December 1, 1999
						Bulletin Number FS-4-99

TO:	ANNUAL STATEMENT CONTACT PERSON OF ALL INSURANCE COMPANIES, FRATERNAL BENEFIT SOCIETIES, HEALTH CARE CENTERS AND LIFE INSURANCE DEPARTMENTS OF SAVINGS BANKS AUTHORIZED TO DO BUSINESS IN THE STATE OF CONNECTICUT.
	
SUBJECT:	1999 ANNUAL STATEMENT

	 Please be advised that the Connecticut Insurance Department (“Department”) has implemented electronic notification of annual statement filing instructions and that this will be the last year the Department will be sending out hard copies of Bulletin FS-4 to all licensed companies.  Beginning in the year 2000, all instructions must be obtained via the Department’s website.  Additional information and checklists for this years filing must also be obtained via the Department’s website at www.state.ct.us/cid/exam/annstate.htm. as noted below.

	Section 38a-53 of the Connecticut General Statutes requires that each of the addressed corporations shall file an Annual Statement with this Department on or before March 1, 2000 prepared in accordance with the National Association of Insurance Commissioners’ (“NAIC”) Annual Statement Instructions Handbook and following those accounting procedures and practices prescribed by the appropriate NAIC Accounting Practices and Procedures Manual.  The securities owned by each such company and society must be valued in accordance with those standards promulgated by the NAIC’s Valuation of Securities Office.

	Section 38a-53a of the Connecticut General Statutes requires that each of the addressed corporations shall file a copy of its Annual Statement and one data diskette to the NAIC’s Support Services Office.  You may use the NAIC’s Internet Filing Website as an alternative to filing a data diskette with the NAIC.  

	To obtain the appropriate filing checklist to be completed and submitted with each Annual Statement filed with this Department and the NAIC you must down load the appropriate document’s from the Department’s website for your particular company type as follows: Fraternal Societies, checklist, notes, general instructions; Health Maintenance Organizations, checklist, notes, general instructions; Limited Health Service Organizations, checklist, notes, general instructions; Life, Accident and Health Insurers, checklist, notes, general instructions; Property and Casualty Insurers, checklist,  notes, general instructions; and Title Companies,  checklist,  notes and general instructions.

	All Property & Casualty Companies authorized to write workers’ compensation in Connecticut must complete the Supplemental Statement for Workers’ Compensation Deductible Loss Information, Form 94-4-1 in accordance with Bulletin RD-18 dated April 17, 1989 and attach it to page 15 of the Annual Statement.

	If you have any questions on this or any of the enclosed documents, you may contact Frances J. O’Connor, Director of the Examination Division at (860) 297-3814 or Frances.Oconnor@po.state.ct.us.

					                          										               	   George M. Reider, Jr.
							 Insurance Commissioner 

								

FORM 94-4-1

CONNECTICUT INSURANCE DEPARTMENT
ANNUAL STATEMENT SUPPLEMENTARY STATEMENT
FOR
WORKERS’ COMPENSATION DEDUCTIBLE LOSS INFORMATION

This statement is to be completed annually by all companies licensed to write workers’ compensation in Connecticut
in accordance with Bulletin RD-18 dated April 17, 1989.  This information supplements information on page 15, line 16, workers’ compensation, of the company’s annual statement for Connecticut.

Company __________________________________________________________     Year____________________

Sum of the Deductible Portion of:

Conn. Page 15		Losses within the		Losses which exceed		      Total
       Loss____		Deductible Limit		the Deductible limit	___________Loss_________
 (1)          (2)		 (3)             (4)		  (5)             (6)			 sum          sum
									 col. (1+3+5)       col.(2+4+6)
Incurred    Paid		Incurred     Paid		Incurred      Paid		    Incurred	       Paid

______       _____               ______     ______             ______       ______              _______             _______

If the company had no workers’ compensation business on a deductible basis, write “ none” in the appropriate space.

An officer of the company must sign this form.

Officer’s Name  ______________________________________

Title                     _______________________________________

Signature             _______________________________________

Date                     _______________________________________

Telephone Number _____________________________________