Insurance Compliance Center - Pro

form, return, premium, report, insurance, annual, statement, filing, quarterly, company

Central Time

This hCalendar-compliant page is optimized for search engines. View this calendar as published at iccpro.eagletm.com.

Annual Industrial Insurance Return

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NV. Domestic/Foreign: Domestic, Foreign. State Form ID: IIP. Link to State Form: http://tax.state.nv.us/documents/Industrial%20Insurance%20Annual%20%20Return%202009.pdf. Link to Filing Website: http://tax.state.nv.us/forms.htm#insuranceforms. Link to Supporting Information: FAQs: http://www.doi.state.nv.us/checklist/FAQ's_Annual_09.pdf. State Authority: Nevada Department of Taxation. Contact Email: alonnegren@tax.state.nv.us. Contact Phone: 775-684-2128. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

Annual Insurance Premiums Tax Return (Form INS-4)

Premium Tax See supporting information link. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: ME. Domestic/Foreign: Domestic, Foreign. State Form ID: INS-4. Link to State Form: http://www.maine.gov/revenue/forms/insurance/2009/%2009%20INS-4.pdf. Link to Filing Website: http://www.maine.gov/revenue/forms/insurance/2008.htm. Link to Supporting Information: Instructions: http://mainegov-images.informe.org/revenue/forms/insurance/2007/ins4inst_07.pdf. State Authority: Maine Department of Administrative and Financial Services. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

Annual Insurance Return

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NV. Domestic/Foreign: Domestic, Foreign. State Form ID: IPT. Link to State Form: http://tax.state.nv.us/documents/Annual%20Insurance%20Premium%20Tax%20Reconciliation%20Return%202009.pdf. Link to Filing Website: http://tax.state.nv.us/forms.htm#insuranceforms. Link to Supporting Information: FAQs: http://www.doi.state.nv.us/checklist/FAQ's_Annual_09.pdf. State Authority: Nevada Department of Taxation. Contact Email: alonnegren@tax.state.nv.us. Contact Phone: 775-684-2128. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

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

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: TX. Domestic/Foreign: Domestic, Foreign. State Form ID: 25-103. Link to State Form: http://www.window.state.tx.us/taxinfo/taxforms/25-103.pdf. Link to Filing Website: http://www.window.state.tx.us/taxinfo/taxforms/25-forms.html. State Authority: Texas State Comptroller. Contact Email: tax.help@cpa.state.tx.us. Contact Phone: 512-463-4600. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Application for Extension of Time to File (Form 355-7004 Misc)

Premium Tax Mail to: Massachusetts Department of Revenue PO Box 7052 Boston, MA 02204. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: MA. Domestic/Foreign: Domestic, Foreign. State Form ID: Form 355-7004 Misc. Link to State Form: http://www.mass.gov/Ador/docs/dor/Forms/Fin_Inst09/7004_Misc.pdf. Link to Filing Website: http://www.mass.gov/Ador/. State Authority: Massachusetts Department of Revenue. Contact Email: companies.mailbox@state.ma.us. Contact Phone: 617-887-6714. Filing Method: Hard Copy. Monday, March 15, 2010.

Captive Franchise Tax Return (Form CT-33-C)

Premium Tax See supporting information link. NY has fire tax due reported by municipality for PC cos. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic, Foreign. State Form ID: CT-33C. Link to State Form: http://www.tax.state.ny.us/pdf/2009/corp/ct33c_2009.pdf. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct33ci_2009.pdf. State Authority: New York Department of Taxation and Finance. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Direct Premium Request Form

Premium Tax Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: NM. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.nmmip.com/2009/2009DirectPremiumRequestForWeb.pdf. Link to Filing Website: www.nmmip.com. State Authority: New Mexico Medical Insurance Pool. Contact Email: info@nmmip.org. Contact Phone: 505-816-4248. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Domestic LAH Premium Tax Form

Premium Tax Notary required on hard copy filings. See supporting information link. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Domestic. State Form ID: MIA/P/602. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/DomesticL&H-premiumtaxform2009.pdf. Link to Filing Website: http://www.mdinsurance.state.md.us/sa/jsp/insurer/premiumTax/PremiumTaxMain.jsp. Link to Supporting Information: Instructions: http://www.mdinsurance.state.md.us/sa/documents/DomL&Hpremtaxinstruct08.pdf. State Authority: Maryland Insurance Administration. Contact Phone: 410-468-4000. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Domestic PC Premium Tax Form

Premium Tax Notary required on hard copy filings. See supporting information link. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Domestic. State Form ID: MIA/P/608. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/DomesticP&C-premiumtaxform2009.pdf. Link to Filing Website: http://www.mdinsurance.state.md.us/sa/jsp/insurer/premiumTax/PremiumTaxMain.jsp. Link to Supporting Information: Instructions: http://www.mdinsurance.state.md.us/sa/documents/DomP&Cpremtaxinstruct08.pdf. State Authority: Maryland Insurance Administration. Contact Phone: 410-468-4000. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Estimated Payment Coupon

Premium Tax Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: PA. Domestic/Foreign: Domestic, Foreign. State Form ID: REV-422. Link to Filing Website: http://www.revenue.state.pa.us. State Authority: Pennsylvania Department of Revenue. Contact Phone: 717-783-6031 Option 3. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Estimated Premiums Tax Payment Coupon - Domestic

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CT. Domestic/Foreign: Domestic. State Form ID: 207ESA, 207ESB, 207ESC, 207ESD. Link to State Form: http://www.ct.gov/drs/lib/drs/forms/2010forms/publicserv/form207es.pdf. Link to Filing Website: http://www.ct.gov/drs/site/default.asp. State Authority: Department of Revenue Services, State of Connecticut. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Estimated Premiums Tax Payment Coupon - Foreign and Nonresident

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CT. Domestic/Foreign: Foreign. State Form ID: 207FESA, 207FESB, 207FESC, 207FESD. Link to State Form: http://www.ct.gov/drs/lib/drs/forms/2010forms/publicserv/form207fes.pdf. Link to Filing Website: http://www.ct.gov/drs/site/default.asp. State Authority: Department of Revenue Services, State of Connecticut. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Estimated Tax for Corporations (Form CT-400-MN)

Premium Tax NY has fire tax due reported by municipality for PC cos. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic, Foreign. State Form ID: CT-400-MN. Link to State Form: http://www.tax.state.ny.us/pdf/current_forms/ct/ct400mn_fill_in.pdf. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct400i_409.pdf Pay electronically: www.nystax.gov. State Authority: New York Department of Taxation and Finance. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Fire Investigation and Prevention Tax Annual Return (Form INS-5)

Premium Tax Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: ME. Domestic/Foreign: Domestic, Foreign. State Form ID: INS-5. Link to State Form: http://www.maine.gov/revenue/forms/insurance/2009/%2009%20INS-5.pdf. Link to Filing Website: http://www.maine.gov/revenue/forms/insurance/2008.htm. State Authority: Maine Department of Administrative and Financial Services. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

Fire Marshal Tax Return

Premium Tax Need Corp Income and Replacement tax paid or Unitary form. IL has Municipal Fire Tax Reporting for PC cos. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: IL. Domestic/Foreign: Domestic, Foreign. State Form ID: IL446-0124. Link to State Form: http://insurance.illinois.gov/form/tax2009/firemarshaltaxreturn.pdf. Link to Filing Website: www.idfpr.com. State Authority: Illinois Department of Financial and Professional Regulation. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-782-4515. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

Foreign LAH Premium Tax Form

Premium Tax Notary required on hard copy filings. See supporting information link. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Foreign. State Form ID: MIA/P/603. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/ForeignL&H-premiumtaxform2009.pdf. Link to Filing Website: http://www.mdinsurance.state.md.us/sa/jsp/insurer/premiumTax/PremiumTaxMain.jsp. Link to Supporting Information: Instructions: http://www.mdinsurance.state.md.us/sa/documents/ForL&Hpremtaxinstruct08.pdf. State Authority: Maryland Insurance Administration. Contact Phone: 410-468-4000. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Foreign PC Premium Tax Form

Premium Tax Notary required on hard copy filings. See supporting information link. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Foreign. State Form ID: MIA/P/603. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/ForeignP&C-premiumtaxform2009.pdf. Link to Filing Website: http://www.mdinsurance.state.md.us/sa/jsp/insurer/premiumTax/PremiumTaxMain.jsp. Link to Supporting Information: Instructions: http://www.mdinsurance.state.md.us/sa/documents/ForP&Cpremtaxinstruct08.pdf. State Authority: Maryland Insurance Administration. Contact Phone: 410-468-4000. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Gross Premium Estimated Tax Voucher (Form T69-ESINS)

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: RI. Domestic/Foreign: Domestic, Foreign. State Form ID: T69-ESINS. Link to State Form: http://www.tax.ri.gov/forms/2009/Other%20Corp/2010%20T69-ESINS.pdf. Link to Filing Website: http://www.tax.ri.gov/taxforms/corporate.php. State Authority: Rhode Island Department of Taxation. Contact Email: clarocque@tax.ri.gov. Contact Phone: 401-222-6265. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic, Hard Copy. Payment Method: EFT Payment accepted. Monday, March 15, 2010.

Gross Premium Tax Return - HMO (Form IB-63)

Premium Tax See supporting information link. Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: NC. Domestic/Foreign: Domestic, Foreign. State Form ID: IB-63. Link to State Form: http://www.dornc.com/downloads/ib63.pdf. Link to Filing Website: http://www.dor.state.nc.us. Link to Supporting Information: Instructions: http://www.dor.state.nc.us/downloads/forms_insurance.php?url=ib63.pdf. State Authority: North Carolina Department of Revenue. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Gross Premium Tax Return - LAH (Form IB-13)

Premium Tax Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: NC. Domestic/Foreign: Domestic, Foreign. State Form ID: IB-13. Link to State Form: http://www.dor.state.nc.us/downloads/ib13.pdf. Link to Filing Website: http://www.dor.state.nc.us. State Authority: North Carolina Department of Revenue. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Gross Premium Tax Return - PC (Form IB-33)

Premium Tax Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: NC. Domestic/Foreign: Domestic, Foreign. State Form ID: IB-33. Link to State Form: http://www.dor.state.nc.us/downloads/ib33.pdf. Link to Filing Website: http://www.dor.state.nc.us. State Authority: North Carolina Department of Revenue. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Gross Premium Tax Return - RPG (Form IB-83)

Premium Tax Insurance Type: Risk Purchasing Group. Filing Period: Qtr 1. StateAbbrv: NC. Domestic/Foreign: Domestic, Foreign. State Form ID: IB-83. Link to State Form: http://www.dornc.com/downloads/ib83.pdf. Link to Filing Website: http://www.dornc.com/. State Authority: North Carolina Department of Revenue. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Payment Method: Check or Money Order. Monday, March 15, 2010.

HCC Estimated Tax Payment Coupon

Premium Tax Complete in blue or black ink only. Mail To: Department of Revenue Services Processing Section PO Box 2990 Hartford CT 06104-2990. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: CT. Domestic/Foreign: Domestic, Foreign. State Form ID: 207 HCC ESA. Link to State Form: http://www.ct.gov/drs/lib/drs/forms/2010forms/publicserv/form207hcces.pdf. Link to Filing Website: http://www.ct.gov/drs/site/default.asp. State Authority: Department of Revenue Services, State of Connecticut. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: Checks payable to: Commissioner of Revenue Services. Monday, March 15, 2010.

Health HMO and Delta Dental Licensed Companies Electronic Premium Tax files

Premium Tax See supporting information link. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: NH. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.nh.gov/insurance/companies/premiumtax/documents/elect_med_2009.xls. Link to Filing Website: http://www.nh.gov/insurance/. Link to Supporting Information: Instructions: http://www.nh.gov/insurance/companies/premiumtax/documents/instruct_med_2008.pdf. State Authority: New Hampshire Insurance Department. Contact Email: janet.colby@ins.nh.gov. Contact Phone: 603-271-7973 Ext 212. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

HMO and MCO Premium Tax Form

Premium Tax See supporting information link. Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Domestic, Foreign. State Form ID: MIA/P/608/12-05. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/HMO-premiumtaxform2009.pdf. Link to Filing Website: http://www.mdinsurance.state.md.us/sa/jsp/insurer/premiumTax/PremiumTaxMain.jsp. Link to Supporting Information: Instructions: http://www.mdinsurance.state.md.us/sa/documents/HMOMCOpremtaxinstruct08.pdf. State Authority: Maryland Insurance Administration. Contact Phone: 410-468-4000. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Installment Tax Report (Form E-INSTALLMENT TAX)

Premium Tax Arizona Department of Insurance Financial Affairs Division – Tax Unit 2910 North 44th Street Suite 210 Phoenix, Arizona 85018-7269. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. State Form ID: E-INSTALLMENT TAX. Link to State Form: http://www.id.state.az.us/forms/tax_forms/E-INSTALLMENT_TAX.pdf. Link to Filing Website: www.id.state.az.us. State Authority: Department of Insurance, State of Arizona, Financial Affairs Division - Tax Unit. Contact Email: jbittner@azinsurance.gov. Contact Phone: 602-364-3997. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: Check payable to: Arizona Department of Insurance. Monday, March 15, 2010.

Insurance Corporation MTA Surcharge Return (Form CT-33-M)

Premium Tax NY has fire tax due reported by municipality for PC cos. Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic, Foreign. State Form ID: CT-33M. Link to State Form: http://www.tax.state.ny.us/pdf/2009/corp/ct33m_2009.pdf. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct33mi_2009.pdf. State Authority: New York Department of Taxation and Finance. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Insurance Estimated Tax - HMO (Form M27)

Premium Tax Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: MN. Domestic/Foreign: Domestic, Foreign. State Form ID: M27. Link to State Form: http://www.taxes.state.mn.us/taxes/special/insurance/forms/m27_web.pdf. Link to Filing Website: http://www.taxes.state.mn.us/. Link to Supporting Information: Instructions: http://www.taxes.state.mn.us/taxes/special/insurance/instructions/insurance_est_inst.pdf. State Authority: Minnesota Department of Revenue. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-297-1772. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

Insurance Estimated Tax (Form M19)

Premium Tax See supporting information link. Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: MN. Domestic/Foreign: Domestic, Foreign. State Form ID: M19, On-line. Link to State Form: http://www.taxes.state.mn.us/taxes/special/insurance/forms/m19_web.pdf. Link to Filing Website: http://www.taxes.state.mn.us/. Link to Supporting Information: Instructions: http://www.taxes.state.mn.us/taxes/special/insurance/instructions/insurance_est_inst.pdf. State Authority: Minnesota Department of Revenue. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-297-1772. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Monday, March 15, 2010.

LAH Combined Franchise Tax Return - Attachment to Form CT-33-A (Form CT-33-A-ATT)

Premium Tax See supporting information link. NY has fire tax due reported by municipality for PC cos. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic, Foreign. State Form ID: CT-33A-ATT. Link to State Form: http://www.tax.state.ny.us/pdf/2009/corp/ct33a_att_2009.pdf. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct33ai_2009.pdf. State Authority: New York Department of Taxation and Finance. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

LAH Combined Franchise Tax Return (Form CT-33-A)

Premium Tax See supporting information link. NY has fire tax due reported by municipality for PC cos. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic, Foreign. State Form ID: CT-33A. Link to State Form: http://www.tax.state.ny.us/pdf/2009/corp/ct33a_2009.pdf. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct33ai_2009.pdf. State Authority: New York Department of Taxation and Finance. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

LAH Franchise Tax Return (Form CT-33)

Premium Tax See supporting information link. NY has fire tax due reported by municipality for PC cos. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic, Foreign. State Form ID: CT-33. Link to State Form: http://www.tax.state.ny.us/pdf/2009/corp/ct33_2009.pdf. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct33i_2009.pdf. State Authority: New York Department of Taxation and Finance. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

LAH Licensed Companies Electronic Premium Tax Files

Premium Tax Notary Required. See supporting information link. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: NH. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.nh.gov/insurance/companies/premiumtax/documents/elect_life_2009.xls. Link to Filing Website: http://www.nh.gov/insurance/. Link to Supporting Information: Instructions: http://www.nh.gov/insurance/companies/premiumtax/documents/instruct_life_2008.pdf. State Authority: New Hampshire Insurance Department. Contact Email: janet.colby@ins.nh.gov. Contact Phone: 603-271-7973 Ext 212. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

Non-Life Franchise Tax Return (Form CT-33-NL)

Premium Tax See supporting information link. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic, Foreign. State Form ID: CT-33-NL. Link to State Form: http://www.tax.state.ny.us/pdf/2009/corp/ct33nl_2009.pdf. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct33nli_2009.pdf NY has fire tax due reported by municipality for PC cos. State Authority: New York Department of Taxation and Finance. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Ocean Marine Profits Tax Form

Premium Tax Notary required on hard copy filings. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Domestic, Foreign. State Form ID: MIA/P/609. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/oceanMarine.pdf. Link to Filing Website: http://www.mdinsurance.state.md.us/sa/jsp/insurer/premiumTax/PremiumTaxMain.jsp. State Authority: Maryland Insurance Administration. Contact Phone: 410-468-4000. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

PC Licensed Companies Electronic Premium Tax Files

Premium Tax Notary Required. See supporting information link. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: NH. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.nh.gov/insurance/companies/premiumtax/documents/elect_pc_2009.xls. Link to Filing Website: http://www.nh.gov/insurance/. Link to Supporting Information: Instructions: http://www.nh.gov/insurance/companies/premiumtax/documents/instruct_pc_2008.pdf. State Authority: New Hampshire Insurance Department. Contact Email: janet.colby@ins.nh.gov. Contact Phone: 603-271-7973 Ext 212. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

Premium Excise Return - Insurance Companies (Form 63-23P)

Premium Tax See supporting information link. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: MA. Domestic/Foreign: Domestic, Foreign. State Form ID: 63-23P. Link to State Form: http://www.mass.gov/Ador/docs/dor/Forms/Fin_Inst09/63_23P.pdf. Link to Filing Website: www.mass.gov. Link to Supporting Information: Instructions: http://www.mass.gov/Ador/docs/dor/Forms/Fin%20Inst08/63_23Pin.pdf. State Authority: Massachusetts Department of Revenue. Contact Email: companies.mailbox@state.ma.us. Contact Phone: 617-887-6714. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Premium Excise Return - LAH (Form 63-20P)

Premium Tax See supporting information link. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: MA. Domestic/Foreign: Domestic, Foreign. State Form ID: 63-20P. Link to State Form: http://www.mass.gov/Ador/docs/dor/Forms/Fin_Inst09/63_20P.pdf. Link to Filing Website: www.mass.gov. Link to Supporting Information: Instructions: http://www.mass.gov/Ador/docs/dor/Forms/Fin%20Inst08/63_20Pin.pdf. State Authority: Massachusetts Department of Revenue. Contact Email: companies.mailbox@state.ma.us. Contact Phone: 617-887-6714. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Privilege and Retaliatory Tax Return - Health (Form IL446-0126-H)

Premium Tax Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: IL. Domestic/Foreign: Domestic, Foreign. State Form ID: IL446-0126-H. Link to State Form: http://insurance.illinois.gov/form/tax2009/HMOtaxreturn.pdf. Link to Filing Website: www.idfpr.com. State Authority: Illinois Department of Financial and Professional Regulation. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-782-4515. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Privilege and Retaliatory Tax Return - LAH (Form IL446-0126-L)

Premium Tax Need Corp Income and Replacement tax paid or Unitary form. IL has Municipal Fire Tax Reporting for PC cos. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: IL. Domestic/Foreign: Domestic, Foreign. State Form ID: IL446-0126-L. Link to State Form: http://insurance.illinois.gov/form/tax2009/Lifetaxreturn.pdf. Link to Filing Website: www.idfpr.com. State Authority: Illinois Department of Financial and Professional Regulation. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-782-4515. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Privilege and Retaliatory Tax Return - PC (Form IL446-0126-P)

Premium Tax Need Corp Income and Replacement tax paid or Unitary form. IL has Municipal Fire Tax Reporting for PC cos. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: IL. Domestic/Foreign: Domestic, Foreign. State Form ID: IL446-0126-P. Link to State Form: http://insurance.illinois.gov/form/tax2009/PCtaxreturn.pdf. Link to Filing Website: www.idfpr.com. State Authority: Illinois Department of Financial and Professional Regulation. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-782-4515. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Privilege and Retaliatory Tax Return - RRG (Form IL446-0126-R)

Premium Tax Need Corp Income and Replacement tax paid or Unitary form. IL has Municipal Fire Tax Reporting for PC cos. Insurance Type: Risk Retention Group. Filing Period: Qtr 1. StateAbbrv: IL. Domestic/Foreign: Domestic, Foreign. State Form ID: IL446-0126-R. Link to State Form: http://insurance.illinois.gov/form/tax2009/RRGtaxreturn.pdf. Link to Filing Website: www.idfpr.com. State Authority: Illinois Department of Financial and Professional Regulation. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-782-4515. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

RRG Licensed Companies Electronic Premium Tax Files

Premium Tax See supporting information link. Insurance Type: Risk Retention Group. Filing Period: Qtr 1. StateAbbrv: NH. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.nh.gov/insurance/companies/premiumtax/documents/elect_rrg_2009.xls. Link to Filing Website: http://www.nh.gov/insurance/. Link to Supporting Information: Instructions: http://www.nh.gov/insurance/companies/premiumtax/documents/instruct_med_2008.pdf. State Authority: New Hampshire Insurance Department. Contact Email: janet.colby@ins.nh.gov. Contact Phone: 603-271-7973 Ext 212. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

SL Premium Tax Annual Return (Form INS-7)

Premium Tax Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: ME. Domestic/Foreign: Domestic, Foreign. State Form ID: INS-7. Link to State Form: http://www.maine.gov/revenue/forms/insurance/2009/09_INS-7.pdf. Link to Filing Website: http://www.maine.gov/revenue/forms/insurance/2008.htm. State Authority: Maine Department of Administrative and Financial Services. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Monday, March 15, 2010.

Underpayment of Estimated Tax by a Corporation (Form CT-222)

Premium Tax See supporting information link. NY has fire tax due reported by municipality for PC cos. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic, Foreign. State Form ID: CT-222. Link to State Form: http://www.tax.state.ny.us/pdf/2009/corp/ct222_2009.pdf. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct222i_2009.pdf. State Authority: New York Department of Taxation and Finance. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Monday, March 15, 2010.

Actuarial Opinion

State Required Filings Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Foreign. Link to Filing Website: http://www.fslso.com/software/filingreq.aspx?o=ins. Link to Supporting Information: Instructions: http://www.fslso.com/software/insurer/2009.Foreign.Due.Dates.pdf Procedures manual: http://www.fslso.com/publications/manuals/Insurer.Procedures.Manual.pdf http://www.fslso.com/software/filingreq.aspx?o=ins. State Authority: Florida Surplus Lines Service Office (FSLSO). Contact Email: gpullen@fslso.com. Contact Phone: 800-562-4496. Filing Method: Hard Copy. Monday, March 15, 2010.

Actuarial Opinion Summary

State Required Filings Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: VA. Domestic/Foreign: Domestic. Link to Filing Website: http://www.scc.virginia.gov/. State Authority: Virginia Bureau of Insurance, Financial Regulation Division. Contact Email: karen.traylor@scc.virginia.gov. Contact Phone: 804-371-9908. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): N/A. Monday, March 15, 2010.

Annual Grievance Report (EForm - 1899)

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: SD. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.sd.us/drr2/reg/insurance/companies/non1899V2-GrievanceReport.pdf. Link to Filing Website: http://www.state.sd.us/drr2/reg/insurance/index.html. State Authority: South Dakota Division of Insurance. Contact Email: insurance@state.sd.us. Contact Phone: 605-692-4300. Filing Method: Hard Copy, Electronic. Monday, March 15, 2010.

Annual Statutory Financial Statement

State Required Filings See supporting information link. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Foreign. Link to Filing Website: http://www.elany.org/. Link to Supporting Information: Instructions: http://www.elany.org/lexicon-click.aspx?LT=0&H=16&T=373&D=D369. State Authority: Excess Line Association of New York (ELANY). Contact Email: rschlesinger@elany.org. Contact Phone: 646-292-5575. Monday, March 15, 2010.

Certification of Compliance with Regulation 41

Claims Payment Report Form

State Required Filings The Prompt Pay Act of 2002” (DC Code §31-3135) which went into effect on July 23, 2002 requires that health insurers file a claims payment report with the Commissioner no later than March 15th of each year. This is an electronic filing. Please refer to the DISB website for the Claims Payment Report form. The Report should only be filed by companies that write health insurance as defined in DC Official Code Title 31, Chapter 33, § 3301.01. A zero report is required from those writing health insurance but have no claims. A copy of the statute is attached to the Claims Payment Report form on the DISB website. Contact person: Alvin James, Financial Economist at (202) 442-7772. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: DC. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://disb.dc.gov/disr/cwp/view,a,1299,q,577321.asp. Link to Filing Website: http://disr.dc.gov/disr/site/default.asp?disrNav=|32801|. State Authority: DC Department of Insurance, Securities and Banking. Contact Email: janice.gordon@dc.gov. Contact Phone: 202-442-7783. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Comprehensive Annual Analysis Checklist

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: SC. Domestic/Foreign: Domestic. Link to State Form: http://www.doi.sc.gov/NR/rdonlyres/672C7CA9-607E-47F9-B71B-EBCE7D1150FD/0/ComprehensiveQuarterlyAnalysisInstructionsandChecklist.pdf. Link to Filing Website: https://www.doi.sc.gov/Index.aspx. State Authority: South Carolina Department of Insurance. Contact Email: tcampbell@doi.sc.gov. Contact Phone: 803-737-6109. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Current license or Certificate of Authority

Current Reinsurance Program Summary

Disclosure of Material Transactions (Form FAD26) - Excel

State Required Filings Every 15th of the Month (when applicable) MS-Excel and Adobe PDF See Appendix A Effective for 2008 filings You are not required to file an electronic copy of a document with the California State Department of Insurance if there is no entry in column 5 for the document in question. Submit an electronic copy of the documents on a single CD, using the formats prescribed in column 5 of the checklist. See APPENDIX A for further instructions on electronic filing requirement. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic. State Form ID: FAD26. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/forms/upload/FAD026-ABC_Disclosure_Material_Tranactions.xls. Link to Filing Website: www.insurance.ca.gov. Link to Supporting Information: Notice: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/disclosure-of-material-transaction.cfm. State Authority: California Department of Insurance, Financial Analysis Division, Financial Records Unit. Contact Email: Financial_Records@Insurance.CA.Gov. Contact Phone: 213-346-6423. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to NAIC (Foreign Insurer): 0. Paper Size: Letter size; Orientation: Portrait. Monday, March 15, 2010.

EL-1 Report

Holding Company Registration Statement

State Required Filings Mail to: Indiana Department of Insurance Attn: Financial Services 311 W Washington St, Suite 300 Indianapolis, IN 46204-2787 Must have original signature and original notarization. Statement shall be verified by the oaths of the president or a vice president and the secretary or an assistant secretary of the company, per IC 27-1-20-21. Only one copy needs to be filed - not 3. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: IN. Domestic/Foreign: Domestic. State Form ID: B & C. Link to Filing Website: www.in.gov. State Authority: Indiana Department of Insurance (IDOI), Financial Services. Contact Phone: 317-232-1369 or 317-232-5246. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): n/a. Monday, March 15, 2010.

Holding Company Registration Statement & Summary of Registration Statement

State Required Filings Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: HI. Domestic/Foreign: Domestic. State Form ID: B & C. Link to Filing Website: www.hawaii.gov. State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division. Contact Email: InsExam@dcca.hawaii.gov. Contact Phone: 808-586-7382. Due by Postmark or Receive Date: Verify with state. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Holding Company Summary of Registration Statement (Form C)

State Required Filings Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: VT. Domestic/Foreign: Domestic. State Form ID: C. Link to State Form: http://www.bishca.state.vt.us/sites/default/files/FORM_C.pdf. Link to Filing Website: www.bishca.state.vt.us. State Authority: Vermont Insurance Division - Department of Banking, Insurance, Securities and Health Care Administration. Contact Email: CompLic@bishca.state.vt.us. Contact Phone: 802-828-2470. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): xxx. Monday, March 15, 2010.

Holding Company System Annual Registration Statement (Form B)

State Required Filings Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: VT. Domestic/Foreign: Domestic. State Form ID: B. Link to State Form: http://www.bishca.state.vt.us/sites/default/files/FORM_B.pdf. Link to Filing Website: www.bishca.state.vt.us. State Authority: Vermont Insurance Division - Department of Banking, Insurance, Securities and Health Care Administration. Contact Email: CompLic@bishca.state.vt.us. Contact Phone: 802-828-2470. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): xxx. Monday, March 15, 2010.

Iowa Comprehensive Health Association Survey

State Required Filings Mail to: Iowa Comprehensive Health Association Att: Assessment & Survey Division PO Box 1090 Grent Bend, KS 67530. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: IA. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://hipiowa.com/docs/survey_icha_2008.pdf. Link to Filing Website: http://hipiowa.com/download_forms.asp. State Authority: Iowa Comprehensive Health Association, Assessment & Survey Division. Contact Email: cremmert@benefitmanagementks.com. Contact Phone: (800) 290-1368 ext. 1011. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

Iowa Individual Health Benefit Reinsurance Association Packet

State Required Filings Mail to: Iowa Individual Health Benefit Reinsurance Association c/o Nyemaster Law Firm 700 Walnut, Suite 1600 Des Moines, IA 50309. Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: IA. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.iid.state.ia.us/docs/2009iihbra.pdf. Link to Filing Website: www.iid.state.ia.us. State Authority: Iowa Individual Health Benefit Reinsurance Association. Contact Phone: 515-283-3172. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

LAH Filing - Annual Small Employer Carrier Form

State Required Filings Insurance Type: LAH. Filing Period: Annual. StateAbbrv: DE. Domestic/Foreign: Domestic. Link to State Form: http://delawareinsurance.gov/departments/berg/Rate/SmallEmployerHealthPlanReportForm.pdf. Link to Filing Website: http://delawareinsurance.gov/. Link to Supporting Information: http://delawareinsurance.gov/departments/berg/Rate/Memo_RequiredAnnualFilingSmallEmploy.pdf. State Authority: Delaware Insurance Department - Linda Nemes. Contact Email: Linda.Nemes@state.de.us. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Monday, March 15, 2010.

List of all State and Territories

Quarterly Report of Subscriber Grievances (Form ACHA 3160-0006)

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic. State Form ID: ACHA 3160-0006. Link to State Form: http://www.fdhc.state.fl.us/MCHQ/Consumer/SPSAP/quarterly_report.pdf. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Monday, March 15, 2010.

Quarterly Statement Sent Directly From The Trustee Bank

Rate Adjustment and Second Injury Fund Assessment Transmittal Form

State Required Filings Make checks payable to the Illinois State Treasurer. Please return the attached transmittal form with payment to: Fiscal Office Illinois Workers’ Compensation Commission 100 W. Randolph St Ste 8-329 Chicago, IL 60601. Insurance Type: PC, Workers Compensation. Filing Period: Qtr 1. StateAbbrv: IL. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.iwcc.il.gov/RAFSIFFORM.doc. Link to Filing Website: www.iwcc.il.gov. Link to Supporting Information: Cover Letter: http://www.iwcc.il.gov/RAF-SIF-Letter.doc. State Authority: Illinois Workers' Compensation Commission. Contact Email: bettie.gong@illinois.gov. Contact Phone: 312-814-6625. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: Check. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings File if applicable. The company, or its representative (e.g. its CPA firm), is expected to provide the form based upon the appropriate state instructions or the NAIC Annual Statement Instructions. Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: KS. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.ksinsurance.org/industry/index.htm. State Authority: Kansas Department of Insurance. Contact Email: Health: ljshep@ksinsurance.orgnLAH: dmhaver@ksinsurance.org. Contact Phone: 785-296-7895. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings This summary is required by 760 IAC 1-57-9(e) for all companies licensed as life and fraternal companies. The requirements of the filing are described in 760 IAC 1-57-9(h). Domestic Companies are required to submit hard copies. Foreign Companies please email to adenton@idoi.in.gov with NAIC#, and name of company on the subject line. In the body of the email please include a contact person, their email address and phone number. Please include summary as attachment to the email. All foreign HMOs and LSHMOs must file like an Indiana Domestic HMO or LSHMO, as indicated on the health checklist, under the domestic column. All foreign companies filing on the Health blank, other than HMOs or LSHMOs, must file as indicated on the health checklist, under the foreign column. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: IN. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.in.gov. State Authority: Indiana Department of Insurance (IDOI), Financial Services. Contact Email: adenton@idoi.in.gov. Contact Phone: 317-232-1369. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings In accordance with G.S. 58-58-50(j), each domestic and foreign company’s appointed actuary must submit this summary as specified in NCAC 11F.0307. The contents of this Summary are described in 11 NCAC 11F.0307(c) and (d). Please note that 11F.0307(c)(6) refers to options in liabilities as well as to options in assets. The RAAIS is a confidential document and should be sent under separate cover or emailed to: Mr. Bob Potter, Actuarial Division 1201 Mail Service Center Raleigh, NC 27699-1201 (919) 733-3284 or Rpotter@ncdoi.net. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: NC. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.ncdoi.com. State Authority: North Carolina Department of Insurance, Actuarial Division. Contact Email: Brenda.young@ncdoi.gov. Contact Phone: 919-424-6276. Due by Postmark or Receive Date: Receive. Filing Method: Electronic, Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): n/a. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings This summary is required by 760 IAC 1-57-9(e) for all companies licensed as life and fraternal companies. The requirements of the filing are described in 760 IAC 1-57-9(h). Domestic Companies are required to submit hard copies. Foreign Companies please email to adenton@idoi.in.gov with NAIC#, and name of company on the subject line. In the body of the email please include a contact person, their email address and phone number. Please include summary as attachment to the email. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: IN. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.in.gov. State Authority: Indiana Department of Insurance (IDOI), Financial Services. Contact Email: adenton@idoi.in.gov. Contact Phone: 317-232-1369. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic, Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): EO. # of Copies to NAIC (Domestic Insurer): N/A. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.floir.com. State Authority: Florida Office of Insurance Regulation. Contact Email: kerry.krantz@floir.com. Contact Phone: 850-413-3153. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): xxx. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: WI. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://oci.wi.gov/. Link to Supporting Information: Bulletin: OCI Bulletin: http://oci.wi.gov/bulletin/1105raais.htm. State Authority: Wisconsin Office of the Commissioner of Insurance. Contact Email: jerry.dearmond@oci.state.wi.us. Contact Phone: 608-267-3558. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: CO. Domestic/Foreign: Domestic. Link to Filing Website: http://www.dora.state.co.us/insurance. State Authority: Colorado Division of Insurance. Contact Email: scott.lloyd@dora.state.co.us. Contact Phone: 303-894-7537. Due by Postmark or Receive Date: Receive. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings As required by California Insurance Code 10506.4(d)(1)(b). Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.insurance.ca.gov. State Authority: California Department of Insurance, Financial Analysis Division, Actuarial Office. Contact Email: Financial_Records@Insurance.CA.Gov. Contact Phone: 213-346-6854. Due by Postmark or Receive Date: Postmark. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings Mailing address: Iowa Insurance Division 330 Maple Street Des Moines, IA 50319-0065 Bar codes (State or NAIC): Please follow the instructions in the NAIC Annual Statement Instructions. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: IA. Domestic/Foreign: Domestic. Link to Filing Website: www.iid.state.ia.us. State Authority: Iowa Insurance Division. Contact Email: Alan.Harder@iid.iowa.gov. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): xxx. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings Mail to: Office of the Insurance Commissioner 600 East Boulevard Avenue, Dept. 401 Bismarck, ND 58505. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: ND. Domestic/Foreign: Domestic. Link to Filing Website: www.nd.gov. State Authority: North Dakota Insurance Department. Contact Email: insurance@nd.gov. Contact Phone: 701-328-3328. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: VA. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.scc.virginia.gov/. State Authority: Virginia Bureau of Insurance, Financial Regulation Division. Contact Email: karen.traylor@scc.virginia.gov. Contact Phone: 804-371-9908. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Monday, March 15, 2010.

Regulatory Asset Adequacy Issues Summary

State Required Filings LAH confidential filing - Mail separately from Annual Statement See Notes P,AL Filed with Texas only. Mail to: Texas Department of Insurance Actuarial Division MC302-3A 333 Guadalupe St. Austin TX 78701 OR electronically to ActuarialDivision@tdi.state.tx.us. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: TX. Domestic/Foreign: Domestic. Link to Filing Website: www.tdi.state.tx.us. State Authority: Texas Department of Insurance, Financial Analysis and Examinations. Contact Email: kristine.ehrlich@tdi.state.tx.us. Contact Phone: 512-322-3507. Filing Method: Hard Copy, Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): N/A. Monday, March 15, 2010.

Review of the asset quality of the investment portfolio

SL Filing instructions

State Required Filings Companies initiating filings after the April 30th due date will not be included in the current review process. Insurance Type: Surplus Lines. StateAbbrv: NH. Domestic/Foreign: Domestic. Link to State Form: http://www.nh.gov/insurance/companies/surpluslines/documents/surplusapp.pdf. Link to Filing Website: http://www.nh.gov/. State Authority: NEW HAMPSHIRE INSURANCE DEPARTMENT. Contact Email: Mary.Verville@ins.nh.gov. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Payment Method: Check. # of Copies to State (Foreign Insurer): 0. # of Copies to State (Domestic Insurer): 1. Monday, March 15, 2010.

SL Filing Requirements for Continuing Eligibility - Alien

State Required Filings Current license or Certificate of Authority Quarterly Statement sent Directly From the Trustee Bank Trust Fund Minimum Amount Calculation EL-1 Report Certification of Compliance with Regulation 41 A Three Year Forward Business Plan Current Reinsurance Program Summary States and territories where eligible Review of the asset quality of the investment portfolio. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: NY. Link to Filing Website: http://www.elany.org/lexicon-click.aspx?LT=0&H=16&T=406&D=D5. State Authority: Excess Line Association of New York (ELANY). Contact Email: rschlesinger@elany.org. Contact Phone: 646-292-5575. Monday, March 15, 2010.

Small Group Market Data and Experience Report

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AL. Link to State Form: http://www.aldoi.gov/Excel/Companies/MarketDataReport.xls. Link to Filing Website: http://www.aldoi.gov/Companies/Forms.aspx. State Authority: Alabama Department of Insurance. Contact Email: Ann.Strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Monday, March 15, 2010.

State Filing Fees

State Required Filings Mail to: 21 South Fruit Street, Suite 14, Concord NH 03301 ATTN: Janet Colby. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NH. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.nh.gov. State Authority: New Hampshire Insurance Department. Contact Email: Mary.Verville@ins.nh.gov. Contact Phone: 603-271-7973. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Statement of Premiums Derived from WC Insurance - WC Special Fund Levy (Form 315)

State Required Filings Only insurers reporting workers' compensation gross premiums written are required to file Form 315. If gross premiums are zero, do not file this form. Make checks payable to: Department of Commerce and Consumer Affairs (DCCA), State of Hawaii. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: HI. Domestic/Foreign: Domestic, Foreign. State Form ID: Form 315. Link to State Form: http://hawaii.gov/dcca/ins/insurers/annual-filing-instructions-and-tax-forms/Form_315-2009.pdf. Link to Filing Website: www.hawaii.gov. State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division. Contact Email: shansen@dcca.hawaii.gov. Contact Phone: 808-586-7381. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Monday, March 15, 2010.

Statement of Premiums Derived from Workers Compensation Insurance Issued During the Year for Workers Compensation Special Compensation Fund

State Required Filings To be filed only if insurer has Workers Compensation premiums - If the premiums are zero the form is not required. This form requires an original signature by a duly authorized office of the Company. Make checks payable to: Department of Commerce and Consumer Affairs, State of Hawaii or DCCA, State of Hawaii unless otherwise noted on the form. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: HI. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.hawaii.gov. State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division. Contact Email: shansen@dcca.hawaii.gov. Contact Phone: 808-586-7381. Due by Postmark or Receive Date: Postmark. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Monday, March 15, 2010.

Three Year Forward Business Plan

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

Premium Tax Insurance Type: PC. Filing Period: Monthly. StateAbbrv: KY. Domestic/Foreign: Domestic, Foreign. State Form ID: 74A117. Link to State Form: http://revenue.ky.gov/NR/rdonlyres/42747390-50FF-4199-A93B-6D5362600794/0/74A117.pdf. Link to Filing Website: http://revenue.ky.gov/forms/curyrfrms.htm. State Authority: Commonwealth of Kentucky, Department of Revenue. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Saturday, March 20, 2010.

Monthly Insurance Surcharge Report (Form 74A118)

Premium Tax Insurance Type: PC. Filing Period: Monthly. StateAbbrv: KY. Domestic/Foreign: Domestic, Foreign. State Form ID: 74A118. Link to State Form: http://revenue.ky.gov/NR/rdonlyres/8241E817-AFC0-4D1A-8493-9788793775F5/0/74A118.pdf. Link to Filing Website: http://revenue.ky.gov/forms/curyrfrms.htm. State Authority: Commonwealth of Kentucky, Department of Revenue. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Saturday, March 20, 2010.

Quarterly Premium Tax Return - RRG (Form GID-215-PT)

Premium Tax Insurance Type: Risk Retention Group. Filing Period: Qtr 1. StateAbbrv: GA. Domestic/Foreign: Domestic. State Form ID: GID-FO-PT-2. Link to State Form: http://www.gainsurance.org/ExternalResources/Forms/Premium%20Tax%20-%20Surplus%20Lines%20and%20Other%20Forms/Risk%20Retention%20Groups%20(Rev%2003-08)%20%20(Interactive).pdf. Link to Filing Website: http://www.gainsurance.org/home.aspx. State Authority: Departments of Revenue, Insurance and Community Affairs. Contact Email: premiumtax@oci.ga.gov. Contact Phone: 404-656.7553. Due by Postmark or Receive Date: Receive. Saturday, March 20, 2010.

Quarterly Premium Tax Return (Form GID-012A-PT)

Premium Tax GA has municipal fees. GID-017A-PT will need number of licenses input either via MuniTax or manually. All payments must be received on or before the respective due date. If payment is mailed, it must be postmarked by the U.S. Postal Service on or before the 20th day of March, June, September, and December. OTHERWISE, THIS FORM MUST BE RECEIVED BY THE GEORGIA INSURANCE DEPARTMENT ON OR BEFORE THE 20TH DAY OF MARCH, JUNE, SEPTEMBER, AND DECEMBER. If you prefer to use the electronic funds transfer method of payment, please contact the Georgia Insurance Department at 404-656-7553 or premiumtax@oci.ga.us for bank information and instructions. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: GA. Domestic/Foreign: Domestic, Foreign. State Form ID: GID-012A-PT. Link to State Form: http://www.inscomm.state.ga.us/Documents/GID12A-07.pdf. Link to Filing Website: http://www.gainsurance.org/home.aspx. Link to Supporting Information: Reminder: http://www.gainsurance.org/PremiumTax/Reminder-LicensedCompanies.aspx. State Authority: Departments of Revenue, Insurance and Community Affairs. Contact Email: premiumtax@oci.ga.gov. Contact Phone: 404-656-7553. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: EFT Payment accepted. Paper Size: Letter. Paper Color: White. Saturday, March 20, 2010.

Wings Introduction - New Users

EagleTM Events ETM Product: Wings. EagleTM Event Type: IBE Session. Pricing: Contact an EagleTM sales representative at sales@byetm.com for available discounts. Summary: This session is designed for individuals who need to come up to speed quickly on basic Wings functionality in order to work effectively on producing statutory statements. We will cover the essential features of Wings so that you can enter, import, export, and validate the accuracy of your data. You will learn how print statements and produce your regulatory filings. Presenter: Terry Newman. Contact ETM by phone: 800-975-3245. Contact ETM by e-mail: support@byetm.com. Tuesday, March 23, 2010, 10:00 AM – 11:00 AM.

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

Premium Tax Send return with check to: Maine Revenue Services, P.O.Box 9120 Augusta, ME 04332-9120 Must be signed by the President, Treasurer, Secretary, Chief Accounting Officer, or Attorney-in-Fact of a Reciprocal Insurer. Insurance Type: PC. Filing Period: Monthly. StateAbbrv: ME. Domestic/Foreign: Domestic, Foreign. State Form ID: INS-2. Link to State Form: http://www.maine.gov/revenue/forms/insurance/2010/10_INS-2.pdf. Link to Filing Website: http://www.maine.gov/revenue/forms/insurance/2009.htm. State Authority: Maine Department of Administrative and Financial Services. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Payment Method: Check payable to: Treasurer, State of Maine. Wednesday, March 31, 2010.

Insurance Company Renewal Information and Payment Voucher

Premium Tax The annual statement/insurance company renewal fees are stated in Minn.Stat. 60A.14, subd. 1 (and in Minn. Stat. 60A.092, subd. 3(4) for accredited reinsurers). The Department will not be issuing invoices to insurance companies. A Payment Voucher must be included with each check. A separate check must be issued for each insurance company. Do not mail your check and voucher with other documents or with your premium tax return. Mail Payment to: Minnesota Dept. of Commerce 85 7th Place East, Suite 500 St. Paul, MN 55101-2198. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: MN. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.mn.us/mn/externalDocs/Commerce/Authorized_Prop_and_Casualty_Insurers_111403103105_AuthorizedPandC.pdf. Link to Filing Website: http://www.taxes.state.mn.us/. State Authority: Minnesota Department of Revenue. Contact Email: Sue.Porter@state.mn.us. Contact Phone: 651-296-6907. Filing Method: Hard Copy. Payment Method: Check payable to: Minnesota Department of Commerce. Wednesday, March 31, 2010.

Insurance Premium Tax Quarterly Prepayment (Form TC-670)

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: UT. Domestic/Foreign: Domestic, Foreign. State Form ID: TC-670. Link to State Form: http://www.tax.utah.gov/forms/current/tc-670.pdf. Link to Filing Website: http://www.tax.utah.gov/forms/current.html. State Authority: Utah State Tax Commission. Contact Email: taxmaster@utah.gov. Contact Phone: 801-297-3525. Due by Postmark or Receive Date: Receive. Wednesday, March 31, 2010.

Insurance Premium Tax Return (Form TC-49)

Premium Tax See supporting information link. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: UT. Domestic/Foreign: Domestic, Foreign. State Form ID: TC-49. Link to State Form: http://www.tax.utah.gov/forms/current/tc-49.pdf. Link to Filing Website: http://www.tax.utah.gov/forms/current.html. Link to Supporting Information: Instructions: http://www.tax.utah.gov/forms/current/tc-49inst.pdf. State Authority: Utah State Tax Commission. Contact Email: taxmaster@utah.gov. Contact Phone: 801-297-3525. Due by Postmark or Receive Date: Receive. Wednesday, March 31, 2010.

Quarterly Report of SL Business

Premium Tax A copy of the Quarterly Report form is available on the Nebraska Department of Insurance web site. You should make additional copies of this form for your own use, as we do not regularly supply them. The Nebraska Department of Insurance must receive the quarterly report no later than 30 days after the last day of each calendar quarter. The report must be filed even if no business was written during the quarter. NOTE FOR PURCHASING GROUPS: A separate form must be submitted for each purchasing group. This form must be submitted with other non-purchasing group surplus lines reports that may be required to be filed under Neb.Rev.Stat. §44-5501-44-5514. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NE. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.doi.ne.gov/surplus_lines/DOI_SL_QUARTERLY.xls. Link to Filing Website: www.doi.ne.gov. State Authority: Nebraska Department of Insurance. Contact Email: Jim.Nixon@nebraska.gov. Contact Phone: 402-471-2201. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Self Insurer Tax Return - Schedule A (Form TC-420A)

Premium Tax See instructions attached to TC-420. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: UT. Domestic/Foreign: Domestic, Foreign. State Form ID: TC-420A. Link to State Form: http://www.tax.utah.gov/forms/current/tc-420a.pdf. Link to Filing Website: http://www.tax.utah.gov/forms/current.html. Link to Supporting Information: Instructions: http://www.tax.utah.gov/forms/current/tc-420.pdf. State Authority: Utah State Tax Commission. Contact Email: taxmaster@utah.gov. Contact Phone: 801-297-3525. Due by Postmark or Receive Date: Receive. Wednesday, March 31, 2010.

Self Insurer Tax Return (Form TC-420)

Premium Tax See instructions attached to TC-420. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: UT. Domestic/Foreign: Domestic, Foreign. State Form ID: TC-420. Link to State Form: http://www.tax.utah.gov/forms/current/tc-420.pdf. Link to Filing Website: http://www.tax.utah.gov/forms/current.html. Link to Supporting Information: Instructions: http://www.tax.utah.gov/forms/current/tc-420.pdf. State Authority: Utah State Tax Commission. Contact Email: taxmaster@utah.gov. Contact Phone: 801-297-3525. Due by Postmark or Receive Date: Receive. Wednesday, March 31, 2010.

Accident and Health Survey

State Required Filings NO SUBSTITUTE FORMS WILL BE ACCEPTED Submit the reporting form even if there has been no activity. Email in .xls format to wvins@wvinsurance.gov. Please use Subject heading 2008 A & H Survey OR Mail to: West Virginia Insurance Commission Financial Conditions Division A & H Survey 2007 PO Box 50540 Charleston, WV 25305-0540. Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: WV. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.wvinsurance.gov/LinkClick.aspx?fileticket=nEnVy5dPEUY%3d&tabid=427. Link to Filing Website: http://www.wvinsurance.gov/. Link to Supporting Information: Instructions: http://www.wvinsurance.gov/Default.aspx?tabid=427. State Authority: West Virginia Insurance Commissioner, Financial Conditions Division. Contact Email: Financial.Conditions@wvinsurance.gov. Contact Phone: 304-558-2100. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy, Electronic. Wednesday, March 31, 2010.

Administrative Zip Code Reporting Exhibit

State Required Filings Insurers will report the following data elements: • Number of policies in effect on first day of previous year, • Number of policies in effect on last day of previous year, • Number of cancellations (insurer initiated only) during previous year, • Number of non-renewals (insurer initiated only) during previous year, • Number of new policies during the previous year, and • Number of renewals during the previous year. Data for the following lines of insurance will be reported: • homeowners (Forms 1,2,3,5 and 8 aggregated), • homeowners (Forms 4 and 6 aggregated), • residential fire (buildings only and buildings and contents aggregated), • residential fire (contents only), • private passenger automobile liability-only, and • private passenger automobile combined (liability & physical damage). All collection units will be policy counts. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: IL. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.idfpr.com/DOI/Regulatory_Filings/CostContainment/Zip_Code_Reporting.pdf. Link to Filing Website: www.idfpr.com. State Authority: Illinois Department of Financial & Professional Regulation, Division of Insurance. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-524-8377. Due by Postmark or Receive Date: Verify with state. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Annual Renewal Fee - Captive

State Required Filings Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.id.state.az.us/captives/Captive_109-Annual_Renewal_Fee09_(2).doc. Link to Filing Website: http://www.id.state.az.us/. State Authority: Arizona Department of Insurance. Contact Phone: 602-364-4490. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: Check payable to: Arizona Department of Insurance. Wednesday, March 31, 2010.

Annual Statement Filings Worksheet - Domestic Life and Disability Reinsurer (Form E-LR.AS)

State Required Filings Insurance Type: LAH, Reinsurance. Filing Period: Annual. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: E-LR.AS. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-lr.as.pdf. Link to Filing Website: http://www.id.state.az.us. Link to Supporting Information: http://www.id.state.az.us/forms/corp_forms/e-lr.i.pdf. State Authority: ARIZONA COMPLIANCE SECTION. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. Paper Size: 8-1/2” X 14”. Wednesday, March 31, 2010.

Anti-Fraud Annual Statistical Reporting Form

State Required Filings Submit ONLY One (1) Composite Report, Per NAIC Group Group reporting: If you need additional space, please submit a separate sheet in Word format to: betty.bates@dc.gov. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: DC. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://disb.dc.gov/disr/frames.asp?doc=http://forms.dc.gov/lfserver/245a24zf9cca92105z2e75192x168x1x138?DFS__FormType=crp. Link to Filing Website: http://www.dc.gov/. Link to Supporting Information: http://disb.dc.gov/disr/lib/disr/pdf/2009_compliance_updated_information.pdf. State Authority: DC Department of Insurance, Securities and Banking. Contact Email: janice.gordon@dc.gov. Contact Phone: 202-442-7783. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Wednesday, March 31, 2010.

ATPA Annual Assessment (Form FIS 0055)

State Required Filings Submission Required By ALL AUTO INSURERS Complete and submit this form even if no assessment is due. Send completed form with payment directly to the Michigan Department of State Police at the address below. Do not send it to Office of Financial & Insurance Services. MICHIGAN DEPARTMENT OF STATE POLICE BUDGET AND FINANCIAL SERVICES DIVISION 714 S. HARRISON RD. EAST LANSING MI 48823. Insurance Type: Risk Retention Group, Risk Purchasing Group. Filing Period: Qtr 1. StateAbbrv: MI. Domestic/Foreign: Domestic, Foreign. State Form ID: FIS 0055. Link to State Form: http://www.michigan.gov/documents/cis_ofis_fis_0055_24101_7.pdf. Link to Filing Website: http://www.michigan.gov/. State Authority: Michigan Department of Labor & Economic Growth. Contact Email: shoupn@michigan.gov. Contact Phone: 517-336-6693. Filing Method: Hard Copy. Payment Method: Check payable to: STATE OF MICHIGAN. Wednesday, March 31, 2010.

Biographical Affidavits

State Required Filings See supporting information link. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: TX. Domestic/Foreign: Foreign. Link to Filing Website: http://www.tdi.state.tx.us. Link to Supporting Information: Checklist: http://www.tdi.state.tx.us/forms/fincolicense/fin422foreignsl.pdf Filing Smart: http://www.tdi.state.tx.us/financial/documents/foreign.pdf. State Authority: Texas Department of Insurance. Contact Phone: 512-322-5002. Wednesday, March 31, 2010.

Business Only Pages

State Required Filings Applicable to Multi-State HCSO Only See Note R. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Certificate of Advertising Compliance (Form E-HCSO.13)

State Required Filings 3/31 HCSO and HMDO with HCSO operation only. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. State Form ID: E-HCSO-13. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-hcso.13.pdf. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-2393. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Certificate of Disclosure - Service Corporation (Form E-HMDO.178)

State Required Filings Service Corporation Certificate of Disclosure – ARS § 20-831(B) Arizona law requires this certificate to be executed by two of your authorized executive officers or directors; therefore we will only accept signatures of such officers who are identified on the Jurat Page of the Annual Statement for the filing year. Filings received with unacceptable signature(s) will be returned as “incomplete” and will be subject to statutory late filing fees where applicable. An incomplete or late filing of the Certificate of Disclosure shall subject you to payment of late fees not to exceed twenty-five dollars ($25.00) for each day of delinquency. The late fees are in addition to any other applicable penalty fee or civil penalty. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. State Form ID: E-HMDO-178. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-hmdo.178.pdf. Link to Filing Website: www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division - Compliance Section. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Receive. Wednesday, March 31, 2010.

Certificate of Disclosure (Form E-178)

State Required Filings 3/1 Foreign 3/31 Domestic HOSPITAL, MEDICAL, DENTAL, OPTOMETRIC SERVICE CORPORATIONS Must file form E-HMDO.178. 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 of $25 per day. Late Filings: License will be summarily suspended if renewal fee is not paid when due or if financial condition is unknown due to failure to file annual statement. Up to $25.00 per day – Certificate of Disclosure Form E-178 or E-HMDO-178. In all cases, we use the USPS postmark or courier pick-up date as the date filed. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: E178. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-178.pdf. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Certificate of Disclosure (Form E-178Captives)

State Required Filings Foreign and Alien Companies: On or before March 1 of each year Arizona Domestic Companies: On or before March 31 of each year. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: E-178. Link to Filing Website: http://www.id.state.az.us/captives/e-178.pdf. Link to Supporting Information: http://www.id.state.az.us/. State Authority: Arizona Department of Insurance. Contact Phone: 602-364-4490. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Certified Copy of Current License or Certificate of Authority

Consumer Credit and Credit Scoring Report

State Required Filings Email as an Excel spreadsheet to Becky.Harrington@arkansas.gov. See supporting information link. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: AR. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.insurance.arkansas.gov/PandC/P&CForms/Act%201452%20Credit%20Rpt%20Form%20Due%202008.xls. Link to Filing Website: http://insurance.arkansas.gov/PandC/Datareports.htm. Link to Supporting Information: Bulletin: http://www.insurance.arkansas.gov/PandC/Bulletins/14-2004%20%20Use%20of%20Credit%20Information.doc. State Authority: Arkansas Insurance Department. Contact Email: becky.harrington@arkansas.gov. Contact Phone: 501-371-2800. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Wednesday, March 31, 2010.

Current List of Texas Surplus Lines Agents

Examination Report

Exhibit of Premiums and Losses (page 20)

State Required Filings Insurance Type: Risk Retention Group. Filing Period: Qtr 1. StateAbbrv: CT. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.ct.gov/cid. Link to Supporting Information: Bulletin: http://www.ct.gov/cid/lib/cid/BullFS4RR-08.pdf. State Authority: Connecticut Insurance Department. Contact Email: cid.financial@ct.gov. Contact Phone: 860-297-3814. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Filing Requirements - SL

State Required Filings Please note that two sets of documents must be prepared. Do NOT use UCAA filings. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: TX. Domestic/Foreign: Foreign. Link to State Form: http://www.tdi.state.tx.us/financial/documents/spl.pdf. Link to Filing Website: www.tdi.state.tx.us. State Authority: Texas Department of Insurance. Contact Phone: 512-322-3507. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Foreign Surplus Lines Quarterly Policy Filing

State Required Filings Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Foreign. Link to Filing Website: http://www.fslso.com/software/filingreq.aspx?o=ins. Link to Supporting Information: Instructions: http://www.fslso.com/software/insurer/2009.Foreign.Due.Dates.pdf Procedures manual: http://www.fslso.com/publications/manuals/Insurer.Procedures.Manual.pdf http://www.fslso.com/software/filingreq.aspx?o=ins. State Authority: FSLSO. Contact Email: gpullen@fslso.com. Contact Phone: 800-562-4496. Wednesday, March 31, 2010.

Form B and C Insurance Holding Company System Registration Statement

State Required Filings See supporting information link. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: E185B and E185C. Link to Filing Website: http://www.id.state.az.us. Link to Supporting Information: Instructions: http://www.id.state.az.us/forms/E185.pdf. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

HCSO Plan for Risk of Insolvency; Actuarial Memorandum and Certification of Rates

State Required Filings HCSO & HMDO with HCSO Operation ONLY See Note V, W Must report any significant modification to information previously furnished in the application for Certification of Authority within 10 days. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Health Care Regulatory and Insurance Regulation Assessment - Supplemental Filing Form

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/assessmentsformFY2011.pdf. Link to Filing Website: www.mdinsurance.state.md.us. Link to Supporting Information: Memo: http://www.mdinsurance.state.md.us/sa/documents/assessmentsmemoFY2010.pdf. State Authority: Maryland Insurance Administration. Contact Email: mc_filings@mdinsurance.state.md.us. Contact Phone: 410-468-2000. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Health Checklist

State Required Filings 3/1 Foreign 3/31 Domestic Pages 1-4 Only of this form with Column 1 and Page 4 contact information completed. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

HMDI Corporations Checklist

State Required Filings MN. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: MN. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.mn.us/mn/externalDocs/Commerce/Hospital_Medical_Dental__Indemnity_Corp_Non_Profit__111403105213_HDMI.pdf. Link to Filing Website: www.insurance.mn.gov. State Authority: Minnesota Department of Commerce. Contact Email: Kathleen.Foley@state.mn.us. Contact Phone: 651-297-7686. Due by Postmark or Receive Date: Receive. # of Copies to State (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

HMO PEIA Rates

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: WV. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.wvinsurance.gov/. State Authority: West Virginia Insurance Commissioner, Rates and Forms Division. Contact Email: Ratesandforms@wvinsurance.gov. Contact Phone: 304-558-2094. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Holding Company - Form B Instructions (Form E-185B)

State Required Filings 3/31 Domestic See Note U DO NOT send in Annual Statement package. Mail To: Arizona Department of Insurance ATTN: Financial Affairs Division- Compliance Section 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018. See supporting information link. Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: Form B. Link to State Form: http://www.id.state.az.us/forms/E185B.pdf. Link to Filing Website: http://www.id.state.az.us/corp_misc.html. Link to Supporting Information: Instructions: http://www.id.state.az.us/forms/E185.pdf. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Holding Company - Form B Instructions (Form E-185B)

State Required Filings Due 3/31: Domestic DI, LD, PC and PPD See Note X DO NOT send in Annual Statement package. Mail To: Arizona Department of Insurance ATTN: Financial Affairs Division- Compliance Section 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018. See supporting information link. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: Form B. Link to State Form: http://www.id.state.az.us/forms/E185B.pdf. Link to Filing Website: http://www.id.state.az.us/corp_misc.html. Link to Supporting Information: Instructions: http://www.id.state.az.us/forms/E185.pdf. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Holding Company - Form C Instructions (Form E-185C)

State Required Filings Due 3/31: Domestic DI, LD, PC and PPD See Note X DO NOT send in Annual Statement package. Mail To: Arizona Department of Insurance ATTN: Financial Affairs Division- Compliance Section 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018 See Forms E-185, E-185B, E-185C, E-185D, E-185XD and E-110. See supporting information link. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: Form C. Link to State Form: http://www.id.state.az.us/forms/E185C.pdf. Link to Filing Website: http://www.id.state.az.us/corp_misc.html. Link to Supporting Information: Instructions: http://www.id.state.az.us/forms/E185.pdf. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Holding Company - Form C Instructions (Form E-185C)

State Required Filings 3/31 Domestic See Note U DO NOT send in Annual Statement package. Mail To: Arizona Department of Insurance ATTN: Financial Affairs Division- Compliance Section 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018 See Forms E-185, E-185B, E-185C, E-185D, E-185XD and E-110. See supporting information link. Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: Form C. Link to State Form: http://www.id.state.az.us/forms/E185C.pdf. Link to Filing Website: http://www.id.state.az.us/corp_misc.html. Link to Supporting Information: Instructions: http://www.id.state.az.us/forms/E185.pdf. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Holding Company Registration - Form B

State Required Filings File with: Holding Company Registration - Form C. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: PA. Domestic/Foreign: Domestic. State Form ID: B. Link to State Form: http://www.ins.state.pa.us/ins/lib/ins/companies/statement/Form_B.pdf. Link to Filing Website: www.ins.state.pa.us/. State Authority: Pennsylvania Insurance Department - Financial Analysis Division. Contact Email: ra-in-analysis@state.pa.us. Contact Phone: 717-787-5890. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): N/A. Wednesday, March 31, 2010.

Holding Company Registration - Form C

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: PA. Domestic/Foreign: Domestic. State Form ID: C. Link to State Form: http://www.ins.state.pa.us/ins/lib/ins/companies/statement/Form_C.pdf. Link to Filing Website: http://www.ins.state.pa.us/. State Authority: Pennsylvania Insurance Department - Financial Analysis Division. Contact Email: ra-in-analysis@state.pa.us. Contact Phone: 717-787-5890. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): N/A. Wednesday, March 31, 2010.

Indiana Pool - Annual Premium Call (Form IN-10)

State Required Filings See supporting information link. Insurance Type: PC, Workers Compensation. Filing Period: Qtr 1. StateAbbrv: IN. Domestic/Foreign: Domestic, Foreign. State Form ID: IN-10. Link to State Form: http://www.compinsservices.com//IN-10.xls. Link to Filing Website: http://www.compinsservices.com//InPremCall.htm. Link to Supporting Information: Instructions: http://www.compinsservices.com//IN-10_inst.pdf Circular: http://sharepoint.icrb.net/public/Lists/CompClues/Attachments/79/Circular%202009-02%20Pool%20Annual%20Prem%20Call.pdf. State Authority: Indiana Department of Insurance (IDOI), Financial Services. Contact Email: INdata@CompInsServices.com. Filing Method: Hard Copy, Electronic. Wednesday, March 31, 2010.

Insurance Fraud Report Form

State Required Filings The form may be completed and e-mailed as above, or sent as a hard copy to this address: Connecticut Insurance Department Insurance Fraud Unit P.O. Box 816 Hartford, CT 06142-0816 Completed hard copy forms may also be faxed to: Connecticut Insurance Department Insurance Fraud Unit Fax: (860) 297-3872. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CT. Link to State Form: http://www.ct.gov/cid/lib/cid/FraudReportingForm.pdf. Link to Filing Website: http://www.ct.gov/cid/. Link to Supporting Information: Instructions: http://www.ct.gov/cid/lib/cid/FraudReportInstructions.pdf Notice: http://www.ct.gov/cid/cwp/view.asp?a=1259&q=289122. State Authority: Connecticut Insurance Department, Insurance Fraud Unit. Contact Email: cid.fraud@ct.gov. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy, Electronic. Wednesday, March 31, 2010.

LAH Checklist

State Required Filings 3/1 Foreign 3/31 Domestic Pages 1-3 Only of this form with Column 1 and contact information completed. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. Link to State Form: http://www.id.state.az.us/forms/corp_forms/E-NAIC.LD.pdf. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): Due 3/1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Life Care Provider Annual Report (Form E-LIFECARE)

State Required Filings $450 Filing Fee FISCAL YEAR END REPORT DUE DATE February 28 →→ May 29 September 30 →→ December 29 October 31 →→ January 29 December 31 →→ March 31 Mail to: Attention: COMPLIANCE SECTION ARIZONA DEPARTMENT OF INSURANCE 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018-7269. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. State Form ID: E-LIFECARE. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-lifecare.pdf. Link to Filing Website: www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division - Compliance Section. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3985. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Payment Method: Check, ACH DELIVERY. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Wednesday, March 31, 2010.

Medical Malpractice Claim Report (Form SFN 17118)

State Required Filings If the provider or the insurer of a provider does not have any claims, settlements or claims or final judgment to report, it is NOT necessary to file a form with the Commissioner. Submit to: North Dakota Insurance Department 600 E. Boulevard Avenue - Dept 401 State Capitol Bismarck, ND 58505-0158. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: ND. Domestic/Foreign: Domestic, Foreign. State Form ID: SFN 17118. Link to State Form: http://www.nd.gov/eforms/Doc/sfn17118.pdf. Link to Filing Website: www.nd.gov. State Authority: North Dakota Insurance Department. Contact Phone: 701-328-3328 Company Licensing. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Medical Malpractice Claim Reporting Form and Statutes

State Required Filings Mail reports to: Division of Insurance 445 E Capitol Pierre, South Dakota 57501. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: SD. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.sd.us/drr2/forms/Insurance/nonE1884V1-MedicalMalpracticeClaimReportingForm.pdf. Link to Filing Website: www.state.sd.us. State Authority: South Dakota Division of Insurance. Contact Email: insurance@state.sd.us. Contact Phone: 605-773-3563. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Wednesday, March 31, 2010.

MHCC User Fee Assessment Survey Login

State Required Filings Before completing the online Assessment Survey, please read the assessment letter. Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://mhcc.maryland.gov/assessments/index.aspx. Link to Filing Website: http://mhcc.maryland.gov/. Link to Supporting Information: Assessment letter: http://mhcc.maryland.gov/assessments/assessment_letter_ins.pdf. State Authority: Maryland Health Care Commission. Contact Email: nbeckman@mhcc.state.md.us. Contact Phone: 410-764-3581. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Wednesday, March 31, 2010.

Mississippi Workers Compensation Assigned Risk Pool - Report of Premiums (Form MS-10)

State Required Filings See supporting information link. Insurance Type: PC, Workers Compensation. Filing Period: Qtr 1. StateAbbrv: MS. Domestic/Foreign: Domestic, Foreign. State Form ID: Form MS-10. Link to State Form: http://www.compinsservices.com/ms-10.xls. Link to Filing Website: www.CompInsServices.com. Link to Supporting Information: Instructions: http://www.compinsservices.com/ms-10_inst.pdf. State Authority: Mississippi Compensation Insurance Services. Contact Email: MSdata@CompInsServices.com. Contact Phone: 601-977-9466. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Wednesday, March 31, 2010.

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

State Required Filings 3/1 Foreign 3/31 Domestic Mortgage Guaranty Insurers Only. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: E-MG.MPP. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-mg.mpp.pdf. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): Due 3/1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

NAIC IRIS Ratio Results

PC Checklist

State Required Filings 3/1 Foreign, 3/31 Domestic See Note A. See supporting information link. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. Link to State Form: http://www.id.state.az.us/forms/corp_forms/E-NAIC.PC.pdf. Link to Filing Website: http://www.id.state.az.us. Link to Supporting Information: PC Filing Instructions: http://www.id.state.az.us/forms/P&C%20General_Instructions_Web_10-18-07.pdf. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): Due 3/1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Premium Growth Report (Form OIR-A1-1229)

State Required Filings Insurance Type: PC. Filing Period: Monthly. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. State Form ID: OIR-A1-1229. Link to State Form: http://www.floir.com/pdf/OIR-A1-1229.pdf. Link to Filing Website: http://www.floir.com/pdf/NotesInstructionsA-KPC.pdf. Link to Supporting Information: http://www.floir.com/pdf/NotesInstructionsA-KPC.pdf. State Authority: Florida Office of Insurance Regulation. Contact Email: Helen.Westberry@floir.com. Contact Phone: 850-413-5212. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. Wednesday, March 31, 2010.

Producer Controlled PC Insurance Report (Form E-PC.350)

State Required Filings Domestic only. Insurance Type: Health, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: E-350. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-pc.350.pdf. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Quarterly Financial Statement Filing

State Required Filings Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. State Form ID: E-QSRQ. Link to Filing Website: http://www.id.state.az.us/. Link to Supporting Information: Instructions: http://www.id.state.az.us/forms/corp_forms/e-qsrq.pdf http://www.id.state.az.us/forms/corp_forms/e-qsx.pdf. State Authority: Department of Insurance. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Quarterly Financial Statement Filing - Health

State Required Filings Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. State Form ID: E-QSRQ-Health. Link to Filing Website: http://www.id.state.az.us/. Link to Supporting Information: Instructions: http://www.id.state.az.us/forms/corp_forms/e-qsrq.pdf http://www.id.state.az.us/forms/corp_forms/e-qsx.pdf. State Authority: Department of Insurance. Contact Email: ldillard@azinsurance.gov. Contact Phone: 602-364-3245. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Quarterly Statements

Records Location Information (Form E-176)

State Required Filings Insurance Type: PC, LAH. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: E-176. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-176.pdf. Link to Filing Website: www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

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

State Required Filings 3/1 Foreign 3/31 Domestic Do not file this report if you did not issue a policy to an industrial insured. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. State Form ID: E-PC.INDINS. Link to State Form: http://www.id.state.az.us/forms/corp_forms/e-pc.indins.pdf. Link to Filing Website: www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): Due 3/1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

Reporting Adverse Decisions and Greivances - Carrier Reporting Form

State Required Filings Reports are to be submitted on a quarterly basis within 15 days of the end of the following reporting periods: 1Q- First Quarter (1/1-3/31) 2Q- Second Quarter (4/1-6/30) 3Q- Third Quarter (7/1-9/30) 4Q- Fourth Quarter (10/1-13/31). Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: MD. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/ReportingForm15-10A-06-rev06.pdf. Link to Filing Website: www.mdinsurance.state.md.us. Link to Supporting Information: Instructions: http://www.mdinsurance.state.md.us/sa/documents/15-10A-06CarrierReportingInstructionsGuide-rev06.pdf https://www.mdinsurance.state.md.us/carrierReport/jsp/carrierReport/CarrierReportLogin.jsp?mode=true. State Authority: Maryland Insurance Administration. Contact Email: lbutler@mdinsurance.state.md.us. Contact Phone: 410-468-2271. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Residential Mortgage Loan Report (Form FAD108) - Excel

State Required Filings MS-Excel and Adobe PDF Effective for 2007 filings. You are not required to file an electronic copy of a document with the California State Department of Insurance if there is no entry in column 7 for the document in question. For Example: You are not required to make an electronic filing with the California Department of Insurance for the Annual Statement but you are required to do so for the Actuarial Opinion Summary. Submit an electronic copy (in addition to required hard copy filings) of the documents on a single CD, using the formats prescribed in column 7 of the checklist. See APPENDIX A for further instructions on electronic filing requirement. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: FAD108 (DOI-1556). Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/2008/upload/FAD108_F1556_RML.xls. Link to Filing Website: www.insurance.ca.gov. State Authority: California Department of Insurance, Financial Analysis Division, Financial Records Unit. Contact Email: Financial_Records@Insurance.CA.Gov. Contact Phone: 213-346-6423. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to NAIC (Foreign Insurer): 0. Paper Size: Select Entire workbook, Letter size; Orientation: Landscape. Wednesday, March 31, 2010.

Signed Jurat

State Required Filings 3/1 Foreign 3/31 Domestic See Notes A,L Domestic – Must have original notarized signatures of two (2) of your executive officers who are listed on your jurat page. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): xxx. Wednesday, March 31, 2010.

SL Annual Filing

State Required Filings Indiana Code 27-1-15.8-4(3) Surplus lines producers required to file the surplus lines company’s AS filed with its state of domicile and the NAIC by March 31st for evaluation as to whether the company will be authorized as a surplus lines carrier. The surplus lines producer should submit statements for those surplus lines companies it currently places or is anticipating placing business with during this year. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: IN. Link to State Form: http://www.in.gov/idoi/2355.htm. Link to Filing Website: http://www.in.gov/idoi. State Authority: Indiana Department of Insurance. Contact Email: sglassburn@idoi.in.gov. Contact Phone: 317-232-5692. Wednesday, March 31, 2010.

SL Checklist - Foreign

State Required Filings See supporting information link. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: TX. Domestic/Foreign: Foreign. State Form ID: FIN422. Link to State Form: http://www.tdi.state.tx.us/forms/fincolicense/fin422foreignsl.pdf. Link to Filing Website: www.tdi.state.tx.us. Link to Supporting Information: Filing Smart: http://www.tdi.state.tx.us/financial/documents/foreign.pdf. State Authority: Texas Department of Insurance, Financial Analysis and Examinations. Contact Phone: 512-322-3507. Filing Method: Hard Copy. Wednesday, March 31, 2010.

Standardized Organizational Hardship Exemption Guidelines (Form E-AFR.OHE)

State Required Filings See supporting information link. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: AZ. State Form ID: E-AFR-OHE. Link to Filing Website: http://www.id.state.az.us/. Link to Supporting Information: Instructions: http://www.id.state.az.us/forms/corp_forms/e-afr.ohe.pdf. State Authority: Arizona Department of Insurance, Financial Affairs Division - Compliance Section. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Wednesday, March 31, 2010.

State Filing Fees

State Required Filings 3/1 Foreign, 3/31 Domestic Annual filing fee amounts vary and are specified in Tax and Fees Report forms. Mail To: Arizona Department of Insurance ATTN: Tax Unit Financial Affairs Division 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018-7269. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. Link to Filing Website: http://www.id.state.az.us/annforms.html. Link to Supporting Information: http://www.id.state.az.us/taxforms.html. State Authority: Arizona Department of Insurance. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1 Due 3/1. # of Copies to NAIC (Domestic Insurer): 0. Wednesday, March 31, 2010.

State of Nevada Publication Form

State Required Filings Upon completion, please forward this form to: The W.N. Gates Company 925 Harvest Drive – Suite 190 Blue Bell, PA 19422. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NV. Domestic/Foreign: Foreign. Link to State Form: http://www.wngates.com/laws_comp/pdf/nevada.PDF. Link to Filing Website: http://www.wngates.com/. Contact Email: gates@wngates.com. Contact Phone: 866-566-5174. Filing Method: Hard Copy. Wednesday, March 31, 2010.

State Page - LAH, PC

State Required Filings 3/1 Foreign 3/31 Domestic See Notes A,F,N. Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): xxx Due 3/1. # of Copies to NAIC (Domestic Insurer): xxx. Wednesday, March 31, 2010.

State Page 30 and Supp28 or Supp64

State Required Filings 3/1 PPD 3/31 Domestic HCSO, HMDO, DI, LD, PC See Notes A,F. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic. Link to Filing Website: http://www.id.state.az.us. State Authority: Arizona Department of Insurance. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): 1. Wednesday, March 31, 2010.

Statement Filing Fees

State Required Filings Companies will not be billed. See renewal information in state forms section. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: MN. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.insurance.mn.gov. State Authority: Minnesota Department of Commerce, Financial Examinations-Insurance. Contact Email: Sue.Porter@state.mn.us. Contact Phone: 651-296-6907. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Wednesday, March 31, 2010.

Supplement 28

Supplement 64

Three-Year Business Plan

Warranty Plans (Form OCI 27-002)

State Required Filings Submit documentation of security with this form. OCI 27-002 is divided into two parts. Companies are required to complete both parts A and B. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: WI. Domestic/Foreign: Domestic, Foreign. State Form ID: 27-002. Link to State Form: http://oci.wi.gov/ociforms/27-002.pdf. Link to Filing Website: http://oci.wi.gov. State Authority: Wisconsin Office of the Commissioner of Insurance. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Wednesday, March 31, 2010.

Wind and Hail Underwriting Association Report of Premiums Login

State Required Filings Please see manual. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: SC. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.scwind.com/MembersLogin.asp. Link to Filing Website: http://www.scwind.com/members2.htm. Link to Supporting Information: Manual: http://www.scwind.com/pdf/Bordereau2007_1.pdf. State Authority: South Carolina Wind and Hail Underwriting Association. Contact Email: david@scwind.com. Contact Phone: 803-779-8373. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Wednesday, March 31, 2010.