PURPOSE: This rule prescribes forms to be followed in proceedings before the Department of Insurance regarding annual statements and effectuates or aids in the interpretation of sections 287.710, 354.105, 354.435, 354.720, 375.041, 375.786, 375.1030, 375.1037, 375.1047, 375.1082, 375.1252, 376.350, 376.370, 376.1012, 376.1092, 376.1093, 377.100, 377.380, 378.350, 379.105, 380.051, 380.482, 382.110, 383.030 and 384.021, RSMo.

PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. Therefore, the material which is so incorporated is on file with the agency who filed this rule, and with the Office of the Secretary of State. Any interested person may view this material at either agency’s headquarters or the same will be made available at the Office of the Secretary of State at a cost not to exceed actual cost of copy reproduction. The entire text of the rule is printed here. This note refers only to the incorporated by reference material.

1. (1) Each health services corporation, health maintenance organization (HMO), stock or mutual life insurance company, assessment or stipulated premium plan life insurance company, fraternal benefit society, stock or mutual insurance company other than life, Chapter 383 assessment company, reciprocal and eligible surplus lines insurer shall file a sworn annual statement on or before March 1 of each year, for its business and affairs for the year ended the next previous December 31, in accordance with the National Association of Insurance Commissioners (NAIC) Annual Statement Blank and the instructions for it, or in accordance with any other form as the director expressly permits to the entity. This statement also shall be prepared in accordance with the applicable accounting standards or principles approved by the NAIC, published in the Accounting Practices and Procedures Manual for Fire and Casualty Insurance Companies, Accounting Practices and Procedures Manual for Life and Accident and Health Insurance Companies, Valuation of Securities or Examiner’s Handbook, or a combination of these, except where the applicable provisions of Chapters 354 and 374–385, RSMo, or other specific rules expressly provide otherwise. For entities not domiciled in Missouri, one (1) copy of the annual statement shall be filed with the Missouri department’s office in Jefferson City and one (1) copy shall be filed with the NAIC’s office in Kansas City, Missouri. For entities domiciled in Missouri, one (1) signed original and two (2) copies of the annual statement shall be filed with the Missouri department’s office in Jefferson City and one
2. (1) copy shall be filed with the NAIC’s Kansas City office; provided, however, that for domiciled companies doing business in seventeen (17) or more states, for life and health insurers writing fifty (50) million dollars or more in gross premium, and for property and casualty insurers writing thirty (30) million dollars or more in gross premium, an additional copy also shall be filed with the NAIC’s office in Kansas City, Missouri, but only upon the written request of the NAIC. The annual and quarterly statements should be signed by three (3) officers of the company.
3. (2) Each entity shall file a diskette including all annual statement information with the NAIC’s office in Kansas City, Missouri. The diskette shall be prepared under guidelines contained in the NAIC’s Annual Statement Diskette Filing Specifications.
4. (3) Each health services corporation, HMO, stock or mutual life insurance company, assessment or stipulated premium plan life insurance company, fraternal benefit society, stock or mutual insurance company other than life, Chapter 383 assessment company, reciprocal and eligible surplus lines insurer shall file, in addition to the sworn annual statement required in section (1), three (3) quarterly statements for its business and affairs for the quarters ending, respectively, the next previous March 31, June 30 and September 30, in accordance with the NAIC Quarterly Statement Blank and the instructions for it, or in accordance with any other forms as the director expressly permits to the entity. For entities not domiciled in Missouri, one (1) copy of each quarterly statement shall be filed with the Missouri department’s office in Jefferson City and one (1) copy shall be filed with the NAIC’s office in Kansas City, Missouri. For entities domiciled in Missouri, one (1) signed original and two (2) copies of each quarterly statement shall be filed with the Missouri department’s office in Jefferson City and one (1) copy shall be filed with the NAIC’s Kansas City office; provided, however, that for domiciled companies doing business in seventeen (17) or more states, for life and health insurers writing fifty (50) million dollars or more in gross premium, and for property and casualty insurers writing thirty
5. (30) million dollars or more in gross premium, an additional copy also shall be filed with the NAIC’s office in Kansas City, Missouri, but only upon the written request of the NAIC.
6. (4) Each entity shall file a diskette including all quarterly statement information with the NAIC’s office in Kansas City, Missouri, and an additional diskette with the Missouri department’s Jefferson City office. The diskette shall be prepared under guidelines contained in the NAIC’s Quarterly Statement Diskette Filing Specifications.
7. (5) Filings for the respective quarters shall be mailed on or before May 15, August 15 and November 15 of each year.
8. (6) This rule will apply to filing of the annual and quarterly statements and diskette beginning with the year ending December 31, 1992, to be filed by March 1, 1993, as well as all future years.

9. (7) All entities regulated by the Department of Insurance shall place bar code labels on the following documents that are required to be filed with the Missouri Department of Insurance:

   1. (A) Annual statement and all exhibits required by the NAIC;
   2. (B) Quarterly financial statements (due three (3) times a year);
   3. (C) Audited financial report; 20 CSR 200-1
   4. (D) Qualification letter;
   5. (E) Application to Renew Certificate of Authority;
   6. (F) Notification of Insurers/Trust Agreement form (third-party administrators);
   7. (G) Premium Tax Form (including quarterly assessment notices);
   8. (H) Actuarial certification included with annual statement filing;
   9. (I) Management Discussion and Analysis form;
   10. (J) Basket clause investments listing;
   11. (K) Electronic data processing equipment listing;
   12. (L) Risk-based capital report;
   13. (M) Confirmation of deposit;
   14. (N) Certificate of Authority (foreign companies);
   15. (O) Certificate of Valuation (foreign companies);
   16. (P) Certificate of Deposit (foreign companies);
   17. (Q) Certificate of Valuation (form MO 375-0420);
   18. (R) Market Value of Securities form (form MO 375-0421);
   19. (S) Page fourteen supplement to the annual statement (property and casualty insurance);
   20. (T) Annual statement supplement to the state page for Missouri (life and health insurance);
   21. (U) Missouri state page of the annual statement;
   22. (V) Self-Insurance Table 1 Payroll and Premium Tax Report form;
   23. (W) Self-Insurance Certification Report for excess Workers’ Compensation premium; and
   24. (X) Any other documents determined by the director.
10. (8) A master sheet of bar code labels will be provided once a year. If the master sheet or any part thereof has to be reproduced for any reason, a fee of ten dollars ($10) will be charged. This fee, along with a written request for a replacement set of labels, must be received by the department before the replacement set of labels will be provided. A document will not be considered filed unless the proper bar code label is affixed thereto. Loss of any bar code label(s) and a request for a replacement set of labels will not excuse the late filing of any documents and appropriate penalties will be imposed for any late filings.

AUTHORITY: sections 354.120, 354.485, 354.723, 374.045 and 380.561, RSMo 2000.* This rule was previously filed as 4 CSR 190-11.180. Original rule filed Sept. 2, 1988, effective Jan. 1, 1989. Amended: Filed Jan. 3, 1990, effective May 1, 1990. Amended: Filed May 21, 1990, effective Sept. 28, 1990. Amended: Filed Oct. 31, 1990, effective March 14, 1991. Amended: Filed April 29, 1992, effective Dec. 3, 1992. Amended: Filed Aug. 4, 1992, effective May 6, 1993. Amended: Filed June 14, 1994, effective Dec. 30, 1994. Amended: Filed June 14, 2001, effective Dec. 30, 2001. *Original authority: 354.120, RSMo 1973, amended 1983, 1993, 1995; 354.485, RSMo 1983, 354.723, RSMo 1987; 374.045, RSMo 1967, amended 1993, 1995; and 380.561, RSMo 1984, amended 1993, 1995.