Within 90 days after the end of each calendar year, each carrier shall complete the form developed by the Commissioner by obtaining, as necessary, and entering on the form the following information: The name of each managed behavioral health care organization with which the carrier has a contract; The calendar year for which the data is reported; Total direct payments made by the carrier to each managed behavioral health care organization during the calendar year; Direct behavioral health care expenses during the calendar year; Amounts included in direct behavioral health care expenses for quality assurance or utilization management activities or treatment plan reviews; Behavioral health care administrative expenses during the calendar year; and The name, title, telephone number, and signature of the individual completing the form and the date that the form was completed.