Insurance Compliance Center - Pro

HI - Quarterly Net Solvency Report

2012-02-14T06:00:00Z

Tuesday, February 14, 2012

StateAbbrv: HI
Insurance Type: Health
Filing Period: Annual
State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division
Link to Filing Website: www.eagletm.com…
Contact: Daniel Cheung
Contact Email: dcheung@dcca.hawaii.gov
Contact Phone: 808-587-6735
Due by Postmark or Receive Date: Receive Date
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

MI - Report of Transaction with an Unauthorized Insurer not Recognized as Eligible (Form 0269)

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

See Checklist Link

State Form ID: 269
StateAbbrv: MI
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Office of Financial and Insurance Regulation
Link to Filing Website: www.eagletm.com…
Contact Phone: 517-636-6925
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MI - SL Agent Semi-Annual Report of Michigan Premiums and Tax (Form FIS 0270)

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

See Checklist Link

State Form ID: FIS 0270
StateAbbrv: MI
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Office of Financial and Insurance Regulation
Link to Filing Website: www.eagletm.com…
Contact Phone: 517-636-6925
Link To State Checklist Manager: www.eagletm.com…

MN - Fire Safety Surcharge (Form IG261)

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

The fire safety surcharge is effective for insurers writing homeowners, fire and commercial nonliability policy premiums.

State Form ID: IG261
StateAbbrv: MN
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

MN - Fire Safety Surcharge for Mutual Insurance Companies (Form IG262)

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

The fire safety surcharge is effective for insurers writing homeowners, fire and commercial nonliability policy premiums.

State Form ID: IG262
StateAbbrv: MN
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MN - Fire Safety Surcharge Return Payment (Form PV55 for IG261 or IG262)

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Make check payable to Minnesota Revenue and mail to:

Minnesota Revenue
Mail Station 1780
St. Paul, MN 55145-1780

State Form ID: PV55
StateAbbrv: MN
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MN - Semiannual Statement of SL Insurance (Form IG260)

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Mail to:

Minnesota Revenue
Mail Station 1780
St. Paul, MN 55145-1780

State Form ID: IG260
StateAbbrv: MN
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: nscheoeder@mnsla.com
Contact Phone: 320-679-4244
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MN - SL Return Payment (Form PV53)

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Make check payable to Minnesota Revenue and mail with Form IG260.

State Form ID: PV53
StateAbbrv: MN
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-297-1772
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Report of SL Business

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

State Form ID: DOI_SL_ANNUAL
StateAbbrv: NE
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

NE - Quarterly Report of SL Business

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

State Form ID: DOI_SL_QUARTERLY
StateAbbrv: NE
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

CA - Disclosure of Material Transactions (Form FAD26) - Excel

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Every 15th of the month, when applicable.

All required documents must be submitted online with (OASIS) Online Assistance System for Insurer Submittal. In addition, please submit a paper copy of pages containing original signatures by the reporting deadline to:

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

State Form ID: FAD26
StateAbbrv: CA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit
Link to Filing Website: www.eagletm.com…
Contact: Financial Records Unit
Contact Phone: 213-346-6423
Filing Method: Hard Copy
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

HI - Drivers Education Fund Underwriters Fee Memorandum 2002-9R

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Make checks payable to:

Department of Commerce and Consumer Affairs
P.O. Box 3614
Honolulu, HI 96811

Please annotate Drivers Ed Fee DEF.

StateAbbrv: HI
Insurance Type: PC
Filing Period: Annual
State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division
Link to Filing Website: www.eagletm.com…
Contact: Rate & Policy Branch
Contact Email: insrpaPC@dcca.hawaii.gov
Contact Phone: 808-586-2809
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

HI - Motor Vehicle Quarterly Report - Memorandum

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Quarterly Reports due 45 days following the end of the quarter. To be filed by all insurers authorized to write motor vehicle insurance in Hawaii.

StateAbbrv: HI
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division
Link to Filing Website: www.eagletm.com…
Contact: Rate & Policy Branch
Contact Email: insrpaPC@dcca.hawaii.gov
Contact Phone: 808-586-2809
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

IL - Illinois Mine Subsidence Insurance Fund

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Mail to:
Illinois Mine Subsidence Insurance Fund
P.O. Box 71915
Chicago, IL 60694-1915

State Form ID: IMSIF 08-1, 08-2, 08-2L, 08-2C, 08-R
StateAbbrv: IL
Insurance Type: PC
Filing Period: Qtr 4
Link to State Form: .
State Authority: Illinois Mine Subsidence Insurance Fund
Link to Filing Website: www.eagletm.com…
Contact Email: hmweber@imsif.com
Contact Phone: 312-819-0060 Ext. 252
Due by Postmark or Receive Date: Receive
Filing Method: Electronic, Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

NY - Motor Vehicle Law Enforcement Fee (MVLEF)

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Check for amount due should accompany return and be made payable to the Superintendent of Financial Services.

Returns to be mailed to:

Superintendent of Financial Services
New York State Department of Financial Services
Attn: Taxes & Accounts
One Commerce Plaza
Albany, New York 12257

Insurers may file and remit fees on-line through the Department website.

StateAbbrv: NY
Insurance Type: PC
Filing Period: Monthly
Link to State Form: www.eagletm.com…
State Authority: New York State Department of Financial Services
Link to Filing Website: www.eagletm.com…
Contact Email: billing@dfs.ny.gov
Contact Phone: billing@ins.state.ny.us
Due by Postmark or Receive Date: Receive Date
Link To State Checklist Manager: www.eagletm.com…

NY - PC Insurance Security Fund Quarterly Report

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Returns to be mailed to:

Superintendent of Financial Services
New York State Department of Financial Services
Bureau of Taxes and Accounts
One Commerce Plaza
Albany, New York 12257

StateAbbrv: NY
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: New York State Department of Financial Services
Link to Filing Website: www.eagletm.com…
Contact: Mark Daigneault
Contact Email: billing@dfs.ny.gov
Filing Method: Hard Copy
Link To State Checklist Manager: www.eagletm.com…

NY - WC Security Fund Quarterly Report

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

A check made payable to the Superintendent of Financial Services for the Workers' Compensation Security Fund of the State of New York should accompany this return and be forwarded to the Superintendent of Financial Services at the following address:

Superintendent of Financial Services
State of New York Insurance Department of Financial Services
Bureau of Taxes and Accounts
One Commerce Plaza
Albany, New York 12257

State Form ID: TA-1
StateAbbrv: NY
Insurance Type: Workers Compensation
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: New York State Department of Financial Services
Link to Filing Website: www.eagletm.com…
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

OR - Health Enrollment Report Form

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

This report is to be filed on a quarterly basis.

Direct all inquiries to:
Carla Wagner
Department of Consumer & Business Services
Market Surveillance-7
PO Box 14480
Salem,OR 97309-0405

StateAbbrv: OR
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Oregon Department of Consumer and Business Services, Insurance Division
Link to Filing Website: www.eagletm.com…
Contact: Carla Wagner
Contact Phone: 503-947-7268
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Link To State Checklist Manager: www.eagletm.com…

OR - Health Premium Assessment Report

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

The Health Premium Assessment Report must be filed on-line with the Oregon Insurance Division within 45 days after the end of every calendar quarter. This is a new assessment that became effective 10/1/2009 and applies to all insurers authorized in Oregon for health insurance.

StateAbbrv: OR
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Oregon Department of Consumer and Business Services, Insurance Division
Link to Filing Website: www.eagletm.com…
Contact: Lynette Hadley, Shannon O'Shea
Contact Email: OrInstax@state.or.us
Contact Phone: 503-947-7046, 503-947-7218
Due by Postmark or Receive Date: Postmark
Filing Method: Electronic
Link To State Checklist Manager: www.eagletm.com…

OR - WC Premium Assessment Report

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

File Form 440-910 and the premium assessment payment with:

DCBS Fiscal and Business Services
P.O. Box 14610
Salem, OR 97309-0445

State Form ID: 440-910
StateAbbrv: OR
Insurance Type: Workers Compensation
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Oregon Department of Consumer and Business Services, Workers' Compensation Division
Link to Filing Website: www.eagletm.com…
Contact: Premium Assessment Senior Accountant
Contact Email: wbfassess.fabs@state.or.us
Contact Phone: 503-947-7941
Due by Postmark or Receive Date: Postmark
Link To State Checklist Manager: www.eagletm.com…

SD - Risk Pool Report of Covered Lives

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Return to:
Division of Insurance
445 E. Capitol Avenue
Pierre, SD 57501
OR
Fax: 605-773-5369 or email Melissa.klemann@state.sd.us.

OR email: tammy.johnson@state.sd.us

OR fax: 605-773-5369

DO NOT send a payment with this form.

StateAbbrv: SD
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: .
State Authority: South Dakota Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Tammy Johnson
Contact Email: sdinsurancereports@state.sd.us
Contact Phone: 605-773-3563
Filing Method: Electronic, Hard Copy
Link To State Checklist Manager: www.eagletm.com…

TX - Call for Fourth Quarter WC Experience Bulletin Form

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

How to file:
PDF Format
Hardcopy filings no longer accepted.

StateAbbrv: TX
Insurance Type: PC, Reinsurance, Workers Compensation
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Texas Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ChiefClerk@tdi.state.tx.us
Contact Phone: 512-475-3030
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

UT - Renewal Instructions - RRG

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

You must pay your renewal fees electronically through the department's secure payment portal using either a credit card or an electronic check.

Please email your completed Risk Retention Group renewal documents and a copy of your annual premium tax report to Brad Tibbots at btibbits@utah.gov.

StateAbbrv: UT
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Utah Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Brad Tibbitts
Contact Email: btibbitts@utah.gov
Contact Phone: 801-537-9177
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Payment Method: You must pay your renewal fees electronically through the department's secure payment portal using either a credit card or an electronic check.
Link To State Checklist Manager: www.eagletm.com…

UT - Renewal Instructions - SL

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

Renewal fees must be paid electronically. Alien insurers only - Please email the date your annual statement is required to be filed by your domiciliary authority to Beth Crim at bcrim@utah.gov.

StateAbbrv: UT
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: .
State Authority: Utah Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Beth Crim
Contact Email: bcrim@utah.gov
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Link To State Checklist Manager: www.eagletm.com…

WI - Annual Actuarial Filing Request

2012-02-15T06:00:00Z

Wednesday, February 15, 2012

StateAbbrv: WI
Insurance Type: Health, LAH
Filing Period: Annual
State Authority: Wisconsin Office of the Commissioner of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Yvonne Sherry
Contact Email: yvonne.sherry@wisconsin.gov
Contact Phone: 608-266-0091
Due by Postmark or Receive Date: Receive
Filing Method: Hard Copy
Link To State Checklist Manager: www.eagletm.com…

GU - Monthly Gross Receipts Use and Occupancy Tax Return (Form GRT-1)

2012-02-20T06:00:00Z

Monday, February 20, 2012

The monthly return shall be filed and any tax then due shall be paid no later than the twentieth day of the following month.

You may file your GRT form by mail at the following address:

Department of Revenue and Taxation
Taxpayer Services Division
P.O. Box 23607 GMF, Guam 96921

Express Mail or In Person:

Guam Department of Revenue and Taxation
Business Privilege Tax Branch
1240 Route 16
Barrigada, Guam

StateAbbrv: GU
Filing Period: Monthly
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Revenue and Taxation
Link to Filing Website: www.eagletm.com…
Contact Email: grt@revtax.gov.gu
Contact Phone: 671-635-1835/6
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.guamtax.com…

HI - Premium Tax Statement - Monthly (Form 323)

2012-02-20T06:00:00Z

Monday, February 20, 2012

See Checklist Link

State Form ID: Form 323
StateAbbrv: HI
Insurance Type: Health, LAH, PC
Filing Period: Monthly
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Hawaii Department of Commerce and Consumer Affairs, Insurance Division
Link to Filing Website: www.eagletm.com…
Contact Email: shansen@dcca.hawaii.gov
Contact Phone: 808-586-7381
Due by Postmark or Receive Date: Postmark
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

KY - Monthly Insurance Surcharge Report - Domestic Mutual Cooperative and Assessment Fire (Form 74A117)

2012-02-20T06:00:00Z

Monday, February 20, 2012

Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address:Kentucky Department of Revenue 501 High Street Frankfort, KY 40601

State Form ID: 74A117
StateAbbrv: KY
Insurance Type: PC
Filing Period: Monthly
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Commonwealth of Kentucky, Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Phone: 502-564-4810
Due by Postmark or Receive Date: Receive
Payment Method: Check
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

KY - Monthly Insurance Surcharge Report (Form 74A118)

2012-02-20T06:00:00Z

Monday, February 20, 2012

Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address:Kentucky Department of Revenue 501 High Street Frankfort, KY 40601

State Form ID: 74A118
StateAbbrv: KY
Insurance Type: PC
Filing Period: Monthly
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Commonwealth of Kentucky, Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Phone: 502-564-4810
Due by Postmark or Receive Date: Receive
Payment Method: Check
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

VT - Insurance Premium Tax Return - Captive (Form IP-2)

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

If sending via US Mail:

VT Department of Taxes
PO Box 547
Montpelier, VT 05601-0547

If sending via courier service:

VT Department of Taxes
133 State Street
Montpelier, VT 05633-1401

State Form ID: IP-2
StateAbbrv: VT
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Vermont Department of Taxes
Link to Filing Website: www.eagletm.com…
Contact Phone: 802-828-2551 Option 4
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

VT - Insurance Premium Tax Return (Form IP-1)

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

State Form ID: IP-1
StateAbbrv: VT
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Vermont Department of Taxes
Link to Filing Website: www.eagletm.com…
Contact Phone: 802-828-2551 Option 4
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

WV - Statement of Premiums - RPG

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

Mailing Address:

P.O. Box 50542
Charleston, WV 25305-0542

StateAbbrv: WV
Insurance Type: Risk Purchasing Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: West Virginia Insurance Commissioner
Link to Filing Website: www.eagletm.com…
Contact Email: wvtaxsection@wvinsurance.gov
Contact Phone: 304-558-2100
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - Accredited Reinsurer Renewal Information

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

Submit application to:

Arkansas Insurance Department

Finance Division

1200 West Third Street

Little Rock, AR 72201-1904

StateAbbrv: AR
Insurance Type: Reinsurance
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact Phone: 501-371-2665
Filing Method: Hard Copy
Link To State Checklist Manager: www.eagletm.com…

AR - Trusteed Reinsurer Renewal Information

2012-02-28T06:00:00Z

AZ - Qualified Reinsurer Annual Statement Worksheet (Form E-QRT.AS)

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

Your Qualified Reinsurer status may be suspended or terminated if you do not comply with financial statement filing requirements.

State Form ID: E-QRT.AS
StateAbbrv: AZ
Insurance Type: Reinsurance
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Insurance Tax Unit - Compliance Section
Link to Filing Website: www.eagletm.com…
Contact: Compliance Section
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

FL - Premium Growth Report (Form OIR-A1-1229)

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

State Form ID: OIR-A1-1229
StateAbbrv: FL
Insurance Type: PC
Filing Period: Monthly
Link to State Form: www.eagletm.com…
State Authority: Florida Office of Insurance Regulation
Link to Filing Website: www.eagletm.com…
Contact: Helen Westberry
Contact Email: Helen.Westberry@floir.com
Contact Phone: 850-413-5212
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

ID - Continuation Fee Statement - Trusteed Reinsurer

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

State Form ID: INS-PTX-FTRST
StateAbbrv: ID
Insurance Type: Reinsurance
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Idaho Department of Insurance
Link to Filing Website: www.eagletm.com…
Filing Method: Hard Copy
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

VT - Domestic RRG and Association Captives Checklist

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

StateAbbrv: VT
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Vermont Insurance Division - Department of Banking, Insurance, Securities and Health Care Administration
Link to Filing Website: www.eagletm.com…
Contact: Company Licensing Section
Contact Email: bishca.complic@state.vt.us
Contact Phone: 802-828-3304
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

VT - Foreign RRG and RPG Checklist

2012-02-28T06:00:00Z

Tuesday, February 28, 2012

StateAbbrv: VT
Insurance Type: Risk Purchasing Group, Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Vermont Insurance Division - Department of Banking, Insurance, Securities and Health Care Administration
Link to Filing Website: www.eagletm.com…
Contact: Company Licensing Section
Contact Email: bishca.complic@state.vt.us
Contact Phone: 802-828-3301
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

NAIC - Actuarial Opinion on Non-guaranteed Elements

2012-03-01T06:00:00Z

Thursday, March 1, 2012

As required in interrogatory #3 to Exhibit 5

Insurance Type: LAH
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Statement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Actuarial Opinion on Participating & Non-Participating Policies

2012-03-01T06:00:00Z

Thursday, March 1, 2012

As required in the instructions for Exhibit 5, Interrogatories #1 & #2

Insurance Type: LAH
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Annual Statement Filing

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Insurance Type: Health, LAH, PC
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Statement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Annual Statement Filing Fee

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The filing fee should be submitted in the envelope provided to each company as part of the Participation Packet Notification that is mailed to the company each year in December. Do not mail your filing fee with your Annual Statement mailing. Your cocode should be included on your check.
Mail to:
NAIC
Attn: Database Filing Fees
P. O. Box 87-9135
Kansas City, MO 64187-9135

Insurance Type: Health, LAH, PC
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Fee
Filing Method: Hard Copy
NAIC Contacts: Accounts Receivalbe, NAIC Accounting 816-783-8089 or AcctgRec@naic.org
Link to Filing Website: www.naic.org…

NAIC - Financial Guaranty Insurance Exhibit

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If applicable

Insurance Type: PC
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Life Supplement

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If applicable

Insurance Type: Health
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Medicare Part D Coverage Supplement

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Insurance Type: Health, LAH, PC
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Medicare Supplement Insurance Experience Exhibit

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If applicable

Insurance Type: Health, LAH, PC
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Premiums Attributed to Protected Cells Exhibit

2012-03-01T06:00:00Z

NAIC - Property & Casualty Supplement

2012-03-01T06:00:00Z

NAIC - Reinsurance Attestation Supplement

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Insurance Type: PC
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Reinsurance Summary Supplemental Filing for General Interrogatory 9

2012-03-01T06:00:00Z

NAIC - Risk-Based Capital Report

2012-03-01T06:00:00Z

NAIC - Separate Accounts Statement Filing

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If applicable

Insurance Type: LAH
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Statement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Statement of Actuarial Opinion

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Insurance Type: Health, LAH, PC
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Supplement A to Schedule T (Medical Malpractice Supplement)

2012-03-01T06:00:00Z

NAIC - Supplemental Schedule O

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If applicable

Insurance Type: LAH
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Trusteed Surplus Statement

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If applicable

Insurance Type: LAH, PC
Filing Period: Annual
Due by Postmark or Receive Date: Receive Date
Filing Type: Supplement
Filing Method: Electronic
NAIC Contacts: www.naic.org…
Link to Filing Website: www.naic.org…

NAIC - Workers’ Compensation Carve-Out Supplement

2012-03-01T06:00:00Z

AK - Annual Premium Tax Payment

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If the annual premium tax payment is not received in the State of Alaska's bank on or before March 1, a late fee will be assessed. If payment is not received by ACH, a penalty will be assessed.

StateAbbrv: AK
Insurance Type: Health, LAH, PC
Filing Period: Annual
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Filing Method: Electronic
Payment Method: ACH
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AK - Health Annual Premium Tax Report (Form 08-201H)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Reminder: State Page and Schedule T - One copy of each to be filed with Annual Premium Tax Report.

First Class Mail (including Registered and Certified):
Alaska Division of Insurance
P.O. Box 110805
Juneau, AK 99811-0805

State Form ID: 08-201H
StateAbbrv: AK
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Color: Blue
Link To State Checklist Manager: www.eagletm.com…

AK - HMSC Annual Premium Tax Report - Domestic (Form 08-201D)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

First Class Delivery:
Alaska Division of Insurance
PO Box 110805
Juneau, AK 99811

State Form ID: 08-201D
StateAbbrv: AK
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic
Paper Color: Blue
Link To State Checklist Manager: www.eagletm.com…

AK - HMSC Annual Premium Tax Report (Form 08-201HM)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

First Class Mail: (including Registered and Certified)
Alaska Division of Insurance
P.O. Box 110805
Juneau, AK 99811-0805

State Form ID: 08-201HM
StateAbbrv: AK
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Color: Blue
Link To State Checklist Manager: www.eagletm.com…

AK - LAH Annual Premium Tax Report (Form 08-201L)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Reminder: State Page and Schedule T - One copy of each to be filed with Annual Premium Tax Report.

First Class Mail (including Registered and Certified):
Alaska Division of Insurance
P.O. Box 110805
Juneau, AK 99811-0805

State Form ID: 08-201L
StateAbbrv: AK
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

AK - PC Annual Premium Tax Report - Domestic (Form 08-200D)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

First Class Delivery:
Alaska Division of Insurance
PO Box 110805
Juneau, AK 99811

State Form ID: 08-200D INS
StateAbbrv: AK
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

AK - PC Annual Premium Tax Report (Form 08-200)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Reminder: State Page and Schedule T - One copy of each to be filed with Annual Premium Tax Report.

First Class Mail (including Registered and Certified):
Alaska Division of Insurance
P.O. Box 110805
Juneau, AK 99811-0805

State Form ID: 08-200 INS
StateAbbrv: AK
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

AK - RRG Tax Packet (Form 08-203RRG)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

First Class Mail: (including Registered and Certified)
Alaska Division of Insurance
P.O. Box 110805
Juneau, AK 99811-0805

State Form ID: 08-203RRG
StateAbbrv: AK
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

AK - Unauthorized Insurers Tax Form (Form 08-1240)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

First Class Mail: (including Registered and Certified)
Alaska Division of Insurance
P.O. Box 110805
Juneau, AK 99811-0805

State Form ID: 08-1240
StateAbbrv: AK
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Audit & Exam Transmittal Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All Companies licensed in the State of Alabama must pay the Annual Audit and Examination Fee of $850.00.
The only exceptions are Mutual Aid Associations, Fraternal Benefits societies, and HMOs. The Fee for Mutual Aids and Fraternals is $225 and the fee for HMOs is $300.
Surplus line insurers doing business in Alabama must pay the Annual Audit and Examination Fee of $850.

Postal Service:
Alabama Department of Insurance
c/o Compass Bank
P.O. Box 830707
Birmingham, AL 35283-0707

State Form ID: PR
StateAbbrv: AL
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Payment Method: Check payable to : Alabama Department of Insurance
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Captive Insurer Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AL
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Credit Allocation Worksheet

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Each company taking a percentage of the credit must attach this form to its annual premium tax return.

StateAbbrv: AL
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Documentation for Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All premium tax credits/deductions taken on the annual premium tax return should be documented with copies of cancelled checks and privilege tax returns (1st page only), ad valorem tax notices, guaranty fund and Alabama Health Insurance Plan assessment notices, invoices.

Premiums which are taxed at less than the maximum should be documented with detailed policy runs. Documentation should be emailed to premiumtax@insurance.alabama.gov. The subject line of the email must have the name of the company and the year.

StateAbbrv: AL
Insurance Type: Health, LAH, PC
Filing Period: Annual
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Domestic HMO Annual

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Postal Service:

Alabama Department of Insurance
c/o Compass Bank
P.O. Box 830691
Birmingham, AL 35283-0691

State Form ID: PA-G
StateAbbrv: AL
Insurance Type: Health, HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.aldoi.gov…

AL - Domestic LAH Annual

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All premium tax credits/deductions taken on the annual premium tax return should be documented with copies of cancelled checks and privilege tax returns (1st page only), ad valorem tax notices, guaranty fund and Alabama Health Insurance Plan assessment notices, invoices.

Premiums which are taxed at less than the maximum should be documented with detailed policy runs. Documentation should be emailed to premiumtax@insurance.alabama.gov. The subject line of the email must have the name of the company and the year.

State Form ID: PA-B
StateAbbrv: AL
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.aldoi.gov…

AL - Domestic PC Annual

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All premium tax credits/deductions taken on the annual premium tax return should be documented with copies of cancelled checks and privilege tax returns (1st page only), ad valorem tax notices, guaranty fund and Alabama Health Insurance Plan assessment notices, invoices.

Premiums which are taxed at less than the maximum should be documented with detailed policy runs. Documentation should be emailed to premiumtax@insurance.alabama.gov. The subject line of the email must have the name of the company and the year.

State Form ID: PB-Y
StateAbbrv: AL
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.aldoi.gov…

AL - Foreign Casualty Annual

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All premium tax credits/deductions taken on the annual premium tax return should be documented with copies of cancelled checks and privilege tax returns (1st page only), ad valorem tax notices, guaranty fund and Alabama Health Insurance Plan assessment notices, invoices.

Premiums which are taxed at less than the maximum should be documented with detailed policy runs. Documentation should be emailed to premiumtax@insurance.alabama.gov. The subject line of the email must have the name of the company and the year.

State Form ID: PF-Y
StateAbbrv: AL
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.aldoi.gov…

AL - Foreign HMO Annual

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Postal Service:

Alabama Department of Insurance
c/o Compass Bank
P.O. Box 830691
Birmingham, AL 35283-0691

State Form ID: PD-G
StateAbbrv: AL
Insurance Type: Health, HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.aldoi.gov…

AL - Foreign LAH Annual

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All premium tax credits/deductions taken on the annual premium tax return should be documented with copies of cancelled checks and privilege tax returns (1st page only), ad valorem tax notices, guaranty fund and Alabama Health Insurance Plan assessment notices, invoices.

Premiums which are taxed at less than the maximum should be documented with detailed policy runs. Documentation should be emailed to premiumtax@insurance.alabama.gov. The subject line of the email must have the name of the company and the year.

State Form ID: PD-B
StateAbbrv: AL
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.aldoi.gov…

AL - Foreign Property Annual

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All premium tax credits/deductions taken on the annual premium tax return should be documented with copies of cancelled checks and privilege tax returns (1st page only), ad valorem tax notices, guaranty fund and Alabama Health Insurance Plan assessment notices, invoices.

Premiums which are taxed at less than the maximum should be documented with detailed policy runs. Documentation should be emailed to premiumtax@insurance.alabama.gov. The subject line of the email must have the name of the company and the year.

State Form ID: PE-Y
StateAbbrv: AL
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.aldoi.gov…

AL - Offices Facilities Credit Worksheet

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The worksheet should be filed only if credit is taken.

StateAbbrv: AL
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Retaliatory Tax Statement

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Postal Service:

Alabama Department of Insurance
c/o Compass Bank
P.O. Box 830691
Birmingham, AL 35283-0691

State Form ID: PG
StateAbbrv: AL
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Risk Retention Companies Annual

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Postal Service:

Alabama Department of Insurance
c/o Compass Bank
P.O. Box 830691
Birmingham, AL 35283-0691

State Form ID: RR-W
StateAbbrv: AL
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.aldoi.gov…

AR - Annual Continuation Filing Fee - Approved Foreign SL Insurers (Form AID AC SLI-T)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC SLI-T
StateAbbrv: AR
Insurance Type: PC, Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Payment Method: Check payable to: The State Insurance Department Trust Fund
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Annual Report of Premiums and Taxes - Captive (Form AID AC CI-T)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

DO NOT include Corporate Franchise Tax with the premium tax filings.

Mail the return, documentation, and check to:
Arkansas Insurance Department
Accounting Division
1200 West Third Street
Little Rock, AR 72201-1904

State Form ID: AID AC CI-T
StateAbbrv: AR
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…(Form_AID_AC_CI-T).pdf&TableName=ICC
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Accounting Division
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Payment Method: Check payable to State Treasurer of Arkansas
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - Annual Report of Premiums and Taxes - FPRF (Form AID AC FPRF)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC FPRF
StateAbbrv: AR
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Payment Method: Check payable to: The Fire Protection Premium Tax Fund
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Annual Report of Premiums Copayments Taxes and Fees - HMO (Form AID AC HMO-T)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC HMO-T, IC-PT
StateAbbrv: AR
Insurance Type: Health, HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Payment Method: CHECK PAYABLE TO: THE STATE TREASURER
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Annual Report of Premiums Copayments Taxes and Fees - HMSC (Form AID AC HM-T)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC HM-T
StateAbbrv: AR
Insurance Type: Health
Filing Period: Annual, Qtr 4
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Payment Method: CHECK PAYABLE TO: THE STATE TREASURER
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Annual Report of Premiums Taxes and Fees - Domestic LAH (Form AID AC LD-TD)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC LD-T(D)
StateAbbrv: AR
Insurance Type: Health, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Payment Method: Check payable to: The State Treasurer of the State of Arkansas
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Annual Report of Premiums Taxes and Fees - Domestic PC (Form AID AC PC-TD)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC PC-T(D)
StateAbbrv: AR
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Annual Report of Premiums Taxes and Fees - Foreign LAH (AID AC LD-T)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC LD-T
StateAbbrv: AR
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: 8 1/2 x 11
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Annual Report of Premiums Taxes and Fees - Foreign PC (Form AID AC PC-T)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC PC-T
StateAbbrv: AR
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Payment Method: Check payable to: The State Insurance Department Trust Fund
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Annual Report of Premiums Taxes and Fees - Registered RRG (Form AID AC RRG-T)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: AID AC RRG-T
StateAbbrv: AR
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Insurance Department, Accounting Division
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.accounting@arkansas.gov
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive
Payment Method: CHECK PAYABLE TO: THE STATE TREASURER
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: EFT Login Menu: www.insurance.arkansas.gov…

AR - Insurance Carrier Worksheet for WC Premium Taxes

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AR
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arkansas Workers' Compensation Commission
Link to Filing Website: www.eagletm.com…
Contact Email: lcampbell@awcc.state.ar.us or agarmon@awcc.state.ar.us
Contact Phone: 501-682-2737 or 501-682-1494
Due by Postmark or Receive Date: Receive
Payment Method: Checks payable to: Arkansas Workers' Compensation Commission
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Accountable Health Plan Small Group Premiums (Form E-AHP)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Only file this schedule if you are approved in Arizona as an accountable health plan and are claiming a small group premium exemption on Annual Tax and Fees Report.

If you are filing your premium tax report electronically, attach the completed spreadsheet to your OPTins filing. If you file a hard copy tax report, provide this spreadsheet on a CD-ROM labeled with your name and NAIC number, or call us for e-mail instructions.

State Form ID: E-AHP
StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.id.state.az.us…

AZ - Annual Fees Report (Form E-ANNUALFEES)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make your check payable to Arizona Insurance Tax Unit, print your NAIC number in the memo section. Do not mail this form or payment with your annual statement.

State Form ID: E-ANNUALFEES
StateAbbrv: AZ
Insurance Type: Reinsurance
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.id.state.az.us…

AZ - Annual Tax and Fees Report - Health Organization (Form E-HEALTHORG)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not mail this form or your payment inside your Annual Statement package. Mail your check with this report separately to:

Arizona Insurance Tax Unit
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

State Form ID: E-HEALTHORG
StateAbbrv: AZ
Insurance Type: Health
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.id.state.az.us…

AZ - Annual Tax and Fees Report - Life and Disability (Form E-LD)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not mail this form or your payment inside your Annual Statement package. Mail your check with this report separately to:

Arizona Insurance Tax Unit
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

State Form ID: E-LD
StateAbbrv: AZ
Insurance Type: LAH
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.id.state.az.us…

AZ - Annual Tax and Fees Report - PC (Form E-PC)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not mail this form or your payment inside your Annual Statement package. Mail your check with this report separately to:

Arizona Insurance Tax Unit
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

State Form ID: E-PC
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.id.state.az.us…

AZ - Annual Tax Report - Foreign RRG (Form E-RG)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not mail this form or your payment inside your Annual Statement package. Mail your check with this report separately to:

Arizona Insurance Tax Unit
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

State Form ID: E-RG
StateAbbrv: AZ
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - HMDO Exempt Government Premiums (Form E-HEALTHORG.HMDO)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: E-HEALTHORG.HMDO
StateAbbrv: AZ
Insurance Type: Health
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - ICA Administrative and Special Funds Premium Tax Form (Form 200)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Please return completed form with a copy of "Statutory Page 14 - Exhibit of Premiums and Losses of the Annual Report" with your check, payable to the Industrial Commission of Arizona, and mail to:

Industrial Commission of Arizona
Attention: Tax Accountant
800 West Washington Street, Room 301
Phoenix, AZ 85007

State Form ID: 200
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…(Form_200).pdf&TableName=ICC
Tax Filing Requirements: www.eagletm.com…
State Authority: Industrial Commission of Arizona
Link to Filing Website: www.eagletm.com…
Contact Email: taxes@ica.state.az.us
Contact Phone: 602-542-1836
Due by Postmark or Receive Date: Postmark
Payment Method: Check made payable to Industrial Commission of Arizona
Link To State Checklist Manager: www.eagletm.com…

AZ - ICA Administrative Fund Premium Tax Form (Form 200B)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail completed form to:

Industrial Commission of Arizona
Attention: Tax Accountant
800 West Washington Street, Room 301
Phoenix, Arizona 85007

State Form ID: 200B
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Industrial Commission of Arizona
Link to Filing Website: www.eagletm.com…
Contact Email: Taxes@ica.state.az.us
Contact Phone: 602-542-1836
Due by Postmark or Receive Date: Postmark
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Carrier Letter: www.ica.state.az.us…, Instructions: www.ica.state.az.us…

AZ - ICA Special Fund Premium Tax Form (Form 200A)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail completed form to:

Industrial Commission of Arizona
Attention: Tax Accountant
800 West Washington Street, Room 301
Phoenix, Arizona 85007

State Form ID: 200A
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Industrial Commission of Arizona
Link to Filing Website: www.eagletm.com…
Contact Email: Taxes@ica.state.az.us
Contact Phone: 602-542-1836
Due by Postmark or Receive Date: Postmark
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Carrier Letter: www.ica.state.az.us…, Instructions: www.ica.state.az.us…

AZ - Local and Regional Taxes and Fees Payments - Domestic Insurers (Form E-LRTF)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Arizona requires each domestic insurer to complete a Survey of Arizona Domestic Insurers as part of its Annual Premium Tax and Fees Report.

You must provide all completed survey documents and spreadsheets electronically, either as attachments to an OPTins filing or on a CD-ROM.

State Form ID: E-LRTF
StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Arizona Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Phone: 602-364-3764
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AZ - SL Claim for Refund (Form E-173SLB)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

This form must be filed with a Form E-SL-1, Form E-SL-2, Form E-SL-AMEND or Form E-159MS tax report that shows a negative tax amount due to claim a tax refund for a prior period.

State Form ID: E-173SLB
StateAbbrv: AZ
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: The Surplus Line Association of Arizona
Link to Filing Website: www.eagletm.com…
Contact Phone: 602-364-3246
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.sla-az.org…

AZ - SL Semi-Annual Tax Report

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Log in to the Surplus Lines Association of Arizona web site to print your tax report.

State Form ID: E-SL-2
StateAbbrv: AZ
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: The Surplus Line Association of Arizona
Link to Filing Website: www.eagletm.com…
Contact Phone: 602-364-3246
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.sla-az.org…

AZ - Statement and Tax Payment for the AZ Portion of a Multi State SL Transaction (Form E-159MS)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The tax payment must be payable to the Arizona Insurance Tax Unit and must accompany the report Form E-159MS. Do not send checks and reports separately.

State Form ID: E-159MS
StateAbbrv: AZ
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.sla-az.org…

AZ - Survey of Arizona Domestic Insurers

2012-03-01T06:00:00Z

Thursday, March 1, 2012

This survey is required to be filed with your Annual Premium Tax and Fees Report Form.

State Form ID: E-SURVEY
StateAbbrv: AZ
Insurance Type: LAH, PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Arizona, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: sgreenberg@azinsurance.gov
Contact Phone: 602-364-3997
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.id.state.az.us…

CO - Premium Taxes Homepage

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: CO
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Colorado Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: copremiumtax@dora.state.co.us
Due by Postmark or Receive Date: Receive Date
Filing Method: Electronic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.dora.state.co.us…

CT - Application for Extension of Time to File - Domestic or HCC Tax Return (Form 207-207 HCC EXT)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this return in blue or black ink only. Make check payable to: Commissioner of Revenue Services. Mail to:

Department of Revenue Services
State of Connecticut
PO Box 2990
Hartford, CT 06104-2990

State Form ID: 207-207 HCC EXT
StateAbbrv: CT
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Revenue Services, State of Connecticut
Link to Filing Website: www.eagletm.com…
Contact Phone: 860-297-5962
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

CT - Application for Extension of Time to File - Nonresident and Foreign Tax Return (Form 207F EXT)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this return in blue or black ink only. Complete this return in blue or black ink only. Make checks payable to: Commissioner of Revenue Services. Mail to:

Department of Revenue Services
State of Connecticut
PO Box 2990
Hartford, CT 06104-2990

State Form ID: 207F EXT
StateAbbrv: CT
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Revenue Services, State of Connecticut
Link to Filing Website: www.eagletm.com…
Contact Phone: 860-297-5962
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

CT - HCC Tax Return (Form 207 HCC)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this return in blue or black ink only. Make checks payable to: Commissioner of Revenue Services. Mail to:

Department of Revenue Services
State of Connecticut
PO Box 2990
Hartford, CT 06104-2990

State Form ID: 207 HCC
StateAbbrv: CT
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Revenue Services, State of Connecticut
Link to Filing Website: www.eagletm.com…
Contact Phone: 860-297-5962
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

CT - Insurance Premiums Tax Return - Domestic (Form 207)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this return in blue or black ink only. Make checks payable to: Commissioner of Revenue Services. Mail to:

Department of Revenue Services
State of Connecticut
PO Box 2990
Hartford, CT 06104-2990

State Form ID: Form 207
StateAbbrv: CT
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Revenue Services, State of Connecticut
Link to Filing Website: www.eagletm.com…
Contact Phone: 860-297-5962
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

CT - Insurance Premiums Tax Return - Nonresident and Foreign (Form 207F)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this return in blue or black ink only. Make checks payable to: Commissioner of Revenue Services. Mail to:

Department of Revenue Services
State of Connecticut
PO Box 2990
Hartford, CT 06104-2990

State Form ID: Form 207F
StateAbbrv: CT
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Revenue Services, State of Connecticut
Link to Filing Website: www.eagletm.com…
Contact Phone: 860-297-5962
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

CT - Premium Tax Return - Tax on Premiums Charged by Unauthorized Insurers (Form 115A)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this return in blue or black ink only. Make checks payable to: Commissioner of Revenue Services. Mail to:
Department of Revenue Services
State of Connecticut
PO Box 2990
Hartford, CT 06104-2990

State Form ID: 115A
StateAbbrv: CT
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Revenue Services, State of Connecticut
Link to Filing Website: www.eagletm.com…
Contact Phone: 860-297-5962
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

CT - Underpayment of Estimated Premiums Tax or HCC Tax (Form 207I)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this form in blue or black ink only.

Attach the completed Form 207I to:

Form 207;
Form 207F; or
Form 207 HCC

If the tax shown on the return for the current year is less than $1,000, it is not necessary to complete this form.

State Form ID: Form 207I
StateAbbrv: CT
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Revenue Services, State of Connecticut
Link to Filing Website: www.eagletm.com…
Contact Phone: 860-297-5962
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

DC - HMO Insurance Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Premium tax checks should be made payable to the D.C. Treasurer. Please send all premium tax checks and tax documents to the following (LOCKBOX) address:

D.C. Treasurer
Insurance Bureau
Lockbox 92180
Washington, D.C. 20090-2180

State Form ID: IA 23
StateAbbrv: DC
Insurance Type: HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Insurance, Securities and Banking - Insurance Bureau
Link to Filing Website: www.eagletm.com…
Contact Email: julia.may@dc.gov
Contact Phone: 202-727-8000, 202-442-7786
Due by Postmark or Receive Date: Postmark
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: disb.dc.gov…

DC - LAH Guaranty Fund Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

This form must be completed and filed with the Insurance Tax Return by all companies taking Life and Health Guaranty Fund tax credits. These include Life and Health companies and Property and Casualty companies that write Life and Health business.

State Form ID: IA 29
StateAbbrv: DC
Insurance Type: LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Insurance, Securities and Banking - Insurance Bureau
Link to Filing Website: www.eagletm.com…
Contact Email: julia.may@dc.gov
Contact Phone: 202-727-8000, 202-442-7786
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: disb.dc.gov…

DC - LAH Insurance Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Premium tax checks should be made payable to the D.C. Treasurer. Please send all premium tax checks and tax documents to the following (LOCKBOX) address:

D.C. Treasurer
Insurance Bureau
Lockbox 92180
Washington, D.C. 20090-2180

State Form ID: IA 23
StateAbbrv: DC
Insurance Type: Health, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Insurance, Securities and Banking - Insurance Bureau
Link to Filing Website: www.eagletm.com…
Contact Email: julia.may@dc.gov
Contact Phone: 202-727-8000, 202-442-7786
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: disb.dc.gov…

DC - PC Insurance Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Premium tax checks should be made payable to the D.C. Treasurer. Please send all premium tax checks and tax documents to the following (LOCKBOX) address:

D.C. Treasurer
Insurance Bureau
Lockbox 92180
Washington, D.C. 20090-2180

State Form ID: IA 23
StateAbbrv: DC
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Insurance, Securities and Banking - Insurance Bureau
Link to Filing Website: www.eagletm.com…
Contact Email: julia.may@dc.gov
Contact Phone: 202-727-8000, 202-442-7786
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: disb.dc.gov…

DC - RRG Insurance Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Premium tax checks should be made payable to the D.C. Treasurer. Please send all premium tax checks and tax documents to the following (LOCKBOX) address:

D.C. Treasurer
Insurance Bureau
Lockbox 92180
Washington, D.C. 20090-2180

State Form ID: IA 23
StateAbbrv: DC
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Department of Insurance, Securities and Banking - Insurance Bureau
Link to Filing Website: www.eagletm.com…
Contact Email: julia.may@dc.gov
Contact Phone: 202-727-8000, 202-442-7786
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: disb.dc.gov…

DE - Annual Tax and Fees Report - Captive

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail completed tax form, payment and required attachments to the following address:

Delaware Department of Insurance
ATTN: Premium Tax Section
841 Silver Lake Blvd.
Dover, DE 19904-2465

StateAbbrv: DE
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Delaware Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.fletcher@state.de.us
Contact Phone: 302-674-7383
Due by Postmark or Receive Date: Receive
Link To State Checklist Manager: www.eagletm.com…

DE - Annual Tax and Fees Report - Domestic

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Send all paper tax and annual renewal forms and payments to:

Delaware Department of Insurance
ATTN: Premium Tax Section
841 Silver Lake Blvd.
Dover, DE 19904-2465

State Form ID: T-1 thru T-8
StateAbbrv: DE
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Delaware Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.fletcher@state.de.us
Contact Phone: 302-674-7383
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

DE - Annual Tax and Fees Report - Foreign

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Send all paper tax and annual renewal forms and payments to:

Delaware Department of Insurance
ATTN: Premium Tax Section
841 Silver Lake Blvd.
Dover, DE 19904-2465

State Form ID: T-1 thru T-8
StateAbbrv: DE
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Delaware Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.fletcher@state.de.us
Contact Phone: 302-674-7383
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

DE - Annual Tax and Fees Report - Health

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail to:

Delaware Insurance Department
ATTN: Premium Tax Section
841 Silver Lake Blvd.
Dover, DE 19904-2465

StateAbbrv: DE
Insurance Type: Health, HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Delaware Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.fletcher@state.de.us
Contact Phone: 302-674-7383
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

DE - Annual Tax and Fees Report - Non-Admitted Accredited Reinsurer and SL

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail to:

Delaware Insurance Department
ATTN: Premium Tax Section
841 Silver Lake Blvd.
Dover, DE 19904-2465

StateAbbrv: DE
Insurance Type: PC, Reinsurance, Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Delaware Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.fletcher@state.de.us
Contact Phone: 302-674-7383
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

DE - Annual Tax and Fees Report - RPG

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Tax and fee checks should be made payable to Delaware Insurance Department. The Insurance Department does not accept a postmark date. Tax forms and checks should be sent to:

Delaware Insurance Department
Attn: PREMIUM TAX SECTION
841 Silver Lake Boulevard
Dover, Delaware 19904-2465

StateAbbrv: DE
Insurance Type: Risk Purchasing Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Delaware Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ann.fletcher@state.de.us
Contact Phone: 302-674-7383
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

FL - Premium Taxes and Fees Return (Form DR-908)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail your completed DR-908 and payment to:

Florida Department of Revenue
5050 W Tennessee St
Tallahassee, FL 32399-0150

State Form ID: DR-908
StateAbbrv: FL
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Florida Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Phone: In FL 800-352-3671 or Outside FL 850-488-6800
Due by Postmark or Receive Date: Postmark
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Instructions: dor.myflorida.com…, Tax Information: dor.myflorida.com…

FL - Premium Taxes Transmittal - RRG (Form OIR-A1-1615)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail to:

Florida Department of Financial Services
Revenue Processing Section
Post Office Box 6100
Tallahassee, FL 32314-6100

State Form ID: OIR-A1-1615
StateAbbrv: FL
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Florida Office of Insurance Regulation
Link to Filing Website: www.eagletm.com…
Link To State Checklist Manager: www.eagletm.com…

GA - Annual Premium Tax Return (Form GID-12)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail completed form along with payment to:

Office of Commissioner of Insurance
2 Martin Luther King Jr. Dr., Suite 916, West Tower
Atlanta, GA 30334

State Form ID: GID-012-PT
StateAbbrv: GA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

GA - Calculation for Abatement of Gross Premium Tax (Form GID-14)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: GID-014PT
StateAbbrv: GA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

GA - Georgia Housing Tax Credit Form (Form IT-HC)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do NOT submit a claim for credit for any property for which a Federal Form 8609 has not been issued. Estimates will not be accepted.

State Form ID: IT-HC
StateAbbrv: GA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.gainsurance.org…

GA - Georgia Retaliatory Tax Computation - Foreign (Form GID-13)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All foreign or alien insurers must attach a completed form GID-013-PT to form GID-012-PT (Annual Premium Tax Return).

State Form ID: GID-013-PT
StateAbbrv: GA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

GA - Insurance Premium Tax Credits (Form GID-205)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

This form must be completed when claiming tax credits on Form GID-012-PT, Annual Premium Tax Return.

State Form ID: GID-0205-PT
StateAbbrv: GA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

GA - Life and Health Guaranty Fund Tax Credit (Form GID-50)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Assessments are eligible for the tax credit beginning in the tax year following the year in which assessment was paid.

State Form ID: GID-050-PT
StateAbbrv: GA
Insurance Type: Health, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

GA - Municipal License Fees (Form GID-17A)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The credit for municipal license fees paid is available only to Life and A&S companies and HMOs. License fees claimed on Form GID-012-PT must be supported by this form.

State Form ID: GID-017A-PT
StateAbbrv: GA
Insurance Type: Health, HMO, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

GA - Reconciliation Statement - Annual Premium Tax Return (Form GID-203)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

This form must be completed when the amounts reported on Line 1 of Form GID 012-PT, Annual Premium Tax Return, do not reconcile with the Annual Statement Schedule T or State Page amounts.

State Form ID: GID-0203-PT-PT
StateAbbrv: GA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

GA - Retaliatory Tax Computation - SL (Form GID-213-PT)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All foreign and alien insurers must attach a completed form GID-013-PT to the 4th quarter affidavit.

State Form ID: GID-213-PT
StateAbbrv: GA
Insurance Type: Risk Retention Group, Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Georgia Department of Insurance, Premium Tax Division
Link to Filing Website: www.eagletm.com…
Contact Email: premiumtax@oci.ga.gov
Contact Phone: 404-656-7553
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

GA - WC Annual Premium Writing Report

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Each insurance carrier shall submit to the Workers' Compensation Board on or before March 1 a sworn statement of its Direct Net Earned Workers' Compensation Premiums written in the state of Georgia.

StateAbbrv: GA
Insurance Type: Workers Compensation
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Georgia, State Board of Workers' Compensation
Link to Filing Website: www.eagletm.com…
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

HI - Hawaii Investments (Form 322)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

This is a required filing for all licensed insurers - If the company does not have any investments in HI file this form as NONE.

StateAbbrv: HI
Insurance Type: LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division
Link to Filing Website: www.eagletm.com…
Contact Email: jpang@dcca.hawaii.gov
Contact Phone: 808-586-7379
Due by Postmark or Receive Date: Verify with state
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

HI - Premium Tax Statement - Annual (Form 314)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: HI
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: State of Hawaii Department of Commerce and Consumer Affairs, Insurance Division
Link to Filing Website: www.eagletm.com…
Contact Email: shansen@dcca.hawaii.gov
Contact Phone: 808-586-7381
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Legal
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

HI - RRG (Foreign) Annual Statement of Premiums Received for Taxation Purposes

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: RRG (3-04) HI
StateAbbrv: HI
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: INSURANCE DIVISION DEPARTMENT OF COMMERCE & CONSUMER AFFAIRS/Albert Yamane
Link to Filing Website: www.eagletm.com…
Contact Phone: (808) 586-8150
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

IA - Application for Renewal of Certificate of Authority - Life and Health

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make the company check payable to: Iowa Division of Insurance. Submit check with the application to:

Iowa Division of Insurance
330 Maple
Des Moines, IA 50319-0065

StateAbbrv: IA
Insurance Type: Health, HMO, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Iowa Insurance Division
Link to Filing Website: www.eagletm.com…
Contact Email: Premium.Tax@iid.iowa.gov
Contact Phone: 515-281-7367
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

IA - Application for Renewal of Certificate of Authority - Other Than Life

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make the company check payable to: Iowa Division of Insurance. Submit check with the application to:

Iowa Division of Insurance
330 Maple
Des Moines, IA 50319-0065

StateAbbrv: IA
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Iowa Insurance Division
Link to Filing Website: www.eagletm.com…
Contact Email: Premium.Tax@iid.iowa.gov
Contact Phone: 515-281-7367
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

IA - Life including HMO and HMDI Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make company check payable to: Treasurer, State of Iowa. Submit the premium tax return and check to:

Department of Revenue
Hoover Building, 3rd Floor, P.O. Box 10455
1305 E. Walnut
Des Moines, Iowa 50319

StateAbbrv: IA
Insurance Type: Health, HMO, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Iowa Insurance Division
Link to Filing Website: www.eagletm.com…
Contact Email: Premium.Tax@iid.iowa.gov
Contact Phone: 515-281-7367
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

IA - Other Than Life Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make company check payable to: Treasurer, State of Iowa. Submit the premium tax return and check to:

Department of Revenue
Hoover Building, 3rd Floor, P.O. Box 10455
1305 E. Walnut
Des Moines, Iowa 50319

StateAbbrv: IA
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Iowa Insurance Division
Link to Filing Website: www.eagletm.com…
Contact Email: Premium.Tax@iid.iowa.gov
Contact Phone: 515-281-7367
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: Yellow
Link To State Checklist Manager: www.eagletm.com…

ID - Domestic Insurers - Business in Jurisdictions Not Licensed

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Must attach a legible copy of the Annual Statement, Page 3 Liabilities, Surplus and Other Funds, Idaho Business Page and Schedule T to the Premium Tax Statement; regardless of negative premiums or if no business was written.

State Form ID: INS-PTX-IDOMESTIC
StateAbbrv: ID
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Idaho Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: kathy.miller@doi.idaho.gov
Contact Phone: 208-334-4282
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Instructions: www.doi.idaho.gov… FAQs: www.doi.idaho.gov…

ID - Schedule for Allocations of Fire Premiums

2012-03-01T06:00:00Z

Thursday, March 1, 2012

A copy of the Annual Statement Idaho Business Page, Exhibit of Premium and Losses must be attached, regardless of negative premiums or if no business was written.

Original signed form must be submitted.

State Form ID: INS-PTX-IFST
StateAbbrv: ID
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Idaho Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: kathy.miller@doi.idaho.gov
Contact Phone: 208-334-4282
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Instructions: www.doi.idaho.gov… FAQs: www.doi.idaho.gov…

ID - Statement of Annual Premium Volume - Purchasing Group

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: INS-PTX-VSPG
StateAbbrv: ID
Insurance Type: Risk Purchasing Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: STATE OF IDAHO DEPARTMENT OF INSURANCE
Link to Filing Website: www.eagletm.com…
Contact Phone: (208) 334-4281 or (208) 334-4282
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.doi.idaho.gov…

ID - Statement of Annual Premium Volume - SL

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Use this form only for reporting surplus lines policies.

StateAbbrv: ID
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Idaho Department of Insurance, Surplus Lines Association
Link to Filing Website: www.eagletm.com…
Contact Phone: 208-342-9346
Due by Postmark or Receive Date: Receive Date
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.eagletm.com…

ID - Statement of Premium Taxes - RRG

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The Tax Statement and remittance are due on or before March 1. The required state documents and Tax Statement can all be submitted in one package either by groups or individual company.

State Form ID: INS-PTX-TRR
StateAbbrv: ID
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Idaho Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: kathy.miller@doi.idaho.gov
Contact Phone: 208-334-4282
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Instructions: www.doi.idaho.gov… FAQs: www.doi.idaho.gov…

ID - Statement of Premium Taxes and Fees - Insurer Using Health Blank

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The Tax Statement and remittance are due on or before March 1. The required state documents and Tax Statement can all be submitted in one package either by groups or individual company.

State Form ID: INS-PTX-THIB
StateAbbrv: ID
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Idaho Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: kathy.miller@doi.idaho.gov
Contact Phone: 208-334-4282
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Instructions: www.doi.idaho.gov… FAQs: www.doi.idaho.gov…

ID - Statement of Premium Taxes and Fees - LAH

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The Tax Statement and remittance are due on or before March 1. The required state documents and Tax Statement can all be submitted in one package either by groups or individual company.

State Form ID: INS-PTX-TLAH
StateAbbrv: ID
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Idaho Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: kathy.miller@doi.idaho.gov
Contact Phone: 208-334-4282
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Instructions: www.doi.idaho.gov… FAQs: www.doi.idaho.gov…

ID - Statement of Premium Taxes and Fees - PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The Tax Statement and remittance are due on or before March 1. The required state documents and Tax Statement can all be submitted in one package either by groups or individual company.

State Form ID: INS-PTX-TPC
StateAbbrv: ID
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Idaho Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: kathy.miller@doi.idaho.gov
Contact Phone: 208-334-4282
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Instructions: www.doi.idaho.gov… FAQs: www.doi.idaho.gov…

IN - Annual Premium Tax Return - LAH

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Attach a completed copy of the Indiana State Page from the Annual Statement to this return and payment. The amount due should be calculated and a check payable to the Indiana Department of Insurance prepared for the amoutn shown on page 2, line 20 of this return. The return must be accompanied by the appropriate payment. Please mail return to:

Indiana Department of Insurance
Bank Lockbox
Post Office Box 577
Indianapolis, IN 46206-0577

State Form ID: 6136
StateAbbrv: IN
Insurance Type: Health, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Indiana Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: dgraves@idoi.in.gov
Contact Phone: 317-232-1993
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

IN - Annual Premium Tax Return - PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Attach a completed copy of the Indiana State Page from the Annual Statement to this return and payment. The amount due should be calculated and a check payable to the Indiana Department of Insurance prepared for the amoutn shown on page 2, line 20 of this return. The return must be accompanied by the appropriate payment. Please mail return to:

Indiana Department of Insurance
Bank Lockbox
Post Office Box 577
Indianapolis, IN 46206-0577

State Form ID: 6135
StateAbbrv: IN
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Indiana Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: dgraves@idoi.in.gov
Contact Phone: 317-232-1993
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

KS - SAMPLE Health Insurance Premiums (Form 100)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Companies are required to submit forms online: towerii.ksinsurance.org…

State Form ID: Form 100
StateAbbrv: KS
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Kansas Insurance Department
Link to Filing Website: www.eagletm.com…
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.ksinsurance.org…

KS - SAMPLE Online Tax Packet

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Companies are required to submit forms online: towerii.ksinsurance.org…

StateAbbrv: KS
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Kansas Insurance Department
Link to Filing Website: www.eagletm.com…
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.ksinsurance.org…

KS - SAMPLE Supplement to AS Exhibit of Premiums & Losses - Page 14 Data

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Companies are required to submit forms online: towerii.ksinsurance.org…

StateAbbrv: KS
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Kansas Insurance Commissioner
Link to Filing Website: www.eagletm.com…
Contact Phone: 785-296-3428
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.ksinsurance.org…

KY - Insurance Premiums Tax Return - Captive Insurer (Form 74A106)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make check Payable to Kentucky State Treasurer and mail return with payment to:
Kentucky Department of Revenue
P.O. Box 1303, Frankfort, KY 40602-1303
Overnight Address: 501 High Street, Frankfort, KY 40601

State Form ID: 74A106
StateAbbrv: KY
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Commonwealth of Kentucky, Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Phone: 502-564-4810
Due by Postmark or Receive Date: Receive
Payment Method: CHECK PAYABLE TO: KENTUCKY STATE TREASURER
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

KY - Insurance Premiums Tax Return - Domestic Mutual and Mutual Fire or Cooperative and Assessment Fire (Form 74A101)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make check Payable to Kentucky State Treasurer and mail return with payment to:
Kentucky Department of Revenue
P.O. Box 1303, Frankfort, KY 40602-1303
Overnight Address: 501 High Street, Frankfort, KY 40601

State Form ID: 74A101
StateAbbrv: KY
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Commonwealth of Kentucky, Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Phone: 502-564-4810
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

KY - Insurance Premiums Tax Return (Form 74A100)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make check Payable to Kentucky State Treasurer and mail return with payment to:
Kentucky Department of Revenue
P.O. Box 1303, Frankfort, KY 40602-1303
Overnight Address: 501 High Street, Frankfort, KY 40601-2103

State Form ID: 74A100
StateAbbrv: KY
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Commonwealth of Kentucky, Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Phone: 502-564-4810
Due by Postmark or Receive Date: Receive
Payment Method: Check payable to: Kentucky State Treasurer
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

KY - Unauthorized Insurance Tax Return (Form 74A105)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make checks payable to Kentucky State Treasurer.

Mail return and remittance to Department of Revenue, Frankfort, KY 40619.

State Form ID: 74A105
StateAbbrv: KY
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Commonwealth of Kentucky, Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Phone: 502-564-4810
Due by Postmark or Receive Date: Receive
Payment Method: Checks payable to: Kentucky State Treasurer
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

LA - Annual Municipal Premium and Tax Statement (Form 1076)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Checks must be made payable to Commissioner of Insurance, State of Louisiana.

State Form ID: 1076
StateAbbrv: LA
Insurance Type: LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Louisiana Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: ipt@lamats.net
Contact Phone: 800-996-9573
Due by Postmark or Receive Date: Postmark
Filing Method: Electronic
Payment Method: EFT Payment accepted
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.ldi.state.la.us…

LA - Annual Premium Tax Statement (Form 1061)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Checks must be made payable to Commissioner of Insurance, State of Louisiana.

State Form ID: 1061
StateAbbrv: LA
Insurance Type: LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Louisiana Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: taxdivision@ldi.state.la.us
Contact Phone: 225-342-1012
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Industry Access: ldiia.ldi.state.la.us…

LA - Investment Tax Credit Report of Qualifying Assets (Form 1068C)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: 1068C
StateAbbrv: LA
Insurance Type: LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Louisiana Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: taxdivision@ldi.state.la.us
Contact Phone: 225-342-1012
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

LA - Military Tax Credit Report (Form 1425)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: 1425
StateAbbrv: LA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Louisiana Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: taxdivision@ldi.state.la.us
Contact Phone: 225-342-1012
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

LA - SL Producer Quarterly Tax Statement - Self Procurement (Form 1265B)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Filing Address:
P.O. Box 94214
Baton Rouge, LA 70802

Physical Address:
1702 North 3rd Street
Baton Rouge, LA 70802

State Form ID: 1265B
StateAbbrv: LA
Insurance Type: PC, Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Louisiana Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: taxdivision@ldi.state.la.us
Contact Phone: 225-342-1012
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

LA - SL Producer Quarterly Tax Statement (Form 1265)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

ALL Louisiana licensed surplus lines producers until license is cancelled, revoked, or expires (even if there are no premiums to report).

Mailing Address:
P. O. Box 94214
Baton Rouge, LA 70804-9214

Physical Address:
1702 North 3rd Street
Baton Rouge, LA 70802

State Form ID: 1265
StateAbbrv: LA
Insurance Type: PC, Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Louisiana Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: taxdivision@ldi.state.la.us
Contact Phone: 225-342-1012
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: Instructions: www.ldi.la.gov…, Info Sheet: www.ldi.la.gov…, 1065A Table: www.ldi.la.gov…, 1062A Table: www.ldi.la.gov…

MA - Tax Disclosure Report - Domestic Life

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Printing Instructions: To properly file the report, they must be printed on 8.5 x 11 white 25% cotton bond paper in black ink only. The reports may be printed on one or two sided documents.

StateAbbrv: MA
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Massachusetts Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: corpinfo@sec.state.ma.us
Contact Phone: 617-727-9640
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Paper Size: 8.5 x 11
Link To State Checklist Manager: www.eagletm.com…

MA - Tax Disclosure Report - Domestic PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Printing Instructions: To properly file the report, they must be printed on 8.5 x 11 white 25% cotton bond paper in black ink only. The reports may be printed on one or two sided documents.

StateAbbrv: MA
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Massachusetts Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: corpinfo@sec.state.ma.us
Contact Phone: 617-727-9640
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Paper Size: 8.5 x 11
Link To State Checklist Manager: www.eagletm.com…

MA - Tax Disclosure Report - Foreign Life

2012-03-01T06:00:00Z

MA - Tax Disclosure Report - Foreign PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Printing Instructions: To properly file the report, they must be printed on 8.5 x 11 white 25% cotton bond paper in black ink only. The reports may be printed on one or two sided documents.

StateAbbrv: MA
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Massachusetts Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: corpinfo@sec.state.ma.us
Contact Phone: 617-727-9640
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: 8.5 x 11
Link To State Checklist Manager: www.eagletm.com…

ME - Fire Investigation and Prevention Tax Estimated Monthly Return (Form INS-2)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make check payable to: Treasurer, State of Maine

Send check and return to:

Maine Revenue Services
P.O. Box 1065
Augusta, ME 04332-9120

State Form ID: INS-2
StateAbbrv: ME
Insurance Type: PC
Filing Period: Monthly
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Maine Revenue Services
Link to Filing Website: www.eagletm.com…
Contact Email: corporatetax@maine.gov
Contact Phone: 207-624-9753
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

MI - Insurance Company Annual Return for Michigan Business and Retaliatory Taxes (Form 4588)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

State Form ID: 4588
StateAbbrv: MI
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Michigan Department of Treasury
Link to Filing Website: www.eagletm.com…
Contact Phone: 517-636-6925
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: MBT Forms and Instruction Booklet: www.michigan.gov…

MI - MBT e-file Annual Return Payment Voucher (Form 4576)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

State Form ID: 4576
StateAbbrv: MI
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Michigan Department of Treasury
Link to Filing Website: www.eagletm.com…
Contact Phone: 517-636-6925
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

MN - Fire Insurance Tax Retaliatory Schedule (Form M11AR)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this form if your state of incorporation collects a fire insurance tax.

State Form ID: M11AR
StateAbbrv: MN
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MN - Insurance Fees (Form M11B)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Fees are not paid to the Department of Revenue.

State Form ID: M11B
StateAbbrv: MN
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Due by Postmark or Receive Date: Postmark
Payment Method: Check payable: Minnesota Commerce Department
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

MN - Insurance Premium Return Payment (Form PV42)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make check payable to Minnesota Revenue and mail with your return.

State Form ID: PV42
StateAbbrv: MN
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MN - Insurance Premium Tax - HMO (Form M11H)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail to:
Minnesota Revenue
Mail Station 1780
St. Paul, MN 55145-1780

For express deliveries:
600 N. Robert St.
St. Paul, MN 55101

State Form ID: M11H
StateAbbrv: MN
Insurance Type: HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MN - Insurance Premium Tax - LAH (Form M11L)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail to:
Minnesota Revenue
Mail Station 1780
St. Paul, MN 55145-1780

For express deliveries:
600 N. Robert St.
St. Paul, MN 55101

State Form ID: M11L
StateAbbrv: MN
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

MN - Insurance Premium Tax - PC (Form M11)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail to:
Minnesota Revenue
Mail Station 1780
St. Paul, MN 55145-1780

For express deliveries:
600 N. Robert St.
St. Paul, MN 55101

State Form ID: M11
StateAbbrv: MN
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: taxes.state.mn.us…

MN - Insurance Tax Return Payment - HMO (Form PV52)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make check payable to Minnesota Revenue and mail with Form M11H.

State Form ID: PV52
StateAbbrv: MN
Insurance Type: HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-556-3024
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MN - Statement of Insurance Placed with Unauthorized Insurers (Form IG255)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The due date for filing Form IG255 and paying the tax due is March 1 of the following year. Mail to:

Minnesota Revenue
Mail Station 1780
St. Paul, MN 55145-1780

State Form ID: IG255
StateAbbrv: MN
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Minnesota Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: insurance.taxes@state.mn.us
Contact Phone: 651-297-1772
Due by Postmark or Receive Date: Postmark
Link To State Checklist Manager: www.eagletm.com…

MO - Premium Tax Return - LAH (Form MO 375-0411)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail report to:

Missouri Department of Insurance, Financial Institutions & Professional Registration
P.O. Box 690
Jefferson City, MO 65102

State Form ID: 375-0411
StateAbbrv: MO
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Missouri Department of Insurance, Financial Institutions and Professional Regulation
Link to Filing Website: www.eagletm.com…
Contact Email: Noland.Stuecken@insurance.mo.gov
Contact Phone: 573-526-4986, 573-751-1929 or 573-526-1589
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MO - Premium Tax Return - PC (Form MO 375-0409)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail report to:

Missouri Department of Insurance, Financial Institutions & Professional Registration
P.O. Box 690
Jefferson City, MO 65102

State Form ID: 375-0409
StateAbbrv: MO
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Missouri Department of Insurance, Financial Institutions and Professional Regulation
Link to Filing Website: www.eagletm.com…
Contact Email: Noland.Stuecken@insurance.mo.gov
Contact Phone: 573-526-4986, 573-751-1929 or 573-526-1589
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MO - Quarterly Administrative Surcharge Report Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Please remit this form with payment to:

Missouri Department of Revenue
P.O. Box 898
Jefferson City, MO 65105-0898

State Form ID: 375-0701
StateAbbrv: MO
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Missouri Department of Insurance, Financial Institutions and Professional Regulation
Link to Filing Website: www.eagletm.com…
Contact Email: Noland.Stuecken@insurance.mo.gov
Contact Phone: 573-526-4986 or 573-751-1929
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

MS - Annual Premium Filing Form - RPG and RRG

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Please complete this annual report and return to:

Mississippi Insurance Department
Attn: Accounting Division
P.O. Box 79
Jackson, MS 39205-0079

StateAbbrv: MS
Insurance Type: Risk Purchasing Group, Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Mississippi Insurance Department
Link to Filing Website: www.eagletm.com…
Due by Postmark or Receive Date: Postmark
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

MS - Insurance Premium Tax Return - Annual Reconciliation and Fifth Period (Form 66-067)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail return to:

State Tax Commission
P.O. Box 23075
Jackson, MS 39225

State Form ID: 66-067
StateAbbrv: MS
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Mississippi Department of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: kgaston@mstc.state.ms.us
Contact Phone: 601-923-7183
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.dor.ms.gov…

MT - Annual Premium Tax Return - LAH (Form SAI-27)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail payments to:

Montana Commissioner of Securities and Insurance
840 Helena Avenue
Helena, MT 59601

State Form ID: SAI-27
StateAbbrv: MT
Insurance Type: Health, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Montana Commissioner of Securities and Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: stateauditor@mt.gov
Contact Phone: 406-444-2040
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

MT - Annual Premium Tax Return - PC (Form SAI-28)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail payments to:

Montana Commissioner of Securities and Insurance
840 Helena Avenue
Helena, MT 59601

State Form ID: SAI-28
StateAbbrv: MT
Insurance Type: Health, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Montana Commissioner of Securities and Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: stateauditor@mt.gov
Contact Phone: 406-444-2040
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

MT - RRG Renewal and Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: MT
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Montana Commissioner of Securities and Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: stateauditor@mt.gov
Contact Phone: 406-444-2040
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

ND - Fire District Reporting Form (Form SFN 52764)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

We encourage you to file electronically by e-mail, or on diskette if at all possible. Send to sweisz@nd.gov.

State Form ID: SFN 52764
StateAbbrv: ND
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: North Dakota Insurance Department
Link to Filing Website: www.eagletm.com…
Contact Phone: 701-328-3328
Due by Postmark or Receive Date: Postmark
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.nd.gov…

ND - Fire Insurance Premiums and Losses (Form SFN 7832)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Please mail with annual statement to:

North Dakota Insurance Department
600 East Boulevard Avenue - Dept 401
Bismarck, ND 58505-0320

State Form ID: SFN 7832
StateAbbrv: ND
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: North Dakota Insurance Department
Link to Filing Website: www.eagletm.com…
Contact Phone: 701-328-3328
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

ND - Premium Tax - Reconciled Tax Form (Form SFN 11050)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Attach an 8 1/2 X 11 copy of the North Dakota State Page from the Annual Statement.

Mail to:
North Dakota Insurance Department
600 East Boulevard Avenue, Dept. 401
Bismarck, ND 58505

State Form ID: SNF 11050
StateAbbrv: ND
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: North Dakota Insurance Department
Link to Filing Website: www.eagletm.com…
Contact Phone: 701-328-2440
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - Domestic HMO

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: HMO Dom L/H
StateAbbrv: NE
Insurance Type: HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - Domestic LAH

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: Dom L/H
StateAbbrv: NE
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - Domestic PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: Dom P/C
StateAbbrv: NE
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - Foreign HMO

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: HMO For L/H
StateAbbrv: NE
Insurance Type: HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - Foreign LAH

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: For L/H
StateAbbrv: NE
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - Foreign PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: For P/C
StateAbbrv: NE
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - Foreign RRG

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

StateAbbrv: NE
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - IN and WI LAH

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: WI L/H
StateAbbrv: NE
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - IN and WI PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: WI P/C
StateAbbrv: NE
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - NH and ND LAH

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: ND-NH L/H
StateAbbrv: NE
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

NE - Annual Premium Tax Return - NH and ND PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Online filing mandatory for 2012. Mail check to:

Nebraska Department of Insurance
P.O. Box 82089
Lincoln, NE 68501-2089.

State Form ID: ND-NH P/C
StateAbbrv: NE
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nebraska Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: martha.hettenbaugh@nebraska.gov
Contact Phone: 402-471-4671
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

NH - Unauthorized Premium Tax Form - PC and Life

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: NH
Insurance Type: LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: New Hampshire Insurance Department
Link to Filing Website: www.eagletm.com…
Contact Email: donna.arland@ins.nh.gov or norma.stallings@ins.nh.gov
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

NJ - Annual Report of Premiums Paid to RRG not Chartered in NJ for Coverage on Risks within NJ

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail your returns to:

Division of Taxation
PO Box 247
Trenton, NJ 08646-0247

Also, a duplicate return must be filed with the Commissioner of Banking and Insurance at the same time:

Department of Banking and Insurance
PO Box 325
Trenton, NJ 08625-0325

State Form ID: RRG
StateAbbrv: NJ
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: New Jersey Department of Treasury, Division of Taxation
Link to Filing Website: www.eagletm.com…
Contact Email: NJ.Insurance@treas.state.nj.us
Contact Phone: 609-984-4128
Due by Postmark or Receive Date: Postmark
Payment Method: Check payable: NJ Division of T axation -- Insurance Tax
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

NJ - Domestic Other Than Life Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail your returns to:

Division of Taxation
PO Box 247
Trenton, NJ 08646-0247

Also, a duplicate return must be filed with the Commissioner of Banking and Insurance at the same time:

Department of Banking and Insurance
PO Box 325
Trenton, NJ 08625-0325

State Form ID: DEM
StateAbbrv: NJ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: New Jersey Department of Treasury, Division of Taxation
Link to Filing Website: www.eagletm.com…
Contact Email: NJ.Insurance@treas.state.nj.us
Contact Phone: 609-984-4128
Due by Postmark or Receive Date: Postmark
Payment Method: Check payable: NJ Division of T axation -- Insurance Tax
Domestic/Foreign: Domestic
Paper Size: Legal
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.state.nj.us…

NJ - Domestic Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail your returns to:

Division of Taxation
PO Box 247
Trenton, NJ 08646-0247

Also, a duplicate return must be filed with the Commissioner of Banking and Insurance at the same time:

Department of Banking and Insurance
PO Box 325
Trenton, NJ 08625-0325

State Form ID: DEXM
StateAbbrv: NJ
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: New Jersey Department of Treasury, Division of Taxation
Link to Filing Website: www.eagletm.com…
Contact Email: NJ.Insurance@treas.state.nj.us
Contact Phone: 609-984-4128
Due by Postmark or Receive Date: Postmark
Payment Method: Check payable: NJ Division of T axation -- Insurance Tax
Domestic/Foreign: Domestic
Paper Size: Legal
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.state.nj.us…

NJ - Foreign or Alien Other Than Life Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail your returns to:

Division of Taxation
PO Box 247
Trenton, NJ 08646-0247

Also, a duplicate return must be filed with the Commissioner of Banking and Insurance at the same time:

Department of Banking and Insurance
PO Box 325
Trenton, NJ 08625-0325

State Form ID: EM
StateAbbrv: NJ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: New Jersey Department of Treasury, Division of Taxation
Link to Filing Website: www.eagletm.com…
Contact Email: NJ.Insurance@treas.state.nj.us
Contact Phone: 609-984-4128
Due by Postmark or Receive Date: Postmark
Payment Method: Check payable: NJ Division of T axation -- Insurance Tax
Domestic/Foreign: Foreign
Paper Size: Legal
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.state.nj.us…

NJ - Foreign or Alien Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail your returns to:

Division of Taxation
PO Box 247
Trenton, NJ 08646-0247

Also, a duplicate return must be filed with the Commissioner of Banking and Insurance at the same time:

Department of Banking and Insurance
PO Box 325
Trenton, NJ 08625-0325

State Form ID: EXM
StateAbbrv: NJ
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: New Jersey Department of Treasury, Division of Taxation
Link to Filing Website: www.eagletm.com…
Contact Email: NJ.Insurance@treas.state.nj.us
Contact Phone: 609-984-4128
Due by Postmark or Receive Date: Postmark
Payment Method: Check payable: NJ Division of T axation -- Insurance Tax
Domestic/Foreign: Foreign
Paper Size: Legal
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.state.nj.us…

NJ - Report and Reconciliation of NJ Property-Liability Insurance Guaranty Association Surcharge

2012-03-01T06:00:00Z

Thursday, March 1, 2012

A separate report must be filed for each company.

StateAbbrv: NJ
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: New Jersey Department of Banking and Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: NJ.Insurance@treas.state.nj.us
Link To State Checklist Manager: www.eagletm.com…

NJ - WC Security Fund Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: NJ
Insurance Type: Workers Compensation
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: New Jersey Department of Banking and Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: NJ.Insurance@treas.state.nj.us
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

NV - Annual Premium Tax Return - Captive

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: NDOI-402
StateAbbrv: NV
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Nevada Department of Business and Industry, Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: mlynch@doi.state.nv.us
Contact Phone: 775-687-0758
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

NY - Annual Report of Fire Premiums Tax

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail report and remittance to:

NYC Department of Finance
Fire Premiums Tax Section
59 Maiden Lane, 19th Floor
New York, NY 10038

State Form ID: NYC-FP
StateAbbrv: NY
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: New York City Department of Finance
Link to Filing Website: www.eagletm.com…
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

OH - Domestic Health Insuring Corporation Franchise Tax Form - SAMPLE (Form INS7141)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file hard copy.

State Form ID: INS7141
StateAbbrv: OH
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: taxes@insurance.ohio.gov
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Domestic Insurance Tax Summary (Form INS7214)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail payment and this form to:

Treasurer of State of Ohio
P.O. Box 163458
Columbus, OH 43216-3458

State Form ID: INS7214
StateAbbrv: OH
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: susan.shidaker@ins.state.oh.us or taxes@insurance.ohio.gov
Contact Phone: 614-644-2566
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Domestic Life Franchise Tax Form - SAMPLE (Form INS7142)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file hard copy.

State Form ID: INS7142
StateAbbrv: OH
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: susan.shidaker@ins.state.oh.us or taxes@insurance.ohio.gov
Contact Phone: 614-644-2566
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Domestic PC Franchise Tax Form - SAMPLE (Form INS7143)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file hard copy.

State Form ID: INS7143
StateAbbrv: OH
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: susan.shidaker@ins.state.oh.us or taxes@insurance.ohio.gov
Contact Phone: 614-644-2566
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Exhibit A - Business Tax Credit - SAMPLE (Form INS7140)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file hard copy.

State Form ID: INS7140
StateAbbrv: OH
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: taxes@insurance.ohio.gov
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Foreign and Alien Insurance Tax Summary (Form INS7215)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mailing Address for Tax Payments:

Treasurer of State of Ohio
P.O. Box 163458
Columbus, OH 43216-3458

Overnight and Hand Delivery:

Treasurer of State of Ohio
30 East Broad Street, 9th Floor REV. MGT.
Columbus, OH 43215
Attention: Kelly Alvis

State Form ID: INS7215
StateAbbrv: OH
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: susan.shidaker@ins.state.oh.us or taxes@insurance.ohio.gov
Contact Phone: 614-644-2566
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Foreign Health Insuring Corporation Premium Tax Form - SAMPLE (Form INS7145)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file hard copy.

State Form ID: INS7145
StateAbbrv: OH
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: taxes@insurance.ohio.gov
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Foreign Life Premium Tax Form - SAMPLE (Form INS7146)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file hard copy.

State Form ID: INS7146
StateAbbrv: OH
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: susan.shidaker@ins.state.oh.us or taxes@insurance.ohio.gov
Contact Phone: 614-644-2566
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Foreign PC Premium Tax Form - SAMPLE (Form INS7147)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file hard copy.

State Form ID: INS7147
StateAbbrv: OH
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: susan.shidaker@ins.state.oh.us or taxes@insurance.ohio.gov
Contact Phone: 614-644-2566
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OH - Ohio Fire Marshal Tax Return - SAMPLE

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: INS7016
StateAbbrv: OH
Insurance Type: PC
Filing Period: Annual
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance, Office of Financial Regulation Services
Link to Filing Website: www.eagletm.com…
Contact Email: taxes@insurance.ohio.gov
Contact Phone: 614-644-2658
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

OH - Ohio Fire Marshal Tax Return - SAMPLE (Form INS7016)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file hard copy.

State Form ID: INS7016
StateAbbrv: OH
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Ohio Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: susan.shidaker@ins.state.oh.us or taxes@insurance.ohio.gov
Contact Phone: 614-644-2566
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.ohio.gov…

OK - Captive Annual Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

OK - Captive Premium Tax Voucher

2012-03-01T06:00:00Z

OK - Health Insurers Annual Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: Health, HMO
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

OK - Health Insurers Premium Tax Voucher

2012-03-01T06:00:00Z

OK - LAH Domestic Annual Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

OK - LAH Domestic Premium Tax Voucher

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: LAH
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

OK - LAH Foreign Annual Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

OK - LAH Foreign Premium Tax Voucher

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: LAH
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

OK - PC Domestic Annual Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

OK - PC Domestic Premium Tax Voucher

2012-03-01T06:00:00Z

OK - PC Foreign Annual Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

OK - PC Foreign Premium Tax Voucher

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

OK - RRG Annual Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

OK - RRG Premium Tax Voucher

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: OK
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Oklahoma Insurance Department, Premium Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Email: gail.lopresto@oid.ok.gov
Contact Phone: 405-521-3966
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

OR - Surplus Lines Licensee Affidavit for Purchasing Groups

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make checks payable to: Department of Consumer and Business Services

Mail to:

Fiscal Services Section
Oregon Department of Consumer and Business Services
P.O. Box 14610
Salem, OR 97309-0445

State Form ID: 440-3928
StateAbbrv: OR
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Oregon Insurance Division
Link to Filing Website: www.eagletm.com…
Contact Email: lynette.m.hadley@state.or.us or shannon.oshea@state.or.us
Contact Phone: 503-947-7046 or 503-947-7218
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

RI - Gross Premiums Tax Return - Health (Form T-71H)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mailing Address:

Overpayments/Refunds
RI Division of Taxation
One Capitol Hill
Providence, RI 02908-5811

Payments
RI Division of Taxation
One Capitol Hill
Providence, RI 02908-5814

State Form ID: T-71H
StateAbbrv: RI
Insurance Type: Health
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: Rhode Island Department of Taxation, Division of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: clarocque@tax.ri.gov
Contact Phone: 401-574-8806
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

RI - Gross Premiums Tax Return (Form T-71)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

A return with a payment should be mailed to:

Rhode Island Division of Taxation
One Capitol Hill
Providence, RI 02908-5814

A return with an overpayment should be mailed to: Rhode Island Division of Taxation
One Capitol Hill
Providence, RI 02908-5811

State Form ID: T-71
StateAbbrv: RI
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Rhode Island Department of Taxation, Division of Revenue
Link to Filing Website: www.eagletm.com…
Contact Email: clarocque@tax.ri.gov
Contact Phone: 401-574-8806
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

SC - Captive Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: SC
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: South Carolina Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: gakram@doi.sc.gov, OR, swaddell@doi.sc.gov
Contact Phone: 803-737-6136, OR, 803-737-4910
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Paper Size: Online Only
Paper Color: Online Only
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: doi.sc.gov…

SC - HMO Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: SC
Insurance Type: HMO
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: South Carolina Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: gakram@doi.sc.gov, OR, swaddell@doi.sc.gov
Contact Phone: 803-737-6136, OR, 803-737-4910
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Paper Size: Online Only
Paper Color: Online Only
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: doi.sc.gov…

SC - LAH Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: SC
Insurance Type: LAH
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: South Carolina Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: gakram@doi.sc.gov, OR, swaddell@doi.sc.gov
Contact Phone: 803-737-6136, OR, 803-737-4910
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Paper Size: Online Only
Paper Color: Online Only
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: doi.sc.gov…

SC - PC Premium Tax Return

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Checklist Link

StateAbbrv: SC
Insurance Type: PC
Filing Period: Annual
Link to State Form: .
Tax Filing Requirements: www.eagletm.com…
State Authority: South Carolina Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: gakram@doi.sc.gov, OR, swaddell@doi.sc.gov
Contact Phone: 803-737-6136, OR, 803-737-4910
Due by Postmark or Receive Date: Receive
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Paper Size: Online Only
Paper Color: Online Only
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: doi.sc.gov…

SD - Premium Tax Report - Life and Health

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The check and payment voucher are mailed to a different address than the tax return.

Mail the check and below payment voucher to:

South Dakota Remittance Center
PO Box 5055
Sioux Falls, SD 57117-5055

OR

(Ground Delivery)
South Dakota Remittance Center
300 So. Sycamore Avenue STE #102
Sioux Falls, SD 57110

Mail the Premium Tax Return, State Page and Schedule T to:

South Dakota Division of Insurance
445 East Capitol Avenue
Pierre, SD 57501

StateAbbrv: SD
Insurance Type: Health, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: South Dakota Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: luann.johnson@state.sd.us
Contact Phone: 605-773-3563
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

SD - Premium Tax Report - PC

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The check and payment voucher are mailed to a different address than the tax return.

Mail the check and below payment voucher to:

South Dakota Remittance Center
PO Box 5055
Sioux Falls, SD 57117-5055

OR

(Ground Delivery)
South Dakota Remittance Center
300 So. Sycamore Avenue STE #102
Sioux Falls, SD 57110

Mail the Premium Tax Return, State Page and Schedule T to:

South Dakota Division of Insurance
445 East Capitol Avenue
Pierre, SD 57501

StateAbbrv: SD
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: South Dakota Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: luann.johnson@state.sd.us
Contact Phone: 605-773-3563
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

SD - Tax Credit for Principal or Regional Home Office

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: SD
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: South Dakota Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: luann.johnson@state.sd.us
Contact Phone: 605-773-3563
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

TN - Captive Annual Premium Tax Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The address for Premium Tax Returns is:

Tennessee Department of Commerce and Insurance
Division of Insurance, P.O. Box 198983
Nashville, TN 37219-8983

If the tax return is mailed via overnight courier, the following address should be used:

Tennessee Department of Commerce and Insurance
Attention: Premium Tax Section
Financial Affairs Section-Analytical Unit 0576
500 James Robertson Parkway, 4th Floor
Nashville, TN 37243

StateAbbrv: TN
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Tennessee Department of Commerce and Insurance
Link to Filing Website: www.eagletm.com…
Contact Phone: 615-741-1670
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TN - HMO Annual Premium Tax Form (Form IN-1183)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The address for Premium Tax Returns is:

Tennessee Department of Commerce and Insurance
Division of Insurance, P.O. Box 198983
Nashville, TN 37219-8983

If the tax return is mailed via overnight courier, the following address should be used:

Tennessee Department of Commerce and Insurance
Attention: Premium Tax Section
Financial Affairs Section-Analytical Unit 0576
500 James Robertson Parkway, 4th Floor
Nashville, TN 37243

State Form ID: IN-1183
StateAbbrv: TN
Insurance Type: HMO
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Tennessee Department of Commerce and Insurance
Link to Filing Website: www.eagletm.com…
Contact Phone: 615-741-1670
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TN - Life Annual Premium Tax Form (Form IN-0581)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The address for Premium Tax Returns is:

Tennessee Department of Commerce and Insurance
Division of Insurance, P.O. Box 198983
Nashville, TN 37219-8983

If the tax return is mailed via overnight courier, the following address should be used:

Tennessee Department of Commerce and Insurance
Attention: Premium Tax Section
Financial Affairs Section-Analytical Unit 0576
500 James Robertson Parkway, 4th Floor
Nashville, TN 37243

State Form ID: IN-0581
StateAbbrv: TN
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Tennessee Department of Commerce and Insurance
Link to Filing Website: www.eagletm.com…
Contact Phone: 615-741-1670
Due by Postmark or Receive Date: Receive Date
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

TN - Other than Life Annual Premium Tax Form (Form IN-0579)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The address for Premium Tax Returns is:

Tennessee Department of Commerce and Insurance
Division of Insurance, P.O. Box 198983
Nashville, TN 37219-8983

If the tax return is mailed via overnight courier, the following address should be used:

Tennessee Department of Commerce and Insurance
Attention: Premium Tax Section
Financial Affairs Section-Analytical Unit 0576
500 James Robertson Parkway, 4th Floor
Nashville, TN 37243

State Form ID: IN-0579
StateAbbrv: TN
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Tennessee Department of Commerce and Insurance
Link to Filing Website: www.eagletm.com…
Contact Phone: 615-741-1670
Due by Postmark or Receive Date: Receive Date
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: Yellow
Link To State Checklist Manager: www.eagletm.com…

TN - PLHS Annual Premium Tax Form (Form IN-1370)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The address for Premium Tax Returns is:

Tennessee Department of Commerce and Insurance
Division of Insurance, P.O. Box 198983
Nashville, TN 37219-8983

If the tax return is mailed via overnight courier, the following address should be used:

Tennessee Department of Commerce and Insurance
Attention: Premium Tax Section
Financial Affairs Section-Analytical Unit 0576
500 James Robertson Parkway, 4th Floor
Nashville, TN 37243

State Form ID: IN-1370
StateAbbrv: TN
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Tennessee Department of Commerce and Insurance
Link to Filing Website: www.eagletm.com…
Contact Phone: 615-741-1670
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TN - Purchasing Group Premium Tax Form (Form IN-1264)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make check payable to: Tennessee Department of Commerce and Insurance

Mail check to:

State of Tennessee
The Department of Commerce and Insurance
P.O. Box 198983
Nashville, TN 37219-8983

State Form ID: IN-1264
StateAbbrv: TN
Insurance Type: Risk Purchasing Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Tennessee Department of Commerce and Insurance
Link to Filing Website: www.eagletm.com…
Contact Phone: 615-741-1756
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TN - Risk Retention Group Premium Tax Form (Form IN-0579)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The address for Premium Tax Returns is:

Tennessee Department of Commerce and Insurance
Division of Insurance, P.O. Box 198983
Nashville, TN 37219-8983

If the tax return is mailed via overnight courier, the following address should be used:

Tennessee Department of Commerce and Insurance
Attention: Premium Tax Section
Financial Affairs Section-Analytical Unit 0576
500 James Robertson Parkway, 4th Floor
Nashville, TN 37243

State Form ID: IN-0579
StateAbbrv: TN
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Tennessee Department of Commerce and Insurance
Link to Filing Website: www.eagletm.com…
Contact Phone: 615-741-1670
Due by Postmark or Receive Date: Receive Date
Domestic/Foreign: Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

TN - SL Premium Tax Form (Form SL 3)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Make check payable to: Tennessee Department of Commerce and Insurance

Mail check to:

State of Tennessee
The Department of Commerce and Insurance
P.O. Box 198983
Nashville, TN 37219-8983

State Form ID: IN-0129
StateAbbrv: TN
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Tennessee Department of Commerce and Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: surplus.lines@tn.gov
Contact Phone: 615-741-1756
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TX - Annual Insurance Maintenance Assessment and Retaliatory Report (Form 25-102)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Tax Filing Requirements

State Form ID: 25-102
StateAbbrv: TX
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.window.state.tx.us…

TX - Annual Insurance Premium Tax Report (Form 25-100)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Tax Filing Requirements

State Form ID: 25-100
StateAbbrv: TX
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

TX - Annual Insurance Tax Report - Independently Procured Insurance (Form 25-103)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Tax Filing Requirements

State Form ID: 25-103
StateAbbrv: TX
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TX - Annual Insurance Tax Report - SL and PG (Form 25-104)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Tax Filing Requirements

State Form ID: 25-104
StateAbbrv: TX
Insurance Type: Risk Purchasing Group, Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

TX - Annual Insurance Tax Report - Unauthorized Insurance (Form 25-108)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Tax Filing Requirements

State Form ID: 25-108
StateAbbrv: TX
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TX - Automobile Theft Prevention Authority Assessment Report (Form 25-106)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Tax Filing Requirements

State Form ID: 25-106
StateAbbrv: TX
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TX - Automobile Theft Prevention Authority Assessment Semi-Annual Payment Worksheet (Form 25-107)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See Tax Filing Requirements

State Form ID: 25-107
StateAbbrv: TX
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TX - Computation of Non-Taxable Premiums (Form 25-205)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this form and file it with your Texas Annual Insurance Premium Tax Report, Form 25-100.

State Form ID: 25-205
StateAbbrv: TX
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

TX - Insurance Semi-Annual Premium Tax Payment (Form 25-101)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

For all licensed insurance companies and miscellaneous organizations, excluding Stipulated Premium Companies and Statewide Mutual Assessment Life, Health and Accident Companies.

Mail the payment to:

Comptroller of Public Accounts
P.O. Box 149356
Austin, TX 78714-9356

State Form ID: 25-101
StateAbbrv: TX
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…

TX - Retaliatory Worksheet (Form 25-200)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Complete this form and file it with your Texas Annual Insurance Maintenance, Assessment and Retaliatory Report, Form 25-102.

State Form ID: 25-200
StateAbbrv: TX
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Texas Comptroller of Public Accounts
Link to Filing Website: www.eagletm.com…
Contact Email: tax.help@cpa.state.tx.us
Contact Phone: 512-463-4600
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

UT - Premium Tax Report - RPG

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All tax report forms must be returned to:

Utah Insurance Department
State Office Building Rm 3110
Salt Lake City, UT 84114

StateAbbrv: UT
Insurance Type: Risk Purchasing Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Utah Insurance Department
Link to Filing Website: www.eagletm.com…
Contact Phone: 801-538-3814
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.insurance.utah.gov…

VA - Annual Tax Packet Download Acknowledgement

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Postal Service:
Wells Fargo/State Corp. Commission
TAA Insurance 2
P.O. Box 759064
Baltimore, MD 21275-9064

Express Mail:
Wells Fargo/State Corp. Commission
TAA Insurance 2
Lockbox 759064
7175 Columbia Gateway Drive
Columbia, MD 21046

State Form ID: T002, T029, T050, T051
StateAbbrv: VA
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Virginia Bureau of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: Joyce.Jones@scc.virginia.gov
Contact Phone: 804-371-9096
Due by Postmark or Receive Date: Postmark
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.scc.virginia.gov…

VA - Annual Tax Packet Download Acknowledgement

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Postal Service:
Wells Fargo/State Corp. Commission
TAA Insurance 2
P.O. Box 759064
Baltimore, MD 21275-9064

Express Mail:
Wells Fargo/State Corp. Commission
TAA Insurance 2
Lockbox 759064
7175 Columbia Gateway Drive
Columbia, MD 21046

State Form ID: T001, T021, T041, T042, T043,T045, T050, T051
StateAbbrv: VA
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Virginia Bureau of Insurance
Link to Filing Website: www.eagletm.com…
Contact Email: Joyce.Jones@scc.virginia.gov
Contact Phone: 804-371-9096
Due by Postmark or Receive Date: Postmark
Filing Method: Electronic
Domestic/Foreign: Domestic, Foreign
Paper Size: Letter
Paper Color: White
Link To State Checklist Manager: www.eagletm.com…
Link to Supporting Information: www.scc.virginia.gov…

AK - Certificate of Assuming Insurer (Form 08-238)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

As an accredited reinsurer with our state, we ask that you please make the notation Accredited Reinsurer on all correspondence and filings with our office.

Please mail to:

Financial Examination Section
Alaska Division of Insurance
550 West 7th Avenue, Suite 1560
Anchorage, AK 99501-3567

State Form ID: 08-238
StateAbbrv: AK
Insurance Type: Reinsurance
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Link To State Checklist Manager: www.eagletm.com…

AK - Certificate of Compliance

2012-03-01T06:00:00Z

Thursday, March 1, 2012

File with Annual Premium Tax Report or separately.

StateAbbrv: AK
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AK - Certificate of Deposit

2012-03-01T06:00:00Z

Thursday, March 1, 2012

File with Annual Premium Tax Report or separately.

StateAbbrv: AK
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AK - Certificate of Valuation

2012-03-01T06:00:00Z

Thursday, March 1, 2012

File with Annual Premium Tax Report or separately.

StateAbbrv: AK
Insurance Type: LAH
Filing Period: Annual
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AK - Health Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If the annual statement is not postmarked by March 1, a late fee will be assessed per day.

StateAbbrv: AK
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AK - LAH Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If the annual statement is not postmarked by March 1, a late fee will be assessed per day.

StateAbbrv: AK
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AK - Minimum Asset Reserve Report

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Domestics Only.

StateAbbrv: AK
Insurance Type: Health, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AK - PC Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

If the annual statement is not postmarked by March 1, a late fee will be assessed per day.

StateAbbrv: AK
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AK - Signed Jurat

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AK
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AK - State Filing Fees

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AK
Insurance Type: Health, LAH, PC, Reinsurance
Filing Period: Annual
State Authority: Alaska Division of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Rebecca Nesheim, Tax Auditor
Contact Email: rebecca.nesheim@alaska.gov
Contact Phone: 907-465-2584
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Accepted Reinsurers Annual Maintenance Transmittal Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All Accepted Reinsurers in the State of Alabama must pay the ANNUAL MAINTENANCE FEE. Make checks payable to the: Alabama Department of Insurance

Mail form and check to:

Postal Service

Alabama Department of Insurance
c/o Compass Bank
PO Box 830707
Birmingham, AL 35283-0707

Courier or Express Service

Alabama Department of Insurance
c/o Compass Bank
701 South 32nd Street
Birmingham, AL 35233

StateAbbrv: AL
Insurance Type: Reinsurance
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Alabama Business Page

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The Alabama business page should be emailed along with premium tax documentation to premiumtax@insurance.alabama.gov.

StateAbbrv: AL
Insurance Type: LAH, PC
Filing Period: Annual
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Application for Renewal of Certificate of Authority

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AL
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Certificate of Compliance

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AL
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Electronic
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Certificate of Deposit

2012-03-01T06:00:00Z

AL - Certificate of Valuation

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AL
Insurance Type: Health, LAH
Filing Period: Annual
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Electronic
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Health Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AL
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - LAH Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mailing address:

Alabama Department of Insurance
201 Monroe Street, Suite 1700
Montgomery, AL 36104

StateAbbrv: AL
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Official List

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mailing Address:
Alabama Department of Insurance
201 Monroe Street, Suite 1700
Montgomery, AL 36104

Or

P.O. Box 303351
Montgomery, AL 36130-3351

StateAbbrv: AL
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - PC Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mailing address:

Alabama Department of Insurance
201 Monroe Street, Suite 1700
Montgomery, AL 36104

StateAbbrv: AL
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - Signed Jurat

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Since the hard copy annual statement is no longer required to be mailed to the Department but filed electonically with the NAIC, submit signed Jurat page to:

Alabama Department of Insurance
201 Monroe Street, Suite 1700
Montgomery, AL 36130-3351

StateAbbrv: AL
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AL - SL Audit and Exam Transmittal Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All insurers are required to submit an annual audit and examination fee of $850 accompanied by this form to:

POSTAL SERVICE:
Alabama Department of Insurance
c/o Compass Bank
P.O. Box 830707
Birmingham, AL 35283-0707

COURIER OR EXPRESS DELIVERY:
Alabama Department of Insurance
c/o Compass Bank
701 South 32nd Street
Birmingham, AL 35233

State Form ID: PR
StateAbbrv: AL
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland
Contact Email: ann.strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Link To State Checklist Manager: www.eagletm.com…

AL - State Filing Fees

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Annual Statement Filing Fee

The Renewal Fee and Filing Fee must be submitted with the Premium Tax Return and mailed by Postal Service to:

Alabama Department of Insurance
c/o Compass Bank
P.O. Box 830691
Birmingham, AL 35283-0691

StateAbbrv: AL
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Alabama Department of Insurance
Link to Filing Website: www.eagletm.com…
Contact: Ann Strickland, Examiner
Contact Email: Ann.Strickland@insurance.alabama.gov
Contact Phone: 334-241-4154
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - Advertising Certificate of Compliance

2012-03-01T06:00:00Z

Thursday, March 1, 2012

This can be emailed to Kimberly.johnson@arkansas.gov in pdf file format only.

StateAbbrv: AR
Insurance Type: Health, LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Kimberly Johnson, Examiner
Contact Email: Kimberly.johnson@arkansas.gov
Contact Phone: 501-371-2680
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - Annual Continuation Filing Fee - Domestic SL Insurers (Form AID AC SLI-T(D))

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Mail to:

Arkansas Insurance Department
ATTN: Accounting Division
1200 W. 3rd Street
Little Rock, AR 72201-1904

State Form ID: AID AC SLI-T(D)
StateAbbrv: AR
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…(Form_AID_AC_SLI-T(D)).pdf&TableName=ICC
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Accounting Division
Contact Phone: 501-371-2605
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AR - AR Domestic Insurers Affiliated Transaction Form (Form AID FI STDR)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Domestics not subjecct to the Holding Co ACY. The original and one copy of the form should be mailed to:

Arkansas Insurance Department
Finance Division
1200 West Third Street
Little Rock, AR 72201-1904

This form may be filed electronically as a PDF file by emailing to insurance.finance@arkansas.gov. If filed electronically, the original form evidencing the original signatures should be kept on file at the Company for 5 years.

State Form ID: AID-FI-STDR
StateAbbrv: AR
Insurance Type: Health, LAH, PC, Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Kimberly Johnson, Examiner
Contact Email: Kimberly.johnson@arkansas.gov
Contact Phone: 501-371-2680
Due by Postmark or Receive Date: Receive Date
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AR - ARRUA Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

See supporting link information.

The ARRUA form collects premium information from companies holding a property license in Arkansas. It must be completed and submitted by March 1, annually. The form is available for online submission between December 15 and March 1.

StateAbbrv: AR
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Becky Harrington or Sandy Williams
Contact Email: alexa.grissom@arkansas.gov or sandyw.@amcins.com
Contact Phone: 501-371-2800 or 501-250-7400
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - Certificate of Deposit

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All foreign insurance companies who hold a certificate of authority in Arkansas are required to send under separate cover an original Certificate of Deposit from their state of domicile.

Send under separate cover to:
Arkansas Insurance Department
Attn: Malisa Landers, Securities Administrator
1200 W. Third Street
Little Rock, AR 72201-1904

StateAbbrv: AR
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact Email: Malisa.landers@arkansas.gov
Contact Phone: 501-371-2679
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - Health Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Domestic Only.

StateAbbrv: AR
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Kimberly Johnson, Examiner
Contact Email: Kimberly.johnson@arkansas.gov
Contact Phone: 501-371-2680
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AR - LAH Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Domestic Only.

StateAbbrv: AR
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Kimberly Johnson, Examiner
Contact Email: Kimberly.johnson@arkansas.gov
Contact Phone: 501-371-2680
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AR - Mandatory AR Comprehensive Health Insurance Pool Form

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All insurers shall complete the attached information form, including those insurers that do not write, or are not licensed to write, accident and health insurance premiums in Arkansas. Mail to:

Arkansas Comprehensive Health Insurance Pool
PO Box 419
Little Rock, Arkansas 72203

Overnight Delivery Address:

Hollie McLain / CHIP
c/o Mitchell, Williams,Selig, Gates & Woodyard
425 W. Capitol Avenue, Suite 1800
Little Rock, Arkansas 72201-3525

StateAbbrv: AR
Insurance Type: Health, LAH, PC, Risk Retention Group, Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Comprehensive Health Insurance Pool
Link to Filing Website: www.eagletm.com…
Contact: Hollie McLain
Contact Email: hmclain@mwlaw.com
Contact Phone: 501-688-8800, OR, 501-370-2659
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - PC Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Domestic Only.

StateAbbrv: AR
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Kimberly Johnson, Examiner
Contact Email: Kimberly.johnson@arkansas.gov
Contact Phone: 501-371-2680
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AR - Premiums to Mandatory PC Guaranty Fund Information Sheet (Form APCGF-1)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Please attach a copy of your Arkansas Business Page, legal size only.

The original signed form should be returned to the following:

Arkansas Property & Casualty Guaranty Fund
1023 West Capitol Ave, Suite 2
Little Rock, Arkansas 72201

State Form ID: APCGF-1
StateAbbrv: AR
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact Phone: 501-371-2776
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - RRG Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Domestic only.

StateAbbrv: AR
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Kimberly Johnson, Examiner
Contact Email: Kimberly.johnson@arkansas.gov
Contact Phone: 501-371-2680
Due by Postmark or Receive Date: Receive Date
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AR - Signed Jurat

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Foreign companies must file this page for Annual filing only. Document must be filed in electronic .pdf format at: Kimberly.johnson@arkansas.gov.

StateAbbrv: AR
Insurance Type: Health, LAH, PC, Risk Retention Group, Surplus Lines
Filing Period: Annual
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Kimberly Johnson, Examiner
Contact Email: Kimberly.johnson@arkansas.gov
Contact Phone: 501-371-2680
Due by Postmark or Receive Date: Receive Date
Filing Method: Electronic
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AR - SL Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Domestic Only.

StateAbbrv: AR
Insurance Type: Surplus Lines
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arkansas Insurance Department
Link to Filing Website: www.eagletm.com…
Contact: Kimberly Johnson, Examiner
Contact Email: Kimberly.johnson@arkansas.gov
Contact Phone: 501-371-2680
Due by Postmark or Receive Date: Receive Date
Filing Method: Hard Copy
Domestic/Foreign: Domestic
Link To State Checklist Manager: www.eagletm.com…

AZ - Annual Statement Filings Worksheet - Foreign and Alien Accredited Reinsurers (Form E-AR.AS)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: E-AR.AS
StateAbbrv: AZ
Insurance Type: Reinsurance
Filing Period: Annual
Link to State Form: .
State Authority: Arizona Department of Insurance, Insurance Tax Unit - Compliance Section
Link to Filing Website: www.eagletm.com…
Contact: Compliance Section
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Electronic, Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Annual Tax and Fees Report - Health Organization (Form E-HEALTHORG)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not mail this form or your payment inside your Annual Statement package. Mail your check with this report separately to Attention: Tax Unit at:

Department of Insurance State of Arizona
Insurance Tax Unit - Tax Unit
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

State Form ID: E-HEALTHORG
StateAbbrv: AZ
Insurance Type: Health
Filing Period: Annual
Link to State Form: .
State Authority: Department of Insurance, State of Arizona, Insurance Tax Unit - Tax Unit
Link to Filing Website: www.eagletm.com…
Contact Phone: 602-364-3997
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Arizona State Page

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AZ
Insurance Type: LAH, PC
Filing Period: Annual
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Arizona State Pages 29 and Supp35 or Supp72

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: AZ
Insurance Type: Health
Filing Period: Annual
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Captive Annual Report Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Department of Insurance
Captive Insurance Division
2910 North 44th Street, Suite 210
Phoenix, Arizona 85018-7269

StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Captive Insurance Division
Link to Filing Website: www.eagletm.com…
Link To State Checklist Manager: www.eagletm.com…

AZ - Certificate of Disclosure (Form E-178)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The form should be directed immediately to your executive officers or directors who are listed on the Jurat Page for notarized original signatures. Incomplete certificates will not be accepted and may result in statutory penalty per day.

Mail certificate to:

Arizona Department of Insurance
Life and Health Division
2910 North 44th Street, Suite 210
Pheonix, AZ 85018-7269

State Form ID: E-178
StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Insurance Tax Unit - Compliance Section
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Certificate of Disclosure (Form E-178Captives)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

An incomplete or late filing of the Certificate of Disclosure will subject an insurer to payment of late fees for each day of delinquency. The late fees are in addition to any other applicable penalty fee or civil penalty.

State Form ID: E-178Captive
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Captive Insurance Division
Link to Filing Website: www.eagletm.com…
Contact: Captive Insurance Division
Contact Phone: 602-364-4490
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Health Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Pages 1-4 only of this form with Column 1 and contact information completed.

State Form ID: E-NAIC.HEALTH
StateAbbrv: AZ
Insurance Type: Health
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - HIPAA Data Report and Instructions (Form HIPAA 3-1)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Must be filed if you offer health insurance coverage in the individual market. This form with Exhibits I, II and III must be sent to:

Life and Health Division, Arizona Department of Insurance
2910 North 44th Street, Suite 210
Phoenix, AZ 85019-7269

State Form ID: HIPAA 3-1
StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Life and Health Division
Link to Filing Website: www.eagletm.com…
Contact: Life and Health Division
Contact Phone: 602-364-2393
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - HIPAA Report on Earned Premium Volumes and Covered Individuals (Form HIPAA-II)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Must be filed if you offer health insurance coverage in the individual market. This form with Exhibits I, II and III must be sent to:

Life and Health Division, Arizona Department of Insurance
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

State Form ID: HIPAA II
StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Life and Health Division
Link to Filing Website: www.eagletm.com…
Contact: Life and Health Division
Contact Phone: 602-364-2393
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - HIPAA Report on Products and Marketing Materials Available to Eligible Individuals (Form HIPAA-III)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Must be filed if you offer health insurance coverage in the individual market. This form with Exhibits I, II and III must be sent to:

Life and Health Division, Arizona Department of Insurance
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

State Form ID: HIPAA III
StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Life and Health Division
Link to Filing Website: www.eagletm.com…
Contact: Life and Health Division
Contact Phone: 602-364-2393
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - HIPAA Report on Products Offered in the Individual Marketplace (Form HIPAA-I)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Must be filed if you offer health insurance coverage in the individual market. This form with Exhibits I, II and III must be sent to:

Life and Health Division, Arizona Department of Insurance
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269

State Form ID: HIPAA I
StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Life and Health Division
Link to Filing Website: www.eagletm.com…
Contact: Life and Health Division
Contact Phone: 602-364-2393
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - LAH Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Pages 1-4 only of this form with Column 1 and contact information completed.

State Form ID: E-NAIC.LD
StateAbbrv: AZ
Insurance Type: LAH
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Mortgage Guaranty Minimum Policyholders Position (Form E-MG.MPP)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All Mortgage Guaranty Insurers must file a hard copy Quarterly Statement including the Confidential Supplementary Schedule F-5 and Form E-MG.MPP.

Foreign mortgage guaranty insurers must file this report with their Form E-NAIC.PC annual filing checklist AND with their hard copy Quarterly Financial Statements.

State Form ID: E-MG.MPP
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Mortgage Guaranty Supplementary Schedule F-5 (Form E-MG.CEDE)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

All Mortgage Guaranty Insurers must file a hard copy Quarterly Statement including the Confidential Supplementary Schedule F-5 and Form E-MG.MPP.

Foreign insurers must file this report with their Form E-NAIC.PC annual filing checklist and with their hard copy Quarterly Financial Statements.

Label your Supplementary Schedule F-5 report as CONFIDENTIAL and send it to:

Arizona Department of Insurance
Insurance Tax Unit - Compliance Section
2910 North 44th Street, Sutie 210
Pheonix, AZ 85018-7269

State Form ID: E-MG.CEDE
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Insurance Tax Unit - Compliance Section
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - PC Checklist

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Pages 1-4 only of this form with Column 1 and contact information completed.

State Form ID: E-NAIC.PC
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Report of Policies Issued to Industrial Insureds (Form E-PC.INDINS)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Do not file this report if you did not issue a policy to an industrial insured.

State Form ID: E-PC.INDINS
StateAbbrv: AZ
Insurance Type: PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - RRG Annual Statement Worksheet - Foreign and Alien (Form E-RRG.AS)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

State Form ID: E-RRG.AS
StateAbbrv: AZ
Insurance Type: Risk Retention Group
Filing Period: Annual
Link to State Form: .
State Authority: Arizona Department of Insurance, Insurance Tax Unit - Compliance Section
Link to Filing Website: www.eagletm.com…
Contact: Compliance Section
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Signed Jurat

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Domestic - must have original notarized signatures of two (2) of your executive officers who are listed on your jurat page.

StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - State Filing Fees

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Annual filing fee amounts vary and are specified in Tax and Fees Report forms. Domestic companies must annually file an Accounts Letter of Qualifications. You may electronically file and pay taxes and fees via NAIC OPTins System.

Mail To:

Arizona Department of Insurance
ATTN: Tax Unit
Insurance Tax Unit
2910 North 44th Street, Suite 210
Phoenix, Arizona 85018-7269

StateAbbrv: AZ
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: Arizona Department of Insurance, Insurance Tax Unit
Link to Filing Website: www.eagletm.com…
Contact: Tony McCormack
Contact Email: AMccormack@azinsurance.gov
Contact Phone: 602-364-3245
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…

AZ - Statement and Tax Payment for the AZ Portion of a Multi State SL Transaction (Form E-159MS)

2012-03-01T06:00:00Z

Thursday, March 1, 2012

The tax payment must be payable to the Arizona Department of Insurance and must accompany the report Form E-159MS. Do not send checks and reports separately.

AZ - Survey of Arizona Domestic Insurers

2012-03-01T06:00:00Z

Thursday, March 1, 2012

This survey is required to be filed with your Annual Premium Tax and Fees Report Form.

CA - Actuarial Statement of Reserve and Pricing Adequacy for Certain Separate Account Guarantees for General Account

2012-03-01T06:00:00Z

Thursday, March 1, 2012

StateAbbrv: CA
Insurance Type: Health
Filing Period: Annual
State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit
Link to Filing Website: www.eagletm.com…
Contact: Actuarial Office
Contact Phone: 213-346-6854 or 213-346-6164
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

CA - AH Insurers-Reinsurers with WC Exposures - LAH (Form FAD151) - Excel

2012-03-01T06:00:00Z

Thursday, March 1, 2012

For insurers and reinsurers with workers' compensation exposures (Licensed for 6). For questions concerning the completion of this form, please contact the Workers' Compensation Deposit Review Team at 213-346-6433.

State Form ID: FAD151
StateAbbrv: CA
Insurance Type: Health, LAH, Reinsurance, Workers Compensation
Filing Period: Annual
Link to State Form: .
State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit
Link to Filing Website: www.eagletm.com…
Contact: Financial Records Unit
Contact Phone: 213-346-6423
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

CA - AH Insurers-Reinsurers with WC Exposures (Form FAD151) - Excel

2012-03-01T06:00:00Z

Thursday, March 1, 2012

For insurers and reinsurers with workers' compensation exposures (Licensed for 6). For questions concerning the completion of this form, please contact the Workers' Compensation Deposit Review Team at 213-346-6433.

State Form ID: FAD151
StateAbbrv: CA
Insurance Type: PC, Reinsurance, Workers Compensation
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit
Link to Filing Website: www.eagletm.com…
Contact: Financial Records Unit
Contact Phone: 213-346-6423
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

CA - Authorization for Disclosure of Financial Records (Form FAD107) - Excel

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Please use blue ink for signature(s) required. Hard copy of signature page(s) required. Send original(s) to:

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

State Form ID: FAD107
StateAbbrv: CA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit
Link to Filing Website: www.eagletm.com…
Contact: Financial Records Unit
Contact Phone: 213-346-6423
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

CA - CA Affidavit - Declaration to Valuation of Property and Securities Verification (Form FAD105) - Excel

2012-03-01T06:00:00Z

Thursday, March 1, 2012

Please use blue ink for signature(s) required. Hard copy of signature page(s) required. Send original(s) to:

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

State Form ID: FAD105
StateAbbrv: CA
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit
Link to Filing Website: www.eagletm.com…
Contact: Financial Records Unit
Contact Phone: 213-346-6423
Filing Method: Hard Copy
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

CA - Certificate of Compliance

2012-03-01T06:00:00Z

Thursday, March 1, 2012

California domestic companies are not required to file a Certificate of Compliance with CDI. Foreign and commercially domiciled companies must file a Certificate of Compliance with CDI from their state of domicile. Submit online using (OASIS) Online Assistance System for Insurer Submittals. California companies that are required to file a Certificate of Compliance with other states should contact the Legal Division to obtain a copy.

California Department of Insurance
Legal Division
Re: Certificate of Compliance
45 Fremont Street, 24th Floor
San Francisco, CA 94105
415-538-4154

StateAbbrv: CA
Insurance Type: Health, LAH, PC
Filing Period: Annual
State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit
Link to Filing Website: www.eagletm.com…
Contact: Financial Records Unit
Contact Phone: 213-346-6423
Filing Method: Hard Copy
Domestic/Foreign: Foreign
Link To State Checklist Manager: www.eagletm.com…