to captives with motor vehicle risks in Hawaii. See Memorandum No. 2002-9-R for payment instructions. For Quarter/Year ending December 31, 2002. 1 February 15 ANNUAL LICENSE RENEWAL FEE Required for renewal of Certificate of Authority. (ref. HAR §16-17-6(a)) 1 April 1 Annual Filing Requirements 2003 December 12, 2002 Memorandum 2002-16C 5 Document / Description # of Copies 2003 Filing Deadline ANNUAL ASSESSMENT FOR WORKERS’ COMPENSATION INSURANCE ADMINISTRATION SPECIAL COMPENSATION FUND (ref. HRS §386:151 & HRS §386:152) Required for captives writing workers compensation risks on a direct basis in Hawaii only. 1 Within 30 Days of Demand