Multiple Employer Welfare Arrangements

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INSURERS: MULTIPLE EMPLOYER WELFARE ARRANGEMENTS (MEWA)- NOTICES AND FORMS 2011 ANNUAL/2012 QUARTERLY

Annual/Quarterly Statement Financial Filing Requirements and Instructions

The following sections contain Filing Instructions and California specific forms for you to view and download. All required documents must be submitted electronically in PDF, MS-Excel or MS-Word formats utilizing the (OASIS) Online Assistance System for Insurance Submittals. Additionally, please submit the original signature pages by the reporting deadline.

Mail to:

California Department of Insurance
Financial Analysis Division
300 South Spring Street, South Tower, 13th Floor
Los Angeles, CA 90013
Attention: Financial Records Unit - MEWA

Questions or Inquiries contact:

Financial Records
Phone:(213) 346-6423
E-mail: Financial_Records@Insurance.ca.gov

Note:Please adjust your left and right margins to zero (0) before selecting the Print button in order to see all text.

All filings must be submitted online before 12:00 midnight of the required due date. A required filing may be subject to a late fee, if submitted after the required filing due date.

View Annual/Quarterly Statement Notices

Form No.	Description	Due Date	Download Format
	Annual/Quarterly Statement Filing Requirements and Instructions Checklist; If applicable (doc - 79 kb)		Print Format: Legal size; Orientation: Portrait Note: If MS-Word-password screen pops up, please click on the [Read Only] button to open the file.
	Notice - MEWA Filing Requirements		Print Format: Letter size; Orientation: Portrait
201	Quarterly Financial Statement	01-Mar-2012	For Quarterly Statement as of December 31, 2011
		30-May-2012	For Quarterly Statement as of March 31, 2012
		29-Aug-2012	For Quarterly Statement as of June 30, 2012
		29-Nov-2012	For Quarterly Statement as of September 30, 2012
106	All MEWA Arrangement CIC 742.31(c) (fiscal year 9/30 accounting basis)	01-Mar-2012	For Arrangement as of December 31, 2011
		30-May-2012	For Arrangement as of March 31, 2012
		29-Aug-2012	For Arrangement as of June 30, 2012
		29-Nov-2012	For Arrangement as of September 31, 2012
440	Actuarial Opinion Statement Required	01-Mar-2012
220	Audited Financial Statement (CPA) Report [PERM]	15-May-2012
221	Accountants Letter of Qualifications	15-May-2012
	List of Assigned MEWA Bar Code Numbers

Company with Fiscal Year ending June 30 - Date filing CPA Report 15-Nov. & Date filing Actuarial Opinion 29-Aug. 1 of each copy

Updated Date: 5/18/2012

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