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AZ - Life Care Provider Annual Report (Form E-LIFECARE)

State Required Filings Filing fee is required for this report. Make check payable to Arizona Department of Insurance and Mail to: Attention: Compliance Section Arizona Department of Insurance 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018-7271. State Form ID: E-LIFECARE. StateAbbrv: AZ. Insurance Type: LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arizona&InsType=AZ-010_Life_Care_Provider_Annual_Report_%28Form_E-LIFECARE%29.pdf&TableName=ICC. State Authority: Arizona Department of Insurance, Insurance Tax Unit - Compliance Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arizona&InsType=AZ-111_Insurance_Homepage.htm&TableName=ICC. Contact: Compliance Section. Contact Phone: 602-364-3245. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, May 29, 2013.

ND - Premium Tax - Estimated Tax Form (Form SFN 11051)

Premium Tax All companies must file a quarterly and reconciled tax statement whether or not a tax is owed. State Form ID: SFN 11051. StateAbbrv: ND. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthDakota&InsType=NDp-111_Premium_Tax_-_Estimated_Tax_Form_%28Form_SFN_11051%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: North Dakota Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthDakota&InsType=ND-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 701-328-2440. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Thursday, May 30, 2013.

FL - Certificate of Authority Annual License Tax

State Required Filings If the insurer does not receive an invoice by April 15, call 850-413-2143 to request an invoice. Must be sent to: Florida Department of Financial Services Receipts Accounting Section P.O. Box 6100 Tallahassee, FL 32314-6100. StateAbbrv: FL. Insurance Type: Health. LAH. Filing Period: Qtr 2. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Florida&InsType=FL-111_Insurance_Homepage.htm&TableName=ICC. Contact: LaTasha Davis. Contact Email: latasha.davis@floir.com. Contact Phone: 850-413-5226. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.floir.com/pdf/NotesInstructionsA-KHealth.pdf. Thursday, May 30, 2013.

ND - Premium Tax - Estimated Tax Form (Form SFN 11051)

State Required Filings All companies must file a quarterly and reconciled tax statement whether or not a tax is owed. No payment is required until the final quarter when the tax is reconciled. Do NOT submit with the annual statement or supplemental filings. State Form ID: SFN 11051. StateAbbrv: ND. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthDakota&InsType=NDp-111_Premium_Tax_-_Estimated_Tax_Form_%28Form_SFN_11051%29.pdf&TableName=ICC. State Authority: North Dakota Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthDakota&InsType=ND-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 701-328-2440. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Thursday, May 30, 2013.

SC - Comprehensive Quarterly Analysis

State Required Filings Domestics only. The filings must be submitted electronically in Microsoft Word format to tcampbell@doi.sc.gov. A hard copy filings is NOT required. StateAbbrv: SC. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. State Authority: South Carolina Department of Insurance, Financial Analysis. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=SouthCarolina&InsType=SC-111_Insurance_Homepage.htm&TableName=ICC. Contact: Chief Financial Analyst. Contact Email: fnclmail@doi.sc.gov. Contact Phone: 803-737-6221. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Thursday, May 30, 2013.

SC - Comprehensive Quarterly Analysis Checklist

State Required Filings Domestics only. The filings must be submitted electronically in Microsoft Word format to tcampbell@doi.sc.gov. A hard copy filings is NOT required. StateAbbrv: SC. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=SouthCarolina&InsType=SC-111_Comprehensive_Quarterly_Analysis_Checklist.pdf&TableName=ICC. State Authority: South Carolina Department of Insurance, Financial Analysis. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=SouthCarolina&InsType=SC-111_Insurance_Homepage.htm&TableName=ICC. Contact: Chief Financial Analyst. Contact Email: fnclmail@doi.sc.gov. Contact Phone: 803-737-6221. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Thursday, May 30, 2013.

AK - Authorized Insurers Quarterly Premium Tax Form (Form 08-205)

Premium Tax If you paid $10,000 or more in tax in 2011, then you must file this form and pay the tax quarterly during 2012. This quarterly tax report must be mailed to: (if no quarterly taxes required, do not mail this form) First Class Mail (including Registered and Certified) Alaska Division of Insurance P.O. Box 110805 Juneau, AK 99811-0805 Express Mail ONLY: Alaska Division of Insurance 333 Willoughby Avenue, 9th Floor Juneau, AK 99801-0805. State Form ID: 08-205. StateAbbrv: AK. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Alaska&InsType=AKp-111_Authorized_Insurers_Quarterly_Premium_Tax_Form_%28Form_08-205%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Alaska Division of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Alaska&InsType=AK-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: rebecca.nesheim@alaska.gov. Contact Phone: 907-465-2584. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Friday, May 31, 2013.

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

Premium Tax Make check payable to: Treasurer, State of Maine Send check and return to: Maine Revenue Services P.O. Box 1065 Augusta, ME 04332-9120. State Form ID: INS-2. StateAbbrv: ME. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maine&InsType=MEp-001_Fire_Investigation_and_Prevention_Tax_Estimated_Monthly_Return_%28Form_INS-2%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Maine Revenue Services. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maine&InsType=ME-111_Prem_Tax_Homepage.htm&TableName=ICC. Contact Email: corporatetax@maine.gov. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Friday, May 31, 2013.

VT - Estimated Premium Tax Return (Form IPE-2)

Premium Tax State Form ID: IPE-2. StateAbbrv: VT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Vermont&InsType=VTp-111_Estimated_Premium_Tax_Return_%28Form_IPE-2%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Vermont Department of Taxes. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Vermont&InsType=VT-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 802-828-2551 Option 4. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Friday, May 31, 2013.

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

State Required Filings State Form ID: OIR-A1-1229. StateAbbrv: FL. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Florida&InsType=FL-001_Premium_Growth_Report_%28Form_OIR-A1-1229%29.pdf&TableName=ICC. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Florida&InsType=FL-111_Insurance_Homepage.htm&TableName=ICC. Contact: All Companies: David Altmaier Tami Bossart Sandra Dupont Jennifer Owings Andrew Gillie Linda McWilliams. Contact Email: David.Altmaier@floir.com Tami.Bossart@floir.com Sandra.Dupont@floir.com Jennifer.Owings@floir.com Andrew.Gillie@floir.com Linda.McWilliams@floir.com. Contact Phone: David: 850-413-3849 Tami: 850-413-5228 Sandra: 850-413-2404 Jennifer: 850-413-5213 Andrew: 850-413-5331 Linda: 850-413-5904. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.floir.com/pdf/NotesInstructionsA-KPC.pdf. Friday, May 31, 2013.

MS - State Filing Fees

State Required Filings StateAbbrv: MS. Insurance Type: PC. Filing Period: Qtr 2. State Authority: Mississippi Insurance Department, Financial & Market Regulation Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Mississippi&InsType=MS-111_Insurance_Homepage.htm&TableName=ICC. Contact: Donna Whitley. Contact Email: filings@mid.ms.gov. Contact Phone: 601-359-2127. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Friday, May 31, 2013.

NAIC - Accountants Letter of Qualifications

NAIC Filings To ensure confidentiality of the following items, they should not be included in the electronic filing of the Audited Financial Report. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Due by Postmark or Receive Date: Receive. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Saturday, June 1, 2013.

NAIC - Audited Financial Report

NAIC Filings Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Due by Postmark or Receive Date: Receive. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Saturday, June 1, 2013.

NAIC - June .PDF Filing

NAIC Filings Insurance Type: HMO. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Statement. Filing Method: Electronic. StateAbbrv: MA, MS, SC. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Saturday, June 1, 2013.

NAIC - June .PDF Filing

NAIC Filings Insurance Type: Health. LAH. PC. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Statement. Filing Method: Electronic. StateAbbrv: AL, AK, AZ, AR, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Saturday, June 1, 2013.

NAIC - Report of Significant Deficiencies in Internal Controls

CA - Premium Tax Voucher - Quarterly Prepayments (Form CIA T-4A)

Premium Tax Complete and send this voucher with your 2nd, 3rd and 4th Quarter Prepayments only. EFT users are still required to submit this voucher. State Form ID: CIA T-4A. StateAbbrv: CA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CAp-111_Premium_Tax_Voucher_-_Quarterly_Prepayments_%28Form_CIA_T-4A%29.xls&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: California Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 213-346-6371 or 213-346-6012. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

DC - Installment Reporting Statement

Premium Tax StateAbbrv: DC. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://disb.dc.gov/disr/lib/disr/pdf/2012_Installment_Form.doc. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: District of Columbia Department of Insurance, Securities and Banking. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=DistrictofColumbia&InsType=DC-111_Insurance_Homepage.htm&TableName=ICC. Contact: Julia C. May. Contact Email: julia.may@dc.gov. Contact Phone: 202-442-7842. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. Hard Copy. Payment Method: Checks should be made payable to DC Treasurer. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

DE - Wet Marine and Transportation Profits Tax Return

Premium Tax Only those companies that have actually written Wet Marine and Transportation Insurance in the United States during any of the past three years are required to submit this form. Zero reports are not required. Mail to: Delaware Insurance Department ATTN: Premium Tax Section 841 Silver Lake Blvd. Dover, DE 19904-2465. StateAbbrv: DE. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Delaware&InsType=DEp-001_Wet_Marine_and_Transportation_Profits_Tax_Return.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Delaware Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Delaware&InsType=DE-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: ann.fletcher@state.de.us. Contact Phone: 302-674-7383. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://delcode.delaware.gov/title18/c007/index.shtml#P225_14467. Saturday, June 1, 2013.

IA - Life Including HMO and HMDI Prepayment Form - June

Premium Tax The check should be made payable to: Treasurer, State of Iowa. Your remittance along with this Prepayment Statement should be mailed to: Department of Revenue 1305 E. Walnut P.O. Box 10455 Des Moines, Iowa 50319. StateAbbrv: IA. Insurance Type: Health. HMO. LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IAp-110_Life_Including_HMO_and_HMDI_Prepayment_Form_-_June.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Iowa Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: Premium.Tax@iid.iowa.gov. Contact Phone: 515-281-7367. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

IA - Ocean Marine Profit Tax

Premium Tax On or before June 1 this return must be completed and mailed with the remittance for taxes to: Department of Revenue Hoover Building, 3rd Floor, P.O. Box 10455 1305 E. Walnut Des Moines, Iowa 50319 Please make check payable to the Treasurer, State of Iowa. StateAbbrv: IA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IAp-001_Ocean_Marine_Profit_Tax.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Iowa Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: Premium.Tax@iid.iowa.gov. Contact Phone: 515-281-7367. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: Gold. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

IA - Other Than Life Prepayment Form - June

Premium Tax The check should be made payable to: Treasurer, State of Iowa. Your remittance along with this Prepayment Statement should be mailed to: Department of Revenue 1305 E. Walnut P.O. Box 10455 Des Moines, Iowa 50319. StateAbbrv: IA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IAp-001_Other_Than_Life_Prepayment_Form_-_June.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Iowa Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: Premium.Tax@iid.iowa.gov. Contact Phone: 515-281-7367. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

KY - Estimated Insurance Premiums Tax (Form 74A110)

Premium Tax Make check Payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303, Frankfort, KY 40602-1303 Overnight Address: 501 High Street, Frankfort, KY 40601. State Form ID: 74A110. StateAbbrv: KY. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KYp-111_Estimated_Insurance_Premiums_Tax_%28Form_74A110%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KY-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

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

Premium Tax Filing Address: P.O. Box 94214 Baton Rouge, LA 70802 Physical Address: 1702 North 3rd Street Baton Rouge, LA 70802 Attach a copy of the Policy Declaration Page to this form. State Form ID: 1265B. StateAbbrv: LA. Insurance Type: PC. Surplus Lines. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Louisiana&InsType=LAp-001_SL_Producer_Quarterly_Tax_Statement_-_Self_Procurement_%28Form_1265B%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Louisiana Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?Year=2010&StAbbrv=LA&InsType=Department_Of_Insurance_Homepage&SubInsType=&LinkType=3. Contact Email: taxdivision@ldi.state.la.us. Contact Phone: 225-342-1012. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

LA - SL Producer Quarterly Tax Statement (Form 1265)

Premium Tax ALL Louisiana licensed surplus lines producers until license is cancelled, revoked, or expires (even if there are no premiums to report). Mailing Address: P. O. Box 94214 Baton Rouge, LA 70804-9214 Physical Address: 1702 North 3rd Street Baton Rouge, LA 70802. State Form ID: 1265. StateAbbrv: LA. Insurance Type: PC. Surplus Lines. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Louisiana&InsType=LAp-001_SL_Producer_Quarterly_Tax_Statement_%28Form_1265%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Louisiana Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?Year=2010&StAbbrv=LA&InsType=Department_Of_Insurance_Homepage&SubInsType=&LinkType=3. Contact Email: taxdivision@ldi.state.la.us. Contact Phone: 225-342-1012. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Instructions: http://www.ldi.la.gov/Documents/FinancialSolvency/Surplus_Lines/TaxFilingRequirements.pdf Info Sheet: http://www.ldi.la.gov/Documents/FinancialSolvency/Surplus_Lines/TaxFilingInfoSheet.pdf 1065A Table: http://www.ldi.la.gov/Documents/FinancialSolvency/Surplus_Lines/Otlifetb02.pdf 1062A Table: http://www.ldi.la.gov/Documents/FinancialSolvency/Surplus_Lines/Lifetb02.pdf. Saturday, June 1, 2013.

MO - Quarterly Administrative Surcharge Report Form

Premium Tax Please remit this form with payment to: Missouri Department of Revenue P.O. Box 898 Jefferson City, MO 65105-0898. State Form ID: 375-0701. StateAbbrv: MO. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Missouri&InsType=MOp-001_Quarterly_Administrative_Surcharge_Report_Form.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Missouri Department of Insurance, Financial Institutions and Professional Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Missouri&InsType=MO-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: Noland.Stuecken@insurance.mo.gov. Contact Phone: 573-526-4986 or 573-751-1929. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

NJ - PT Prepayment Statement

Premium Tax StateAbbrv: NJ. Insurance Type: LAH. PC. Filing Period: Qtr 2. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: New Jersey Department of Treasury, Division of Taxation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewJersey&InsType=NJ-111_Premium_Tax.htm&TableName=ICC. Contact Email: admissions&selfinsurance@dobi.state.nj.us. Contact Phone: 609-292-5350 ext. 50085. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

PA - Marine Insurance Tax Report (Form RCT-124)

Premium Tax Mail RCT-124 with remittance, if applicable, to the following address: PA Department of Revenue PO Box 280407 Harrisburg, PA 17128-0407. State Form ID: RCT-124. StateAbbrv: PA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Pennsylvania&InsType=PAp-111_Marine_Insurance_Tax_Report_%28Form_RCT-124%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Pennsylvania Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Pennsylvania&InsType=PA-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 717-783-6031 Option 3. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.portal.state.pa.us/portal/server.pt/document/758236/2009_rct-124-i_pdf. Saturday, June 1, 2013.

SC - Quarterly Tax Return Installments

Premium Tax See Checklist Link. StateAbbrv: SC. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: https://online.doi.sc.gov/Eng/Members/Login.aspx. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: South Carolina Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=SouthCarolina&InsType=SC-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: swaddell@doi.sc.gov. Contact Phone: 803-737-4910. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Paper Size: Online Only. Paper Color: Online Only. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://doi.sc.gov/Documents/Taxation/Instructions%20for%20Quarterlies%202013.pdf. Saturday, June 1, 2013.

TN - HMO Quarterly Premium Tax Form

Premium Tax Mailing Address for Premium Tax Returns: State of Tennessee Department of Commerce and Business Division of Insurance P.O. Box 198983 Nashville, TN 37219-8983 Overnight Courier Address: Tennessee Department of Commerce and Insurance Financial Affairs Section/Analytical Unit 0576 Attention: Premium Tax Section 500 James Robertson Parkway, 7th Floor Nashville, TN 37243. StateAbbrv: TN. Insurance Type: HMO. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TNp-100_HMO_Quarterly_Premium_Tax_Form.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Tennessee Department of Commerce and Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TN-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: Mark.Brothers@tn.gov. Contact Phone: 615-741-1203. Due by Postmark or Receive Date: Receive Date. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

TN - Life Quarterly Premium Tax Form

Premium Tax Mailing Address for Premium Tax Returns: State of Tennessee Department of Commerce and Business Division of Insurance P.O. Box 198983 Nashville, TN 37219-8983 Overnight Courier Address: Tennessee Department of Commerce and Insurance Financial Affairs Section/Analytical Unit 0576 Attention: Premium Tax Section 500 James Robertson Parkway, 7th Floor Nashville, TN 37243. StateAbbrv: TN. Insurance Type: LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TNp-010_Life_Quarterly_Premium_Tax_Form.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Tennessee Department of Commerce and Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TN-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: Mark.Brothers@tn.gov. Contact Phone: 615-741-1203. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

TN - Other than Life Quarterly Premium Tax Form

Premium Tax Mailing Address for Premium Tax Returns: State of Tennessee Department of Commerce and Business Division of Insurance P.O. Box 198983 Nashville, TN 37219-8983 Overnight Courier Address: Tennessee Department of Commerce and Insurance Financial Affairs Section/Analytical Unit 0576 Attention: Premium Tax Section 500 James Robertson Parkway, 7th Floor Nashville, TN 37243. State Form ID: IN-0578. StateAbbrv: TN. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TNp-001_Other_than_Life_Quarterly_Premium_Tax_Form.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Tennessee Department of Commerce and Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TN-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: Mark.Brothers@tn.gov. Contact Phone: 615-741-1203. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

TN - PLHS Quarterly Premium Tax Form

Premium Tax Mailing Address for Premium Tax Returns: State of Tennessee Department of Commerce and Business Division of Insurance P.O. Box 198983 Nashville, TN 37219-8983 Overnight Courier Address: Tennessee Department of Commerce and Insurance Financial Affairs Section/Analytical Unit 0576 Attention: Premium Tax Section 500 James Robertson Parkway, 7th Floor Nashville, TN 37243. StateAbbrv: TN. Insurance Type: Health. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TNp-100_PLHS_Quarterly_Premium_Tax_Form.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Tennessee Department of Commerce and Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TN-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: Mark.Brothers@tn.gov. Contact Phone: 615-741-1203. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

AL - Holding Company Registration Statement

State Required Filings Domestic companies are required to file a Holding Company Registration Statement and pay a filing fee no later than June 1. It should be mailed to the Alabama Department of Insurance at 201 Monroe Street, Suite 1700, Montgomery, AL 36104. StateAbbrv: AL. Insurance Type: LAH. PC. Filing Period: Qtr 2. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Alabama&InsType=AL-111_Insurance_Homepage.htm&TableName=ICC. Contact: Ann Strickland, Examiner. Contact Email: Ann.Strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive Date. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

AR - Act 1345 County Fire Loss Annual Report

State Required Filings Please submit as an attachment to an email to becky.harrington@arkansas.gov. StateAbbrv: AR. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arkansas&InsType=AR-001_Act_1345_County_Fire_Loss_Annual_Report.xls&TableName=ICC. State Authority: Arkansas Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arkansas&InsType=AR-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: alexa.grissom@arkansas.gov. Due by Postmark or Receive Date: Receive Date. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

AR - Company Financial Regulation Fee - Form and Instructions (Form AID AC CFRF)

State Required Filings All companies must file this form even if you have not written any business in our state. Please DO NOT confuse the CFRF fee with the Fraud Assessment Fee. DO NOT send them in the same envelope. If you file late, there is a fine for each day you are late. Mail form and company check to: Accounting Division 1200 West Third Street Little Rock, AR 72201-1904. State Form ID: AID AC CFRF. StateAbbrv: AR. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.insurance.arkansas.gov/Accounting/CFRFinfo/CFRF%20Form2011.pdf. State Authority: Arkansas Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arkansas&InsType=AR-111_Insurance_Homepage.htm&TableName=ICC. Contact: Carla Kincannon. Contact Phone: 501-371-2605. Due by Postmark or Receive Date: Receive Date. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://insurance.arkansas.gov/Accounting/CFRFpage.htm. Saturday, June 1, 2013.

AZ - Audited Financial Report Transmittal (Form E-AFR)

State Required Filings Form E-AFR MUST be completed and attached to front cover of the Audited Financial Report filed with us. State Form ID: E-AFR. StateAbbrv: AZ. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arizona&InsType=AZ-111_Audited_Financial_Report_Transmittal_%28Form_E-AFR%29.pdf&TableName=ICC. State Authority: Arizona Department of Insurance, Insurance Tax Unit - Compliance Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arizona&InsType=AZ-111_Insurance_Homepage.htm&TableName=ICC. Contact: Tony McCormack. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

CT - Holding Company Registration Statement

State Required Filings StateAbbrv: CT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. State Authority: Connecticut Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Connecticut&InsType=CT-111_Insurance_Homepage.htm&TableName=ICC. Contact: Financial Analysis & Compliance Division. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-291-3814. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

GU - Renewal of Certificate of Authority Packet and Checklist

State Required Filings All insurers holding a current certificate shall annually, no later than June 1, file with the Commissioner an application for renewal. Please provide an email address of company's Compliance Officer in charge of filing for Renewal Application of Certificate of Authority. StateAbbrv: GU. Filing Period: Annual. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Guam&InsType=GU-111_Renewal_of_Certificate_of_Authority_Packet_and_Checklist.pdf&TableName=ICC. State Authority: Department of Revenue and Taxation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Guam&InsType=GU-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: acruz@revtax.gov.gu. Contact Phone: 671-635-1843-1846. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.govguamdocs.com/revtax/docs/COARENEWALLETTER_2010.pdf. Saturday, June 1, 2013.

IA - Medical Malpractice Insurance Closed Claims Spreadsheet

State Required Filings The report should consist of two EXCEL spreadsheets, one for closed claims and one for open claims, and the contact information sheet. The report should be submitted via e-mail to Karen Armstrong at medmal@iid.iowa.gov. The EXCEL spreadsheets may be zipped using the WinZip program if the file is too large for e-mail. Please complete the contact information sheet and submit it with your spreadsheets. StateAbbrv: IA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IA-111_Medical_Malpractice_Insurance_Closed_Claims_Spreadsheet.xls&TableName=ICC. State Authority: Iowa Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: karen.armstrong@iid.iowa.gov. Contact Phone: 515-281-4450. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Instructions and Contact sheet: http://www.iid.state.ia.us/downloadable_reports_forms/medmalinstructions.pdf Layout: http://www.iid.state.ia.us/downloadable_reports_forms/layoutmedmal.xls. Saturday, June 1, 2013.

IA - Medical Malpractice Insurance Open Claims Spreadsheet

State Required Filings The report should consist of two EXCEL spreadsheets, one for closed claims and one for open claims, and the contact information sheet. The report should be submitted via e-mail to Karen Armstrong at medmal@iid.iowa.gov. The EXCEL spreadsheets may be zipped using the WinZip program if the file is too large for e-mail. Please complete the contact information sheet and submit it with your spreadsheets. StateAbbrv: IA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: . State Authority: Iowa Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Iowa&InsType=IA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: karen.armstrong@iid.iowa.gov. Contact Phone: 515-281-4450. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Instructions and Contact sheet: http://www.iid.state.ia.us/downloadable_reports_forms/medmalinstructions.pdf Layout: http://www.iid.state.ia.us/downloadable_reports_forms/layoutmedmal.xls. Saturday, June 1, 2013.

ID - Health Survey Form

State Required Filings StateAbbrv: ID. Insurance Type: Health. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Idaho&InsType=ID-100_Health_Survey_Form.aspx&TableName=ICC. State Authority: Idaho Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Idaho&InsType=ID-111_Insurance_Homepage.htm&TableName=ICC. Contact: Donna Daniel. Contact Email: HealthSurvey@doi.idaho.gov. Contact Phone: 208-334-4362. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: . Saturday, June 1, 2013.

MN - Audited Financial Statement by Independent Certified Public Accountant and Actuarial Certification

State Required Filings StateAbbrv: MN. Insurance Type: Risk Retention Group. Filing Period: Qtr 2. State Authority: Minnesota Department of Commerce. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MN-111_Insurance_Homepage.htm&TableName=ICC. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.state.mn.us/mn/externalDocs/Commerce/Risk_Retention_Groups_111403013348_RiskRetention.pdf. Saturday, June 1, 2013.

MN - Holding Company Annual Registration Statement

State Required Filings MN Stat. 60D.19. State Form ID: B & C. StateAbbrv: MN. Insurance Type: Health. LAH. PC. Filing Period: Annual. Link to State Form: . State Authority: Minnesota Department of Commerce, Financial Examinations-Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MN-111_Insurance_Homepage.htm&TableName=ICC. Contact: LAH, PC & Fraternal Benefit Societies: Kathleen Foley Health: Constance Peterson. Contact Email: LAH, PC & Fraternal Benefit Societies: Kathleen.Foley@state.mn.us Health, HMDIs, and HMOs: Constance.Peterson@state.mn.us. Contact Phone: LAH, PC & Fraternal Benefit Societies: 651-297-7686 Health: 651-297-8943. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

MN - Long-Tail Casualty Reinsurance Certification

State Required Filings This form should be filed with: Minnesota Department of Commerce Financial Institutions-Insurance 85 7th Place East, Suite 500 St. Paul, MN 55145-2198. StateAbbrv: MN. Insurance Type: Reinsurance. Filing Period: Qtr 2. Link to State Form: . State Authority: Minnesota Department of Commerce, Financial Examinations-Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MN-111_Insurance_Homepage.htm&TableName=ICC. Contact: Kathleen Foley. Contact Email: Kathleen.Foley@state.mn.us. Contact Phone: 651-297-7686. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

MN - Report by Independent CPA Regarding Application of Valuation Procedures

State Required Filings MN Stat. 60A.124. StateAbbrv: MN. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. State Authority: Minnesota Department of Commerce, Financial Examinations-Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MN-111_Insurance_Homepage.htm&TableName=ICC. Contact: LAH, PC & Fraternal Benefit Societies: Kathleen Foley Health: Constance Peterson. Contact Email: LAH, PC & Fraternal Benefit Societies: Kathleen.Foley@state.mn.us Health, HMDIs, and HMOs: Constance.Peterson@state.mn.us. Contact Phone: LAH, PC & Fraternal Benefit Societies: 651-297-7686 Health: 651-297-8943. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

MS - Certificate of Valuation

State Required Filings Foreign insurers shall file an electronic copy with the Department to filings@mid.ms.gov on or before the statutory due date. StateAbbrv: MS. Insurance Type: LAH. Filing Period: Qtr 2. State Authority: Mississippi Insurance Department, Financial & Market Regulation Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Mississippi&InsType=MS-111_Insurance_Homepage.htm&TableName=ICC. Contact: Donna Whitley. Contact Email: filings@mid.ms.gov. Contact Phone: 601-359-2127. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

MS - Holding Company System

State Required Filings Foreign companies which do not have a Holding Company law similar to MS are required to file pursuant to Miss. Code Ann. 83-6-3. State Form ID: B & C. StateAbbrv: MS. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. State Authority: Mississippi Insurance Department, Financial & Market Regulation Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Mississippi&InsType=MS-111_Insurance_Homepage.htm&TableName=ICC. Contact: Donna Whitley. Contact Email: filings@mid.ms.gov. Contact Phone: 601-359-2127. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

NV - Insurer Complaint Reporting Form

State Required Filings Reports must be submitted via SERFF under the specific TOI Required Industry Reports. Reports submitted under the wrong TOI will be returned to the carrier. State Form ID: LH-56. StateAbbrv: NV. Insurance Type: Health. LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NV-110_Insurer_Complaint_Reporting_Form.pdf&TableName=ICC. State Authority: Department of Business and Industry, Division of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NV-111_Insurance_Homepage.htm&TableName=ICC. Contact: Nanci Hoffman. Contact Email: NHoffman@doi.state.nv.us. Contact Phone: 775-687-0760. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: . Saturday, June 1, 2013.

OR - OIGA Assessment Recoupment

State Required Filings Forms are mailed to companies that are still required to file. StateAbbrv: OR. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oregon&InsType=OR-001_PC_Checklist.pdf&TableName=ICC. State Authority: Oregon Department of Consumer and Business Services, Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oregon&InsType=OR-111_Insurance_Homepage.htm&TableName=ICC. Contact: Lynette Hadley Shannon O'Shea. Contact Email: lynette.m.hadley@state.or.us shannon.oshea@state.or.us. Contact Phone: 503-947-7046 503-947-7218. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

PA - CPA Audit Report

State Required Filings A hard copy is no longer required to be filed with the department provided that a hard copy is filed with the state of domicile and if the date is filed electronically with the NAIC. If you have any questions or need assistance, please contact us at: Pennsylvania Insurance Department Office of Corporate and Financial Regulation Attn: Company Licensing Division 1345 Strawberry Square Harrisburg, PA 17120. StateAbbrv: PA. Insurance Type: Risk Retention Group. Filing Period: Qtr 2. State Authority: Pennsylvania Insurance Department, Corporate and Financial Regulation, Company Licensing Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Pennsylvania&InsType=PA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Company Licensing Division. Contact Email: nlukens@pa.gov. Contact Phone: 717-787-2735. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.portal.state.pa.us/portal/server.pt/document/877536/rrg_annual_filing_for_web_110509_pdf. Saturday, June 1, 2013.

PA - CPA Audit Report

State Required Filings A hard copy is no longer required to be filed with the department provided that a hard copy is filed with the state of domicile and if the date is filed electronically with the NAIC. If you have any questions or need assistance, please contact us at: Pennsylvania Insurance Department Office of Corporate and Financial Regulation Attn: Company Licensing Division 1345 Strawberry Square Harrisburg, PA 17120. StateAbbrv: PA. Insurance Type: Surplus Lines. Filing Period: Qtr 2. State Authority: Pennsylvania Insurance Department, Corporate and Financial Regulation, Company Licensing Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Pennsylvania&InsType=PA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Company Licensing Division. Contact Email: ra-in-company@pa.gov. Contact Phone: 717-787-2735. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.portal.state.pa.us/portal/server.pt/document/877730/foreign_requal_for_internet(110509)_pdf. Saturday, June 1, 2013.

RI - Credit Life/Accident and Health Filing

State Required Filings See Regulation 9 , Section 9, enumerates filing requirements. Please submit on an individual company basis, under separate cover, electronically to specialreports@dbr.ri.gov. StateAbbrv: RI. Insurance Type: LAH. PC. Filing Period: Qtr 2. State Authority: Rhode Island Department of Business Regulation, Division of Insurance Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=RhodeIsland&InsType=RI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Paul Sheridan, Senior Insurance Rate Analyst (Life A & H Section). Contact Email: Mdimaio@dbr.ri.gov or CompanyLicensing@dbr.ri.gov. Contact Phone: 401-462-9618. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

RI - Labor Rate Survey

State Required Filings R.I.G.L. 27-29-4.4 and Insurance Regulation 108, section 7 enumerate the filing requirements. Please visit the Department's website yearly to determine if your insurer is required to submit a filing based upon market share. Insurers may submit reports on a group basis. For those licensees subject to filing with the Department, please submit reports electronically to the attention of Paula M. Pallozzi, Chief Property & Casualty Insurance Rate Analyst at drrww@dbr.ri.gov - may be reached at 401-462-9616. StateAbbrv: RI. Insurance Type: PC. Filing Period: Qtr 2. State Authority: Rhode Island Department of Business Regulation, Division of Insurance Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=RhodeIsland&InsType=RI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Paula M. Pallozzi. Contact Email: Mdimaio@dbr.ri.gov or CompanyLicensing@dbr.ri.gov. Contact Phone: 401-462-9616. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

TN - SL Continuing Eligibility Review - Foreign

State Required Filings The Audited Financial Report must be filed electronically with the NAIC by June 1. StateAbbrv: TN. Insurance Type: Surplus Lines. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TNs-001_SL_Renewal_Information_-_Foreign.pdf&TableName=ICC. State Authority: Tennessee Department of Commerce and Insurance, Financial Affairs, Analytical Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TN-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 615-532-2391. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

TN - SL Continuing Eligibility Review – Alien

State Required Filings The Audited Financial Report and Trust Agreement/Certification should be mailed to the following address: Tennessee Department of Commerce and Insurance Attn: Debby Trask Financial Affairs Section/Analytical Unit 0576 500 James Robertson Parkway, 7th Floor Nashville, TN 37243. StateAbbrv: TN. Insurance Type: Surplus Lines. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TNs-001_SL_Renewal_Information_-_Alien.pdf&TableName=ICC. State Authority: Tennessee Department of Commerce and Insurance, Financial Affairs, Analytical Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Tennessee&InsType=TN-111_Insurance_Homepage.htm&TableName=ICC. Contact: Debby Trask. Contact Phone: 615-532-2391. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

TX - Audited GAAP/SAP Financial Statement

State Required Filings Copy of the audited GAAP or SAP financial statements and opinions of the insurer and/or insurer's parent corporation. StateAbbrv: TX. Insurance Type: Surplus Lines. Filing Period: Qtr 2. State Authority: Texas Department of Insurance, Financial Regulation Division, Financial Analysis Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 512-322-3535. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.tdi.state.tx.us/forms/fincolicense/fin422foreignsl.pdf http://www.tdi.state.tx.us/financial/documents/foreign.pdf. Saturday, June 1, 2013.

TX - Premiums Written in Texas

State Required Filings File hard copy with Texas only. StateAbbrv: TX. Insurance Type: PC. Surplus Lines. Filing Period: Qtr 2. State Authority: Texas Department of Insurance, Financial Regulation Division, Financial Analysis Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 512-322-3507. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Checklist: http://www.tdi.state.tx.us/forms/fincolicense/fin423alienslrq.pdf Filing Smart: http://www.tdi.state.tx.us/financial/documents/aliens.pdf. Saturday, June 1, 2013.

TX - S.E.C. 10K Report

State Required Filings If a publicly traded company, a copy of the Securities and Exchange Commission (S.E.C.) Form 10K as well as any other S.E.C. filing relating to any material event. StateAbbrv: TX. Insurance Type: Surplus Lines. Filing Period: Qtr 2. State Authority: Texas Department of Insurance, Financial Regulation Division, Financial Analysis Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 512-322-3535. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.tdi.state.tx.us/forms/fincolicense/fin422foreignsl.pdf http://www.tdi.state.tx.us/financial/documents/foreign.pdf. Saturday, June 1, 2013.

TX - SL Checklist - Alien

State Required Filings A complete copy of all evidence must be filed with the Surplus Lines Stamping Office of Texas. State Form ID: FIN423. StateAbbrv: TX. Insurance Type: Surplus Lines. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TXs-001_SL_Checklist_-_Alien.pdf&TableName=ICC. State Authority: Texas Department of Insurance, Financial Regulation Division, Financial Analysis Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: companylicense@tdi.state.tx.us. Contact Phone: 512-322-3535. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.tdi.state.tx.us/financial/documents/aliens.pdf. Saturday, June 1, 2013.

TX - Trust Fund Agreement and Current Statement of Account

State Required Filings Trust fund must be maintained in a U.S. Federal Reserve System member bank. Trust Fund should be on the International Insurers Department (IID) (formerly Non-Admitted Insurers Information Office - NAIIO) Standard Trust Fund agreement and is for the protection of U.S. policyholders. StateAbbrv: TX. Insurance Type: Surplus Lines. Filing Period: Qtr 2. State Authority: Texas Department of Insurance, Financial Regulation Division, Financial Analysis Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 512-322-3535. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.tdi.state.tx.us/forms/fincolicense/fin423alienslrq.pdf http://www.tdi.state.tx.us/financial/documents/aliens.pdf. Saturday, June 1, 2013.

VA - Open Enrollment Statement

State Required Filings An Open Enrollment Statement detailing the information pursuant to Section 38.2-4217B is required to be filed. StateAbbrv: VA. Insurance Type: Health. Filing Period: Qtr 2. State Authority: Virginia Bureau of Insurance, Financial Regulation Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Virginia&InsType=VA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Domestic: Karen Traylor Foreign: Gala Yung HMOsDPOs (Foreign or Domestic): Connie Duong. Contact Email: Domestic Companies: karen.traylor@scc.virginia.gov Foreign Companies: galang.yung@scc.virginia.gov HMOs/DPOs (Foreign or Domestic): connie.duong@scc.virginia.gov. Contact Phone: Domestic: 804-371-9908 Foreign: 804-371-9136 HMOs/DPOs (Foreign or Domestic): 804-371-9901. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: . Saturday, June 1, 2013.

WA - Paper Signature Pages

State Required Filings Mail to: Attention: Company Supervision Division PO Box 40259 Olympia, WA 98504-0259 Hand Delivery: Attention: Company Supervision Division 5000 Capitol Boulevard SE Tumwater, WA 98501. StateAbbrv: WA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. State Authority: Washington State Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Washington&InsType=WA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: ASFI@oic.wa.gov. Contact Phone: 360-725-7200. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.insurance.wa.gov/insurers/financial_statements/annualstate_reqbustype.shtml. Saturday, June 1, 2013.

WI - Audited Financial Statements Exemption Affidavit

State Required Filings . StateAbbrv: WI. Insurance Type: Health. LAH. Filing Period: Qtr 2. Link to State Form: . State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Yvonne Sherry. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

WI - CPA Audit Checklist

State Required Filings Complete and return this with your CPA audit report unless a CPA Audit Exemption Certification is filed. Nondomestic insurers are not required to file this form if the insurer has made the required filings with the domiciliary state. Nondomestic insurers are required to file the CPA audit reports by June 1. StateAbbrv: WI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: . State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Yvonne Sherry. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

WI - CPA Audited Financial Statements Exemption Affidavit

State Required Filings Complete and return this with your CPA audit report unless a CPA Audit Exemption Certification is filed. Nondomestic insurers are not required to file this form if the insurer has made the required filings with the domiciliary state. Nondomestic insurers are required to file the CPA audit reports by June 1. StateAbbrv: WI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: . State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Yvonne Sherry. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

WI - Holding Company Registration Statement

State Required Filings Only applies to WI-domiciled insurers which are a member of an insurance holding company system. See Chapter Ins 40, Wis. Adm. Code. State Form ID: B & C. StateAbbrv: WI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Yvonne Sherry. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

WV - Certificate of Compliance

State Required Filings Foreign and alien licensed insurers must file these certificates with the Annual Premium Tax Statement (Form IC-PT) or Application for License (Form A-10). The Certificate of Compliance is a Certificate of Compliance/Good Standing from your state of domicile and not the Certificate of Authority. StateAbbrv: WV. Insurance Type: Health. Filing Period: Qtr 2. State Authority: West Virginia Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=WestVirginia&InsType=WV-111_Insurance_Homepage.htm&TableName=ICC. Contact: Darlene Parsons. Contact Email: Darlene.Parsons@wvinsurance.gov. Contact Phone: 304-558-2100. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

WV - Certificate of Deposit

State Required Filings Foreign and alien licensed insurers must file these certificates with the Annual Premium Tax Statement (Form IC-PT) or Application for License (Form A-10). StateAbbrv: WV. Insurance Type: Health. Filing Period: Qtr 2. State Authority: West Virginia Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=WestVirginia&InsType=WV-111_Insurance_Homepage.htm&TableName=ICC. Contact: Darlene Parsons. Contact Email: Darlene.Parsons@wvinsurance.gov. Contact Phone: 304-558-2100. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

WV - Holding Company Registration

State Required Filings Foreign licensed HMOs are required to make the same type and number of filings as a domestic HMO. StateAbbrv: WV. Insurance Type: Health. Filing Period: Qtr 2. State Authority: West Virginia Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=WestVirginia&InsType=WV-111_Insurance_Homepage.htm&TableName=ICC. Contact: Darlene Parsons. Contact Email: Darlene.Parsons@wvinsurance.gov. Contact Phone: 304-558-2100. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 1, 2013.

AZ - Installment Payment Report (Form E-INSTALL)

Premium Tax You must submit your filing and payment of the TOTAL AMOUNT DUE through OPTins or the mail on or before the due date. State Form ID: E-INSTALL. StateAbbrv: AZ. Insurance Type: Health. LAH. PC. Risk Retention Group. Filing Period: Qtr 2. Link to State Form: http://www.id.state.az.us/taxunit/documents/e-install.xls. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: State of Arizona, Insurance Tax Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arizona&InsType=AZ-111_ICA_Homepage.htm&TableName=ICC. Contact Email: Syepez@azinsurance.gov. Contact Phone: 602-364-3997. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

CA - Ocean Marine Insurance Tax Return (Form CDI FS-005)

Premium Tax If payment by CHECK, mail to: State of California Department of Insurance Tax Accounting Unit P.O. Box 1918 Sacramento, CA 95812-1918 If payment by EFT, mail to (First Class/Express Delivery): State of California Department of Insurance Tax Accounting Unit 300 Capitol Mall, Suite 1400 Sacramento, CA 95814. State Form ID: CDI FS-005. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CAp-001_Ocean_Marine_Insurance_Tax_Return_%28Form_CDI_FS-005%29.xls&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: California Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

CT - Estimated Premiums Tax Payment Coupon - Domestic

Premium Tax Complete this return in blue or black ink only. Make check payable to: Commissioner of Revenue Services. Mail to: Department of Revenue Services Processing Section PO Box 2990 Hartford, CT 06104-2990. State Form ID: 207 ESB. StateAbbrv: CT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Connecticut&InsType=CTp-111_Estimated_Premiums_Tax_Payment_Coupon_-_Domestic.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Department of Revenue Services, State of Connecticut. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Connecticut&InsType=CT-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

CT - Estimated Premiums Tax Payment Coupon - Foreign and Nonresident

Premium Tax Complete this return in blue or black ink only. Make check payable to: Commissioner of Revenue Services. Mail to: Department of Revenue Services Processing Section PO Box 2990 Hartford, CT 06104-2990. State Form ID: 207F ESB. StateAbbrv: CT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Connecticut&InsType=CTp-111_Estimated_Premiums_Tax_Payment_Coupon_-_Foreign_and_Nonresident.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Department of Revenue Services, State of Connecticut. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Connecticut&InsType=CT-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

CT - HCC Estimated Tax Payment Coupon

Premium Tax Complete this return in blue or black ink only. Make check payable to: Commissioner of Revenue Services. Mail to: Department of Revenue Services Processing Section PO Box 2990 Hartford, CT 06104-2990. State Form ID: 207 HCC ESB. StateAbbrv: CT. Insurance Type: Health. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Connecticut&InsType=CTp-100_HCC_Estimated_Tax_Payment_Coupon.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Department of Revenue Services, State of Connecticut. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Connecticut&InsType=CT-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

DE - Quarterly Premium Tax Prepayment (Form WFT-9)

Premium Tax If there is no quarterly payment amount due, a zero filing is NOT required. Mail this form along with a check made payable to Delaware Department of Insurance to the following address: Delaware Department of Insurance ATTN: Premium Tax Section 841 Silver Lake Blvd. Dover, DE 19904-2465. State Form ID: WFT-9. StateAbbrv: DE. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Delaware&InsType=DEp-111_Quarterly_Premium_Tax_Prepayment_%28Form_WFT-9%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Delaware Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Delaware&InsType=DE-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: ann.fletcher@state.de.us. Contact Phone: 302-674-7383. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

FL - Premium Installment Payment and Instructions (Form DR-907)

Premium Tax Mail form and remittance to: Florida Department of Revenue 5050 W Tennessee Street Tallahassee, FL 32399-0150. State Form ID: DR-907. StateAbbrv: FL. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Florida&InsType=FLp-111_Premium_Installment_Payment_and_Instructions_%28Form_DR-907%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Florida Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Florida&InsType=FL-111_Premium_Tax_Homepage.htm&TableName=ICC. Contact Phone: In FL 800-352-3671 or Outside FL 850-488-6800. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

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

Premium Tax Mail to: Florida Department of Financial Services Revenue Processing Section Post Office Box 6100 Tallahassee, FL 32314-6100. State Form ID: OIR-A1-1615. StateAbbrv: FL. Insurance Type: Risk Retention Group. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Florida&InsType=FLp-001_Premium_Taxes_Transmittal_-_RRG_%28Form_OIR-A1-1615%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Florida&InsType=FL-111_Premium_Tax_Homepage.htm&TableName=ICC. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

ID - Quarterly Estimated Prepayment Installments - Quarter 1

Premium Tax Make check payable to: IDAHO DEPARTMENT OF INSURANCE REQUIRED: Separate payments for each company. Signature and title of officer. Delinquent if not mailed on or before due date to: State of Idaho - Department of Insurance 700 West State Street, 3rd Floor Boise, ID 83720-0043. State Form ID: INS-PTX-QP1. StateAbbrv: ID. Insurance Type: Health. LAH. PC. Filing Period: Qtr 1. Link to State Form: http://www.doi.idaho.gov/Company/Ippt.pdf. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Idaho Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Idaho&InsType=ID-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: kathy.miller@doi.idaho.gov. Contact Phone: 208-334-4282. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.doi.idaho.gov/Company/Ippt.pdf. Saturday, June 15, 2013.

IL - Privilege and Retaliatory Tax Installment (Form PRT1)

Premium Tax All companies whose annual tax for the preceding calendar year was less than $5,000 need not file this installment. Please complete and return one copy of this tax installment each quarter. Remittance should be payable to Illinois State Treasurer and mailed to: Illinois Department of Insurance, PO Box 7087, Springfield, IL 62791. State Form ID: PRT1. StateAbbrv: IL. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Illinois&InsType=ILp-111_Privilege_and_Retaliatory_Tax_Installment_%28Form_PRT1%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Illinois Department of Financial and Professional Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Illinois&InsType=IL-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-782-4515. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

IN - Estimated Premium Tax - Quarterly

Premium Tax Make check payable: Indiana Department of Insurance. Send remittance with form to: Indiana Department of Insurance Bank Lockbox Post Office Box 577 Indianapolis, Indiana 46206-0577. State Form ID: 38337. StateAbbrv: IN. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Indiana&InsType=INp-111_Estimated_Premium_Tax_-_Quarterly.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Indiana Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Indiana&InsType=IN-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: dgraves@idoi.in.gov. Contact Phone: 317-232-1993. Due by Postmark or Receive Date: Receive. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.in.gov/idoi/files/Schedule_of_fees_taxes_deposits.pdf. Saturday, June 15, 2013.

KS - Installment Payment

Premium Tax Kansas estimated tax invoices due June 15 have been posted to Company Desktop, Kansas' secure online portal. Invoices are not being sent by postal mail to companies that have provided us with a valid email address to receive this notice. Companies should log in to Company Desktop to view their bills. Links on the log-in page explain Kansas' secure portal and how company personnel can get an ID and password. Bills may be paid online by credit card up to $10,000 or by ACH electronic check for any amount. Companies also can mail a check along with a copy of their invoice. StateAbbrv: KS. Filing Period: Annual, Qtr 1, Qtr 2, Qtr 3, Qtr 4. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Kansas Insurance Department. Filing Method: Electronic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: https://login.ksinsurance.org/kid/. Saturday, June 15, 2013.

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

Premium Tax Companies are required to submit forms online: https://towerii.ksinsurance.org/kid/signon.do. StateAbbrv: KS. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Kansas Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kansas&InsType=KS-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 785-296-3428. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.ksinsurance.org/industry/company/co_docs/taxforms/General_Instructions2009.pdf. Saturday, June 15, 2013.

MN - Insurance Estimated Tax - HMO (Form M27)

Premium Tax Make check payable to Minnesota Revenue and mail to: Minnesota Revenue Mail Station 1780 St. Paul, MN 55145-1780 DO NOT send in the voucher below unless you are paying by check. State Form ID: M27. StateAbbrv: MN. Insurance Type: HMO. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MNp-100_Insurance_Estimated_Tax_-_HMO_%28Form_M27%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Minnesota Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MN-111_Premium_Tax_Homepage.htm&TableName=ICC. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-556-4729. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://taxes.state.mn.us/special/insurance/Documents/instructions_m27_inst.pdf. Saturday, June 15, 2013.

MN - Insurance Estimated Tax (Form M19)

Premium Tax Make check payable to Minnesota Revenue and mail to: Minnesota Revenue Mail Station 1780 St. Paul, MN 55145-1780 DO NOT send in the voucher below unless you are paying by check. State Form ID: M19. StateAbbrv: MN. Insurance Type: LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MNp-011_Insurance_Estimated_Tax_%28Form_M19%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Minnesota Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MN-111_Premium_Tax_Homepage.htm&TableName=ICC. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-556-4729. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://taxes.state.mn.us/special/insurance/Documents/instructions_m19_inst.pdf. Saturday, June 15, 2013.

MT - Quarterly Premium Tax Prepayment - LAH (Form SAI-22)

Premium Tax Mail payments to: Montana Insurance Department 840 Helena Avenue Helena, MT 59601. State Form ID: SAI-22. StateAbbrv: MT. Insurance Type: Health. LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Montana&InsType=MTp-110_Quarterly_Premium_Tax_Prepayment_-_LAH_%28Form_SAI-22%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Montana Insurance Department, Examinations Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Montana&InsType=MT-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: stateauditor@mt.gov. Contact Phone: 406-444-2040. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

MT - Quarterly Premium Tax Prepayment - PC (Form SAI-23.)

Premium Tax Mail payments to: Montana Insurance Department 840 Helena Avenue Helena, MT 59601. State Form ID: SAI-23. StateAbbrv: MT. Insurance Type: Health. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Montana&InsType=MTp-101_Quarterly_Premium_Tax_Prepayment_-_PC_%28Form_SAI-23%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Montana Insurance Department, Examinations Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Montana&InsType=MT-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: stateauditor@mt.gov. Contact Phone: 406-444-2040. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

MT - Quarterly Premium Tax Prepayment - RRG (Form SAI-25)

Premium Tax Mail payments to: Montana Insurance Department 840 Helena Avenue Helena, MT 59601. State Form ID: SAI-25. StateAbbrv: MT. Insurance Type: Risk Retention Group. Filing Period: Qtr 1. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Montana&InsType=MTp-001_Quarterly_Premium_Tax_Prepayment_-_RRG_%28Form_SAI-25%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Montana Insurance Department, Examinations Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Montana&InsType=MT-111_Insurance_Homepage.htm&TableName=ICC. Contact Phone: 406-444-2040. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

NC - Installment Payment - HMO (Form IB-65)

Premium Tax See Checklist Link. State Form ID: IB-64. StateAbbrv: NC. Insurance Type: Health. HMO. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthCarolina&InsType=NCp-100_Installment_Payment_-_HMO_%28Form_IB-54%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: North Carolina Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthCarolina&InsType=NC-111_Premium_Tax.htm&TableName=ICC. Contact Email: chris.long@dornc.com. Contact Phone: 919-715-0869. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

NC - Installment Payment - LAH (Form IB-15)

Premium Tax See Checklist Link. State Form ID: IB-14. StateAbbrv: NC. Insurance Type: LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthCarolina&InsType=NCp-010_Installment_Payment_-_LAH_%28Form_IB-14%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: North Carolina Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthCarolina&InsType=NC-111_Premium_Tax.htm&TableName=ICC. Contact Email: chris.long@dornc.com. Contact Phone: 919-715-0869. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

NC - Installment Payment - PC (Form IB-35)

Premium Tax See Checklist Link. State Form ID: IB-34. StateAbbrv: NC. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthCarolina&InsType=NCp-001_Installment_Payment_-_PC_%28Form_IB-34%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: North Carolina Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthCarolina&InsType=NC-111_Premium_Tax.htm&TableName=ICC. Contact Email: chris.long@dornc.com. Contact Phone: 919-715-0869. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

NE - Quarterly Premium Tax Return

Premium Tax See Checklist Link. State Form ID: Qtrlyform. StateAbbrv: NE. Insurance Type: Health. LAH. PC. Risk Retention Group. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nebraska&InsType=NEp-111_Quarterly_Premium_Tax_Return.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Nebraska Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nebraska&InsType=NE-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: martha.hettenbaugh@nebraska.gov. Contact Phone: 402-471-4671. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

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

Premium Tax Make check or money order payable to: New York State Corporation Tax. Return this form with your payment to: NYS Estimated Corporation Tax PO Box 4136 Binghamton, NY 13902-4136. State Form ID: CT-400-MN. StateAbbrv: NY. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NYp-111_Estimated_Tax_for_Corporations_%28Form_CT-400-MN%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: New York State Department of Taxation and Finance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NY-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.tax.state.ny.us/pdf/2010/corp/ct400i_410.pdf. Saturday, June 15, 2013.

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

Premium Tax State Form ID: CT-222. StateAbbrv: NY. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NYp-111_Underpayment_of_Estimated_Tax_by_a_Corporation_%28Form_CT-222%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: New York State Department of Taxation and Finance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NY-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.tax.state.ny.us/pdf/2009/corp/ct222i_2009.pdf. Saturday, June 15, 2013.

OK - Captive Estimated Tax Vouchers 1 and 2

Premium Tax Return to: Oklahoma Insurance Department Financial Division - Premium Tax Unit 5 Corporate Plaza 3625 N.W. 56th Street, Suite 100 Oklahoma City, OK 73112. State Form ID: Voucher 2. StateAbbrv: OK. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oklahoma Insurance Department, Premium Tax Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OK_-WC_Prem_Tax.htm&TableName=ICC. Contact Email: gail.lopresto@oid.ok.gov. Contact Phone: 405-521-3966. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

OK - Health Insurers Estimated Tax Vouchers 1 and 2

Premium Tax Return to: Oklahoma Insurance Department Financial Division - Premium Tax Unit 5 Corporate Plaza 3625 N.W. 56th Street, Suite 100 Oklahoma City, OK 73112. State Form ID: Voucher 2. StateAbbrv: OK. Insurance Type: Health. HMO. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oklahoma Insurance Department, Premium Tax Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OK_-WC_Prem_Tax.htm&TableName=ICC. Contact Email: gail.lopresto@oid.ok.gov. Contact Phone: 405-521-3966. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

OK - LAH Estimated Tax Voucher 1 and 2

Premium Tax Return to: Oklahoma Insurance Department Financial Division - Premium Tax Unit 5 Corporate Plaza 3625 N.W. 56th Street, Suite 100 Oklahoma City, OK 73112. State Form ID: Voucher 2. StateAbbrv: OK. Insurance Type: LAH. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oklahoma Insurance Department, Premium Tax Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OK_-WC_Prem_Tax.htm&TableName=ICC. Contact Email: gail.lopresto@oid.ok.gov. Contact Phone: 405-521-3966. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

OK - PC Estimated Tax Voucher 1 and 2

Premium Tax Return to: Oklahoma Insurance Department Financial Division - Premium Tax Unit 5 Corporate Plaza 3625 N.W. 56th Street, Suite 100 Oklahoma City, OK 73112. State Form ID: Voucher 2. StateAbbrv: OK. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oklahoma Insurance Department, Premium Tax Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OK_-WC_Prem_Tax.htm&TableName=ICC. Contact Email: gail.lopresto@oid.ok.gov. Contact Phone: 405-521-3966. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

OK - RRG Estimated Tax Vouchers 1 and 2

Premium Tax Return to: Oklahoma Insurance Department Financial Division - Premium Tax Unit 5 Corporate Plaza 3625 N.W. 56th Street, Suite 100 Oklahoma City, OK 73112. State Form ID: Voucher 2. StateAbbrv: OK. Insurance Type: Risk Retention Group. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oklahoma Insurance Department, Premium Tax Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OK_-WC_Prem_Tax.htm&TableName=ICC. Contact Email: gail.lopresto@oid.ok.gov. Contact Phone: 405-521-3966. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

OR - Ocean Marine Tax Packet - PDF

Premium Tax Make your check payable to: Department of Consumer and Business Services. Return completed forms: Oregon Fiscal Services Division P.O. Box 14610 Salem, OR 97309-0445. State Form ID: 440-3935. StateAbbrv: OR. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oregon&InsType=ORp-001_Ocean_Marine_Tax_Packet_-_PDF.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oregon Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oregon&InsType=OR-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: lynette.m.hadley@state.or.us or shannon.oshea@state.or.us. Contact Phone: 503-947-7046 or 503-947-7218. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

OR - PT Prepayment Statement

Premium Tax StateAbbrv: OR. Insurance Type: LAH. PC. Filing Period: Qtr 2. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oregon Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oregon&InsType=OR-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: lynette.m.hadley@state.or.us or shannon.oshea@state.or.us. Contact Phone: 503-947-7046 or 503-947-7218. Due by Postmark or Receive Date: Postmark. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

RI - Gross Premium Estimated Tax Voucher (Form T69-ESINS)

Premium Tax Mail voucher and payment to: RI Division of Taxation One Capitol Hill - Suite 9 Providence, RI 02908-5811. State Form ID: T69-ESINS. StateAbbrv: RI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.tax.ri.gov/forms/2012/Other%20Corp/2013%20T-69ES-INS.pdf. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Rhode Island Department of Taxation, Division of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=RhodeIsland&InsType=RI-111_Premium_Tax.htm&TableName=ICC. Contact Email: clarocque@tax.ri.gov. Contact Phone: 401-574-8806. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

WA - Quarterly Payment Worksheet

Premium Tax If tax liability is less than $400, prepayments are not required. StateAbbrv: WA. Insurance Type: LAH. PC. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Washington State Office of the Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Washington&InsType=WA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: taxes@oic.wa.gov. Contact Phone: 360-725-7032. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: https://fortress.wa.gov/oic/onlineservices/Help/FAQ_Help.pdf. Saturday, June 15, 2013.

WI - Premium Tax Annual and Quarterly Fees Payment Form (Form OCI 27-013)

Premium Tax Companies are required to remit payments through OCI e-payments. State Form ID: OCI 27-013. StateAbbrv: WI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WIp-111_Premium_Tax_Annual_and_Quarterly_Fees_Payment_Form_%28Form_OCI_27-013%29.htm&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WI-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: ocifinancial@Wisconsin.gov. Contact Phone: 608-266-0091. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://oci.wi.gov/ociforms/premtax.htm. Saturday, June 15, 2013.

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

State Required Filings Every 15th of the month, when applicable. All required documents must be submitted online with (OASIS) Online Assistance System for Insurer Submittal. In addition, please submit a paper copy of pages containing original signatures by the reporting deadline to: California Department of Insurance Financial Analysis Division-Financial Records 300 South Spring Street, 13th Floor, South Tower Los Angeles, CA 90013. State Form ID: FAD26. StateAbbrv: CA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Disclosure_of_Material_Transactions_%28Form_FAD26%29_-_Excel.xls&TableName=ICC. State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Financial Records Unit. Contact Phone: 213-346-6423. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/annualnotices/disclosure.cfm. Saturday, June 15, 2013.

FL - State Filing Fees

State Required Filings Annual and Quarterly Statement filing fees should be remitted to the Florida Department of Revenue with the annual and quarterly premium taxes on Forms DR-908 (annual) and DR-907 (quarterly) in accordance with instructions provided for those forms. Surplus Lines companies, Risk Retention Groups and Accredited Reinsurers are exempt from this filing of fees. StateAbbrv: FL. Insurance Type: PC. Filing Period: Annual. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Florida&InsType=FL-111_Insurance_Homepage.htm&TableName=ICC. Contact: All Companies: David Altmaier Tami Bossart Sandra Dupont Jennifer Owings Andrew Gillie Linda McWilliams. Contact Email: David.Altmaier@floir.com Tami.Bossart@floir.com Sandra.Dupont@floir.com Jennifer.Owings@floir.com Andrew.Gillie@floir.com Linda.McWilliams@floir.com. Contact Phone: David: 850-413-3849 Tami: 850-413-5228 Sandra: 850-413-2404 Jennifer: 850-413-5213 Andrew: 850-413-5331 Linda: 850-413-5904. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, June 15, 2013.

NY - Motor Vehicle Law Enforcement Fee (MVLEF)

State Required Filings Check for amount due should accompany return and be made payable to the Superintendent of Financial Services. Returns to be mailed to: Superintendent of Financial Services New York State Insurance Department Attn: Taxes & Accounts One Commerce Plaza Albany, New York 12257 Insurers may file and remit fees on-line through the Department website. StateAbbrv: NY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NY-001_Motor_Vehicle_Law_Enforcement_Fee_%28MVLEF%29.pdf&TableName=ICC. State Authority: New York State Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NY-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: billing@dfs.ny.gov. Contact Phone: billing@ins.state.ny.us. Due by Postmark or Receive Date: Receive Date. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Circular Letter: http://www.ins.state.ny.us./circltr/2009/cl2009_13.htm Instructions: http://www.ins.state.ny.us./insurers/property/ta/mvlef.htm. Saturday, June 15, 2013.

WI - HMO Data Collection Report (Form OCI 26-903)

State Required Filings The HMO Data Collection report must be filed electronically through the OCI internet-based reporting application. State Form ID: OCI 26-903. StateAbbrv: WI. Insurance Type: Health. HMO. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WI-100_HMO_Data_Collection_Report_%28Form_OCI_26-903%29.htm&TableName=ICC. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Managed Care Specialist. Contact Email: ocihmo@wisconsin.gov. Contact Phone: 608-266-3585. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://oci.wi.gov/ociforms/hmodata.htm. Saturday, June 15, 2013.

GA - Quarterly Premium Tax Return (Form GID-12A)

Premium Tax If Paying by Check: Georgia Department of Insurance - Premium Tax Division P.O. Box 935134 Atlanta, GA 31193-5134 Overnight Carrier: Wachovia Bank GA Ins. Dept - Premium Tax Division Lockbox 935134 3585 Atlanta Avenue Hapeville, GA 30354 If Filing Paper Return AND Paying by Check: GA Department of Insurance Suite 916 2 Martin Luther King Jr. Dr. Atlanta, GA 30334. State Form ID: GID-012A-PT. StateAbbrv: GA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Georgia&InsType=GAp-111_Quarterly_Premium_Tax_Return_%28Form_GID-12A%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Georgia Department of Insurance, Premium Tax Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Georgia&InsType=GA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: premiumtax@oci.ga.gov. Contact Phone: 404-656-7553. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Thursday, June 20, 2013.

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

Premium Tax The monthly return shall be filed and any tax then due shall be paid no later than the twentieth day of the following month. You may file your GRT form by mail at the following address: Department of Revenue and Taxation Taxpayer Services Division P.O. Box 23607 GMF, Guam 96921 Express Mail or In Person: Guam Department of Revenue and Taxation Business Privilege Tax Branch 1240 Route 16 Barrigada, Guam. StateAbbrv: GU. Filing Period: Monthly. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Guam&InsType=GUp-111_Monthly_Gross_Receipts_Use_and_Occupancy_Tax_Return_%28Form_GRT-1%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Department of Revenue and Taxation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Guam&InsType=GU-111_Prem_Tax_Homepage.htm&TableName=ICC. Contact Email: grt@revtax.gov.gu. Contact Phone: 671-635-1835/6. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: https://www.guamtax.com/forms/GRTi.pdf. Thursday, June 20, 2013.

HI - Premium Tax Statement - Monthly (Form 323)

Premium Tax See Checklist Link. State Form ID: Form 323. StateAbbrv: HI. Insurance Type: Health. LAH. PC. Filing Period: Monthly. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: State of Hawaii Department of Commerce and Consumer Affairs, Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Hawaii&InsType=HI-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: shansen@dcca.hawaii.gov. Contact Phone: 808-586-7381. Due by Postmark or Receive Date: Postmark. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Thursday, June 20, 2013.

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

Premium Tax Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address: Kentucky Department of Revenue 501 High Street Frankfort, KY 40601. State Form ID: 74A117. StateAbbrv: KY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KYp-001_Monthly_Insurance_Surcharge_Report_-_Domestic_Mutual_Cooperative_and_Assessment_Fire_%28Form_74A117%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KY-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Thursday, June 20, 2013.

KY - Monthly Insurance Surcharge Report (Form 74A118)

Premium Tax Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address: Kentucky Department of Revenue 501 High Street Frankfort, KY 40601. State Form ID: 74A118. StateAbbrv: KY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KYp-001_Monthly_Insurance_Surcharge_Report_%28Form_74A118%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KY-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Thursday, June 20, 2013.

ME - Insurance Premiums and WC Tax Estimated Quarterly Return (Form INS-1)

Premium Tax Make check payable to: Treasurer, State of Maine Send check and return to: Maine Revenue Services P.O. Box 1065 Augusta, ME 04332-9120. State Form ID: INS-1. StateAbbrv: ME. Insurance Type: Health. LAH. PC. Workers Compensation. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maine&InsType=MEp-111_Insurance_Premiums_and_WC_Tax_Estimated_Quarterly_Return_%28Form_INS-1%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Maine Revenue Services. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maine&InsType=ME-111_Prem_Tax_Homepage.htm&TableName=ICC. Contact Email: corporatetax@maine.gov. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Tuesday, June 25, 2013.

ME - SL Premium Tax Estimated Quarterly Return (Form INS-6)

Premium Tax Make check payable to: Treasurer, State of Maine Send check and return to: Maine Revenue Services P.O. Box 1065 Augusta, ME 04332-9120. State Form ID: INS-6. StateAbbrv: ME. Insurance Type: Surplus Lines. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maine&InsType=MEp-001_SL_Premium_Tax_Estimated_Quarterly_Return_%28Form_INS-6%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Maine Revenue Services. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maine&InsType=ME-111_Prem_Tax_Homepage.htm&TableName=ICC. Contact Email: corporatetax@maine.gov. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Tuesday, June 25, 2013.

MN - Insurance Surcharge Return (Form IG257)

Premium Tax Mail to: Minnesota Revenue Mail Station 1780 St. Paul, MN 55145-1780. State Form ID: IG257. StateAbbrv: MN. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MNp-001_Insurance_Surcharge_Return_%28Form_IG257%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Minnesota Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Minnesota&InsType=MN-111_Premium_Tax_Homepage.htm&TableName=ICC. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-556-4729. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Sunday, June 30, 2013.

AR - AntiFraud Assessment Form

State Required Filings Form must be filed even if you have not written any business in our state. If you file late, there is a fine for each day you are late. Payment made payable to State Insurance Department Criminal Investigation Division Trust Fund. Mail forms and payment to: Arkansas Insurance Department Accounting Division 1200 West Third Street Little Rock, AR 72201-1904. StateAbbrv: AR. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arkansas&InsType=AR-111_AntiFraud_Assessment_Form.pdf&TableName=ICC. State Authority: Arkansas Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arkansas&InsType=AR-111_Insurance_Homepage.htm&TableName=ICC. Contact: Pam Looney. Contact Phone: 501-371-2613. Due by Postmark or Receive Date: Receive Date. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Sunday, June 30, 2013.

CA - Certification of Valuation

State Required Filings State of domicile, Life Companies Only. StateAbbrv: CA. Insurance Type: LAH. Filing Period: Qtr 2. State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Financial Records Unit. Contact Phone: 213-346-6423. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Sunday, June 30, 2013.

CA - Earthquake Probable Maximum Loss Questionnaire - Form A

State Required Filings For companies that have data to report on Form A or Form B, we ask that you download the Excel files of the forms from our website. If you have any problems downloading the files, call the Rate Specialist Bureau Staff at 213-346-6731. Fill out the form using the downloaded file and the Signature Page and email them to: RSBeqpml@insurance.ca.gov. We are no longer requiring companies to print out the reporting forms. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-001_Earthquake_Probable_Maximum_Loss_Questionnaire_-_Form_A.xls&TableName=ICC. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Rate Specialist Bureau. Contact Email: rsb@insurance.ca.gov. Contact Phone: 213-346-6556. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Paper Size: 8 1/2x14. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: See Checklist Link. Sunday, June 30, 2013.

CA - Earthquake Probable Maximum Loss Questionnaire - Form B

State Required Filings For companies that have data to report on Form A or Form B, we ask that you download the Excel files of the forms from our website. If you have any problems downloading the files, call the Rate Specialist Bureau Staff at 213-346-6731. Fill out the form using the downloaded file and the Signature Page and email them to: RSBeqpml@insurance.ca.gov. We are no longer requiring companies to print out the reporting forms. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-001_Earthquake_Probable_Maximum_Loss_Questionnaire_-_Form_B.xls&TableName=ICC. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Rate Specialist Bureau. Contact Email: rsb@insurance.ca.gov. Contact Phone: 213-346-6556. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Paper Size: 8 ��x14�. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: See Checklist Link. Sunday, June 30, 2013.

CA - Earthquake Probable Maximum Loss Questionnaire - Form X

State Required Filings This special form is for reporting by the primary (ceding) insurers to the assuming reinsurers and should be sent by the ceding insurer to each assuming reinsurer. Do not send to the California Department of Insurance. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-001_Earthquake_Probable_Maximum_Loss_Questionnaire_-_Form_X.pdf&TableName=ICC. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Rate Specialist Bureau. Contact Email: rsb@insurance.ca.gov. Contact Phone: 213-346-6556. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Paper Size: 8 1/2x14. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: See Checklist Link. Sunday, June 30, 2013.

CA - Earthquake Probable Maximum Loss Questionnaire - Signature Page

State Required Filings Companies which had no Earthquake Insurance in force under any form on December 31, 2009, may satisfy the reporting requirement by so indicating at our Signature Page. You can save/scan the completed Signature Page to a PDF file and email it to: RSBeqpml@insurance.ca.gov. If you are unable to scan the Signature Page back to a PDF file, you can mail it to: California Department of Insurance Rate Specialist Bureau 300 South Spring Street, 14th Floor Los Angeles, CA 90013. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-001_Earthquake_Probable_Maximum_Loss_Questionnaire_-_Signature_Page.pdf&TableName=ICC. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Rate Specialist Bureau. Contact Email: rsb@insurance.ca.gov. Contact Phone: 213-346-6556. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Paper Size: 8 1/2x14. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: See Checklist Link. Sunday, June 30, 2013.

CA - Marketing System Survey - Signature Page

State Required Filings Please submit the completed survey to the Rate Specialist Bureau by send either: an electronic copy of the file by e-mail to: rsbmktsys@insurance.ca.gov OR a copy of the file on CD/DVD to: California Department of Insurance Attn: Rate Specialist Bureau 300 South Spring Street, South Tower, 14th Floor Los Angeles, CA 90013-1230. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-001_Marketing_System_Survey_-_Signature_Page.pdf&TableName=ICC. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Rate Specialist Bureau. Contact Email: rsbmktsys@insurance.ca.gov. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/MktSys09CoverPage_Rsvd.pdf. Sunday, June 30, 2013.

CA - Marketing System Survey Form

State Required Filings Please submit the completed survey to the Rate Specialist Bureau by send either: an electronic copy of the file by e-mail to: rsbmktsys@insurance.ca.gov OR a copy of the file on CD/DVD to: California Department of Insurance Attn: Rate Specialist Bureau 300 South Spring Street, South Tower, 14th Floor Los Angeles, CA 90013-1230. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-001_Marketing_System_Survey_Form.xls&TableName=ICC. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Rate Specialist Bureau. Contact Email: rsbmktsys@insurance.ca.gov. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/MktSys09CoverPage_Rsvd.pdf. Sunday, June 30, 2013.

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

HI - Long-Term Care Insurance - Claim Denial Reporting Form

State Required Filings Must be filed by health entities writing long-term care insurance and/or health entities that have long-term care policies in force. StateAbbrv: HI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Hawaii&InsType=HI-111_Long-Term_Care_Insurance_-_Claim_Denial_Reporting_Form.pdf&TableName=ICC. State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Hawaii&InsType=HI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Colin Hayashida. Contact Email: ihealth@dcca.hawaii.gov. Contact Phone: 808-586-2790. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Sunday, June 30, 2013.

HI - Long-Term Care Insurance - Replacement and Lapse Reporting Form

State Required Filings Must be filed by health entities writing long-term care insurance and/or health entities that have long-term care policies in force. StateAbbrv: HI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Hawaii&InsType=HI-111_Long-Term_Care_Insurance_-_Replacement_and_Lapse_Reporting_Form.pdf&TableName=ICC. State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Hawaii&InsType=HI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Colin Hayashida. Contact Email: ihealth@dcca.hawaii.gov. Contact Phone: 808-586-2790. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Sunday, June 30, 2013.

MD - Certificate of Authority Renewal Application

State Required Filings Do not submit address changes on this form. Submit change of mailing address in a separate letter to the Examination and Audition Section of the Maryland Insurance Administration. StateAbbrv: MD. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-111_Certificate_of_Authority_Renewal_Application.pdf&TableName=ICC. State Authority: Maryland Insurance Administration, Company Licensing Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-111_Insurance_Homepage.htm&TableName=ICC. Contact: Glenda Manning. Contact Email: #BLANK#. Contact Phone: 410-468-2137. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.kristin.dehoff@maryland.gov/sa/jsp/insurer/InsLicensing.jsp. Sunday, June 30, 2013.

MD - Certificate of Authority Renewal On-Line Login

State Required Filings If you have not received the User ID and passoword contact MIA at: 1-800-6116 ext 2104. StateAbbrv: MD. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-111_Certificate_of_Authority_Renewal_On-Line_Login.htm&TableName=ICC. State Authority: Maryland Insurance Administration, Company Licensing Unit. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-111_Insurance_Homepage.htm&TableName=ICC. Contact: Glenda Manning. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: https://www.kristin.dehoff@maryland.gov/cls/jsp/companyLicensing/CompLicensingLogin.jsp?mode=true. Sunday, June 30, 2013.

MD - Credit Life and Health Insurance Experience Reports

State Required Filings Do not file with Annual Statement. State Form ID: CLH 21-28. StateAbbrv: MD. Insurance Type: Health. LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-110_Credit_Life_and_Health_Insurance_Experience_Reports.pdf&TableName=ICC. State Authority: Maryland Insurance Administration. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: mc_filings@kristin.dehoff@maryland.gov. Contact Phone: 410-468-2000. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Sunday, June 30, 2013.

MD - Reporting Adverse Decisions and Greivances - Carrier Reporting Form

State Required Filings All companies have the option of filing their required report electronically. You may also report by downloading the form and mailing or faxing a copy. Mail responses should be forwarded to: Maryland Insurance Administration Attn: Louis Butler 525 St. Paul Place Baltimore, MD 21202-2272. Faxed responses should be sent to Louis Butler at 410-468-2271. StateAbbrv: MD. Insurance Type: Health. LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-110_Reporting_Adverse_Decisions_and_Greivances_-_Carrier_Reporting_Form.pdf&TableName=ICC. State Authority: Maryland Insurance Administration. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: lbutler@kristin.dehoff@maryland.gov. Contact Phone: 410-468-2271. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Instructions: http://www.kristin.dehoff@maryland.gov/sa/documents/15-10A-06CarrierReportingInstructionsGuide-rev06.pdf https://www.kristin.dehoff@maryland.gov/carrierReport/jsp/carrierReport/CarrierReportLogin.jsp?mode=true. Sunday, June 30, 2013.

MN - Insurance Surcharge Return (Form IG257)

State Required Filings Mail to: Minnesota Revenue Mail Station 1780 St. Paul, MN 55145-1780. Sunday, June 30, 2013.

NV - Holding Company Registration Statements

State Required Filings StateAbbrv: NV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. State Authority: Nevada Division of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NV-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: pwillard@doi.nv.gov. Contact Phone: 775-687-0760. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: . Sunday, June 30, 2013.

SD - WC Policy Filing Fee Voucher

State Required Filings Send to: South Dakota Division of Insurance 445 East Capitol Pierre, SD 57501 Filing fee per policy. StateAbbrv: SD. Insurance Type: Workers Compensation. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=SouthDakota&InsType=SDw-001_WC_Policy_Filing_Fee_Voucher.pdf&TableName=ICC. State Authority: South Dakota Division of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=SouthDakota&InsType=SD-111_Insurance_Homepage.htm&TableName=ICC. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Sunday, June 30, 2013.

TX - Affidavit For Exemption From Filing CPA Report (Form FIN246)

State Required Filings See Checklist and Form Instructions. State Form ID: FIN246. StateAbbrv: TX. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-111_Affidavit_For_Exemption_From_Filing_CPA_Report_%28Form_FIN246%29.pdf&TableName=ICC. State Authority: Texas Department of Insurance, Financial Regulation Division, Financial Analysis Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: FinancialAnalysis@tdi.state.tx.us. Contact Phone: 512-322-5082. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.tdi.state.tx.us/forms/finanalysis/fin246cpaexeaff.pdf. Sunday, June 30, 2013.

WI - Service Area Update - HMO

State Required Filings All domestic insurers are required to file two hard copies of the quarterly financial statements and quarterly electronic compulsory and security surplus calculation. StateAbbrv: WI. Insurance Type: Health. HMO. Filing Period: Qtr 2. Link to State Form: . State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wisconsin&InsType=WI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Yvonne Sherry. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Sunday, June 30, 2013.

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

CA - Credit Property Insurance Experience Report

State Required Filings The filing that is due would include an Excel workbook for companies that have a data report, a form CPIER and/or CUIER, duly executed. The form CPIER and/or CUIER is in PDF format. Please email them to: RSBcredit@insurance.ca.gov. Or mail them to: California Department of Insurance Rate Specialist Bureau 300 South Spring Street, South Tower, 14th Floor Los Angeles, CA 90013-1230. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-001_Credit_Property_Insurance_Experience_Report.xls&TableName=ICC. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Rate Specialist Bureau. Contact Email: RSBcredit@insurance.ca.gov. Contact Phone: 213-346-6732. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: See Checklist Link. Monday, July 1, 2013.

CA - Credit Unemployment Insurance Experience Report

State Required Filings Completed form is to be emailed to: RSBcredit@insurance.ca.gov or by regular U.S. mail to: California Department of Insurance Rate Specialist Bureau 300 South Spring Street, South Tower, 14th Floor Los Angeles CA 90013-1230. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-001_Credit_Unemployment_Insurance_Experience_Report.xls&TableName=ICC. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=California&InsType=CA-111_Insurance_Homepage.htm&TableName=ICC. Contact: Rate Specialist Bureau. Contact Email: RSBcredit@insurance.ca.gov. Contact Phone: 213-346-6732. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: General Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/Credit_GenInstr2009.pdf Report Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/Credit_ReportInstr2009.pdf Column Definitions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/Credit_ColumnInstr2009.pdf Allocation Instructions: http://www.insurance.ca.gov/0250-insurers/0300-i… Monday, July 1, 2013.

HI - Compliance Resolution Fund Assessment

State Required Filings StateAbbrv: HI. Insurance Type: Health. Filing Period: Qtr 2. State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Hawaii&InsType=HI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Jerry Bump. Contact Email: jbump@dcca.hawaii.gov. Contact Phone: 808-586-0985. Due by Postmark or Receive Date: Receive Date. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 1, 2013.

MA - HMO License Renewal/Notification of Material Change(s)

State Required Filings Mail ALL HMO License Renewal/Notification of Material Changes, with the check for the appropriate fees are to be mailed to: Commonwealth of Massachusetts Division of Insurance Financial Surveillance Section 1000 Washington Street, Suite 810 Boston, MA 02218-6200. StateAbbrv: MA. Insurance Type: Health. Filing Period: Qtr 2. State Authority: Massachusetts Division of Insurance, Financial Surveillance Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Massachusetts&InsType=MA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: peter.arens@state.ma.us Companies.Mailbox@state.ma.us. Contact Phone: 617-521-7794. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: . Monday, July 1, 2013.

MA - State Filing Fees

State Required Filings See Checklist Notes. StateAbbrv: MA. Insurance Type: HMO. Filing Period: Qtr 2. State Authority: Massachusetts Division of Insurance, Financial Surveillance Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Massachusetts&InsType=MA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: peter.arens@state.ma.us Companies.Mailbox@state.ma.us. Contact Phone: 617-521-7794. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: . Monday, July 1, 2013.

MI - Certificate of Valuation

State Required Filings StateAbbrv: MI. Insurance Type: LAH. Filing Period: Qtr 2. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Michigan&InsType=MI-111_Insurance_Homepage3.htm&TableName=ICC. Contact Email: finleym@michigan.gov. Contact Phone: 517-241-4490. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 1, 2013.

MI - Valuation of Section 411 Trusteed Assets Under Section 901 (Form FIS 0063)

State Required Filings State Form ID: FIS-0063. StateAbbrv: MI. Insurance Type: LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Michigan&InsType=MI-010_Valuation_of_Section_411_Trusteed_Assets_Under_Section_901_%28Form_FIS_0063%29.pdf&TableName=ICC. State Authority: Michigan Department of Labor & Economic Growth. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Michigan&InsType=MI-111_Insurance_Homepage3.htm&TableName=ICC. Contact: Mischelle Finley. Contact Email: finleym@michigan.gov. Contact Phone: 517-241-4490. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.michigan.gov/documents/cis_ofis_life_book_2003_80216_7.pdf. Monday, July 1, 2013.

MO - Application to Renew Certificate of Authority (Form MO 375-0079)

State Required Filings State Form ID: MO 375-0079. StateAbbrv: MO. Insurance Type: Health. LAH. PC. Filing Period: Annual. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Missouri&InsType=MO-111_Application_to_Renew_Certificate_of_Authority_%28Form_MO_375-0079%29.pdf&TableName=ICC. State Authority: Missouri Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Missouri&InsType=MO-111_Insurance_Homepage.htm&TableName=ICC. Contact: Linda Doerhoff Cindy Monroe. Contact Email: Jennifer.Ploys@insurance.mo.gov Cynthia.Monroe@insurance.mo.gov. Contact Phone: 573-526-5001 573-526-4362. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 1, 2013.

RI - Workers' Compensation Excess Profits Report

State Required Filings Each insurance group writing workers' compensation and/or employers' liability insurance is required by R.I. Gen. Laws 27-9-51 (a) to file an annual excess profit report on the form prescribed by the Department. Please submit reports electronically to specialreports@dbr.ri.gov. StateAbbrv: RI. Insurance Type: PC. Filing Period: Qtr 2. State Authority: Rhode Island Department of Business Regulation, Division of Insurance Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=RhodeIsland&InsType=RI-111_Insurance_Homepage.htm&TableName=ICC. Contact: Teresa P. DeLuca. Contact Email: Mdimaio@dbr.ri.gov or CompanyLicensing@dbr.ri.gov. Contact Phone: 401-462-9610. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Forms and Instructions: https://www.ncci.com/ncci/index.aspx. Monday, July 1, 2013.

WV - Examination Assessment Fee

State Required Filings Examination Assessment Fee Mailing Address: West Virginia Insurance Commissioner STO/RPD PO Box 1861 Charleston WV 25327 Form is mailed to company annually. Two forms of payments include: OPTins - https://eapps.naic.org/optinsstatic/implementation.html (to pre-register) by Check. StateAbbrv: WV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. State Authority: West Virginia Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=WestVirginia&InsType=WV-111_Insurance_Homepage.htm&TableName=ICC. Contact: Darlene Parsons. Contact Email: Darlene.Parsons@wvinsurance.gov. Contact Phone: 304-558-2100. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 1, 2013.

WY - Holding Company Registration

State Required Filings W.S. 26-44-104. State Form ID: Form B and C. StateAbbrv: WY. Insurance Type: PC. Filing Period: Qtr 2. State Authority: Wyoming Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wyoming&InsType=WY-111_Insurance_Homepage.htm&TableName=ICC. Contact: Mavis Earnshaw, Auditor I. Contact Email: mavis.earnshaw@wyo.gov. Contact Phone: 307-777-6884. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 1, 2013.

WY - Holding Company Registration

State Required Filings W.S. 26-44-104. State Form ID: Form B and C. StateAbbrv: WY. Insurance Type: Health. Filing Period: Qtr 2. State Authority: Wyoming Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wyoming&InsType=WY-111_Insurance_Homepage.htm&TableName=ICC. Contact: Mavis Earnshaw, Auditor I. Contact Email: mavis.earnshaw@wyo.gov. Contact Phone: 307-777-6884. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 1, 2013.

WY - Holding Company Registration

State Required Filings W.S. 26-44-104. State Form ID: Form B and C. StateAbbrv: WY. Insurance Type: LAH. Filing Period: Qtr 2. State Authority: Wyoming Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wyoming&InsType=WY-111_Insurance_Homepage.htm&TableName=ICC. Contact: Mavis Earnshaw, Auditor I. Contact Email: mavis.earnshaw@wyo.gov. Contact Phone: 307-777-6884. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 1, 2013.

NY - Annual Audited Financial Statement

State Required Filings Provide GAAP and statutory audited financial statements. StateAbbrv: NY. Insurance Type: Surplus Lines. Filing Period: Qtr 2. State Authority: Excess Line Association of New York (ELANY). Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NY-111_Insurance_Homepage.htm&TableName=ICC. Contact: Sharon Pereira. Contact Email: spereira@elany.org. Contact Phone: 646-292-5575. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Alien Requirements: http://www.elany.org/lexicon-click.aspx?LT=0&H=16&T=406&D=D5 Foreign Requirements: http://www.elany.org/lexicon-click.aspx?LT=0&H=16&T=404&D=D5. Wednesday, July 10, 2013.

NY - Annual Report and 10-K Report

State Required Filings Copy if the company or ultimately holding company is publicly traded. If not, provide the most recent audited financial statements for the ultimate parent of the company. StateAbbrv: NY. Insurance Type: Surplus Lines. Filing Period: Qtr 2. State Authority: Excess Line Association of New York (ELANY). Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NY-111_Insurance_Homepage.htm&TableName=ICC. Contact: Sharon Pereira. Contact Email: spereira@elany.org. Contact Phone: 646-292-5575. Domestic/Foreign: Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Alien Requirements: http://www.elany.org/lexicon-click.aspx?LT=0&H=16&T=406&D=D5 Foreign Requirements: http://www.elany.org/lexicon-click.aspx?LT=0&H=16&T=404&D=D5. Wednesday, July 10, 2013.

Compliance Calendar to Wings Integration

EagleTM Events ETM Product: ICC. EagleTM Event Type: IBE Session. Pricing: Contact an EagleTM sales representative at sales@byetm.com for available discounts. Summary: The 2013 year-end sees the compliance calendar moving into the Wings application so that users can configure and use the new "My Calendar" function. "My Calendar" monitors, reminds and tracks NAIC, state filing form, premium tax and private, individual events to complement other internal financial controls inherent in the Wings system. Presenter: Nick/Dennis. Contact ETM by phone: 800-975-3245. Contact ETM by e-mail: support@byetm.com. Thursday, July 11, 2013, 10:00 AM – 11:00 AM.

AZ - Installment Payment Report (Form E-INSTALL)

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

Premium Tax All foreign and alien risk retention groups must attach a completed Form GID-213-PT to the fourth quarter affidavit. If Paying by Check: Georgia Department of Insurance - Premium Tax Division P.O. Box 935134 Atlanta, GA 31193-5134 Overnight Carrier: Wachovia Bank GA Ins. Dept - Premium Tax Division Lockbox 935134 3585 Atlanta Avenue Hapeville, GA 30354 If Filing Paper Return AND Paying by Check: GA Department of Insurance Suite 916 2 Martin Luther King Jr. Dr. Atlanta, GA 30334 RRG Returns: Office of Insurance and Safety Fire Commissioner Premium Tax DivisionbSuite 916, West Tower 2 Martin Luther King Jr. Dr. Atlanta, GA 30334. State Form ID: GID-215-PT. StateAbbrv: GA. Insurance Type: Risk Retention Group. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Georgia&InsType=GAp-001_Quarterly_Premium_Tax_Return_-_RRG_%28Form_GID-215-PT%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Georgia Department of Insurance, Premium Tax Division. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Georgia&InsType=GA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: premiumtax@oci.ga.gov. Contact Phone: 404-656-7553. Domestic/Foreign: Domestic. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 15, 2013.

LA - Quarterly Tax Statement (Form 1071)

Premium Tax File online. State Form ID: 1071. StateAbbrv: LA. Insurance Type: LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Louisiana&InsType=LAp-111_Quarterly_Tax_Statement_%28Form_1071%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Louisiana Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?Year=2010&StAbbrv=LA&InsType=Department_Of_Insurance_Homepage&SubInsType=&LinkType=3. Contact Email: taxdivision@ldi.state.la.us. Contact Phone: 225-342-1012. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 15, 2013.

MI - Corporate Income Tax Quarterly Return (Form 4913)

Premium Tax Complete voucher and cut at the dotted line. Mail to: Michigan Department of Treasury P.O. Box 30774 Lansing, MI 48909-8274. StateAbbrv: MI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.michigan.gov/documents/taxes/4913_2013_form_408956_7.pdf. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. Link to Filing Website: http://www.michigan.gov/taxes/0,1607,7-238-46621_47362---.html. Contact Phone: 517-373-3200. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.michigan.gov/documents/taxes/4913_2013_Instr_408957_7.pdf. Monday, July 15, 2013.

NM - Estimated Quarterly Premium Tax Report (Form 306)

Premium Tax Make one check payable to NM PRC Insurance Division. State Form ID: 306. StateAbbrv: NM. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewMexico&InsType=NMp-111_Estimated_Quarterly_Premium_Tax_Report_%28Form_306%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: New Mexico Public Regulation Commission, Division of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewMexico&InsType=NM-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: raymond.valdez@state.nm.us. Contact Phone: 505-827-4506. Domestic/Foreign: Domestic. Foreign. Paper Size: Legal. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.nmprc.state.nm.us/insurance/financialaudit/pdf/PremiumTaxInstructions.pdf. Monday, July 15, 2013.

OK - WC Administration Fund (Form WC-2)

Premium Tax Mail your report to: Oklahoma Tax Commission Account Maintenance Division Special Taxes 2501 North Lincoln Blvd. Oklahoma City, OK 73194. State Form ID: WC-2. StateAbbrv: OK. Insurance Type: Workers Compensation. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OKp-001_WC_Multiple_Injury_Trust_Fund.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oklahoma Tax Commission. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OK_-WC_Prem_Tax.htm&TableName=ICC. Contact Email: gail.lopresto@oid.ok.gov. Contact Phone: 405-521-3938. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 15, 2013.

OK - WC Multiple Injury Trust Fund

Premium Tax Mail your report and remittance to: Oklahoma Tax Commission Account Maintenance Division Special Taxes 2501 North Lincoln Blvd. Oklahoma City, OK 73194-0004. State Form ID: WC-10. StateAbbrv: OK. Insurance Type: Workers Compensation. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OKp-001_WC_Multiple_Injury_Trust_Fund.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Oklahoma Tax Commission. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Oklahoma&InsType=OK_-WC_Prem_Tax.htm&TableName=ICC. Contact Email: gail.lopresto@oid.ok.gov. Contact Phone: 405-521-3938. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 15, 2013.

WA - ETax Regulatory Surcharge

Premium Tax Access the Regulatory Surcharge using the Make or View Payments option after logging in to E-Tax. Current payment options are to pay by check or by EFT using US Bank's e-check. StateAbbrv: WA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Washington&InsType=WAp-111_ETax_Regulatory_Surcharge.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Washington State Office of the Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Washington&InsType=WA-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: taxes@oic.wa.gov. Contact Phone: 360-725-7032. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Instructions: https://fortress.wa.gov/oic/onlineservices/Help/Regulatory_Surcharge_Help.pdf FAQs: https://fortress.wa.gov/oic/onlineservices/Help/FAQ_Help.pdf. Monday, July 15, 2013.

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

MD - Reporting Adverse Decisions and Greivances - Carrier Reporting Form

State Required Filings All companies have the option of filing their required report electronically. You may also report by downloading the form and mailing or faxing a copy. Mail responses should be forwarded to: Maryland Insurance Administration Attn: Louis Butler 525 St. Paul Place Baltimore, MD 21202-2272. Faxed responses should be sent to Louis Butler at 410-468-2271. StateAbbrv: MD. Insurance Type: Health. LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-110_Reporting_Adverse_Decisions_and_Greivances_-_Carrier_Reporting_Form.pdf&TableName=ICC. State Authority: Maryland Insurance Administration. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Maryland&InsType=MD-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: lbutler@kristin.dehoff@maryland.gov. Contact Phone: 410-468-2271. Due by Postmark or Receive Date: Postmark. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: Instructions: http://www.kristin.dehoff@maryland.gov/sa/documents/15-10A-06CarrierReportingInstructionsGuide-rev06.pdf https://www.kristin.dehoff@maryland.gov/carrierReport/jsp/carrierReport/CarrierReportLogin.jsp?mode=true. Monday, July 15, 2013.

MT - Quarterly Expenditure Report

State Required Filings StateAbbrv: MT. Insurance Type: Workers Compensation. Filing Period: Qtr 1. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Montana&InsType=MTw-001_Quarterly_Expenditure_Report.pdf&TableName=ICC. State Authority: Department of Labor & Industry, Workers’ Compensation Regulation Bureau. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Montana&InsType=MT-111_Insurance_Homepage.htm&TableName=ICC. Contact: . Contact Email: WCRegBureauQER@mt.gov. Contact Phone: 406-444-0564. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Hard Copy. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://erd.dli.mt.gov/images/stories/pdf/wcr/qerinst2005.pdf. Monday, July 15, 2013.

NH - Supplemental Reporting - Excel Registration Only Template

State Required Filings StateAbbrv: NH. Insurance Type: Health. LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewHampshire&InsType=NH-100_Supplemental_Reporting_-_Excel_Registration_Only_Template.xls&TableName=ICC. State Authority: New Hampshire Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewHampshire&InsType=NH-111_Insurance_Homepage.htm&TableName=ICC. Contact: Domestic: Larry Lucas Foreign: Mary Verville. Contact Email: Domestic: Mary.Verville@ins.nh.gov, Pat.Gosselin@ins.nh.gov, Larry.Lucas@ins.nh.gov Foreign: Mary.Verville.ins.nh.gov. Contact Phone: 603-271-7973. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.nh.gov/insurance/lah/documents/suprpt_bull2010.pdf http://www.nh.gov/insurance/lah/documents/supprt_letter.pdf. Monday, July 15, 2013.

NH - Supplemental Reporting - Excel Template

State Required Filings StateAbbrv: NH. Insurance Type: Health. LAH. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewHampshire&InsType=NH-100_Supplemental_Reporting_-_Excel_Template.xls&TableName=ICC. State Authority: New Hampshire Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewHampshire&InsType=NH-111_Insurance_Homepage.htm&TableName=ICC. Contact: Domestic: Larry Lucas Foreign: Mary Verville. Contact Email: Domestic: Mary.Verville@ins.nh.gov, Pat.Gosselin@ins.nh.gov, Larry.Lucas@ins.nh.gov Foreign: Mary.Verville.ins.nh.gov. Contact Phone: 603-271-7973. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.nh.gov/insurance/lah/documents/suprpt_bull2010.pdf http://www.nh.gov/insurance/lah/documents/supprt_letter.pdf. Monday, July 15, 2013.

NY - Fire Insurance Fee Form

State Required Filings Completed return and remittance should be forwarded to: New York State Deparment of Financial Services One Commerce Plaza Albany, NY 12257 Any questions relating to the fire insurance fee, contact: Mr. Frank M. D'Amico Director of Taxes and Accounts New York Department of Financial Services Governor Nelson A. Rockefeller Plaza Agency Building One Albany, nY 12257. StateAbbrv: NY. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NY-001_Fire_Insurance_Fee_Form.pdf&TableName=ICC. State Authority: New York State Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewYork&InsType=NY-111_Insurance_Homepage.htm&TableName=ICC. Contact: Frank M. D'Amico. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.ins.state.ny.us./circltr/1982/cl1982_19.htm. Monday, July 15, 2013.

NY - Motor Vehicle Law Enforcement Fee (MVLEF)

TX - Closed Claim Annual Aggregate Acknowledgment of Receipt

State Required Filings Mail to: Vicky Knox Data Services MC 105-5D P.O. Box 149104 Austin, TX 78714-9104 Fax to: Vicky Knox Data Services 512-463-6122 Email: vicky.knox@tdi.state.tx.us Electronic version of form. StateAbbrv: TX. Insurance Type: PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-001_Closed_Claim_Annual_Aggregate_Acknowledgment_of_Receipt.doc&TableName=ICC. State Authority: Texas Department of Insurance, Financial Regulation Division, Financial Analysis Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Texas&InsType=TX-111_Insurance_Homepage.htm&TableName=ICC. Contact: Vicky Knox. Contact Email: vicky.knox@tdi.state.tx.us. Contact Phone: 512-463-6122. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Monday, July 15, 2013.

Wings Technical Overview

EagleTM Events ETM Product: Wings. EagleTM Event Type: IBE Session. Pricing: Contact an EagleTM sales representative at sales@byetm.com for available discounts. Summary: Learn about the Wings system architecture from a technical perspective. Learn how and why improvements have been made. We’ll cover configuration options that you can utilize to customize Wings to run optimally in your own environment. Presenter: Barry. Contact ETM by phone: 800-975-3245. Contact ETM by e-mail: support@byetm.com. Tuesday, July 16, 2013, 2:00 PM – 3:00 PM.

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

HI - Premium Tax Statement - Monthly (Form 323)

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

KY - Monthly Insurance Surcharge Report (Form 74A118)

Premium Tax Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address: Kentucky Department of Revenue 501 High Street Frankfort, KY 40601. State Form ID: 74A118. StateAbbrv: KY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KYp-001_Monthly_Insurance_Surcharge_Report_%28Form_74A118%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KY-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Saturday, July 20, 2013.

WV - Quarterly Tax Payment Form

Premium Tax StateAbbrv: WV. Insurance Type: Health. LAH. PC. Risk Retention Group. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: West Virginia Insurance Commissioner. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=WestVirginia&InsType=WV-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: wvtaxsection@wvinsurance.gov. Contact Phone: 304-558-2100. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.wvinsurance.gov/LinkClick.aspx?fileticket=-PLKB_wp4Ds%3d&tabid=319&mid=866. Thursday, July 25, 2013.

KY - KWCFC Quarterly Premiums Report - WC

Premium Tax Make check payable to and mail report and check to: Kentucky Workers Compensation Funding Commission #42 Millcreek Park P.O. Box 1128 Frankfort, Kentucky 40602-1128. StateAbbrv: KY. Insurance Type: PC. Workers Compensation. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Kentucky Workers’ Compensation Funding Commission. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Kentucky&InsType=KY-111_Premium_Tax.htm&TableName=ICC. Contact Email: renee.campbell@ky.gov. Contact Phone: 502-573-3505 ext. 235. Due by Postmark or Receive Date: Postmark. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Tuesday, July 30, 2013.

MI - Report of RRG Premium and Tax (Form 0260)

Premium Tax See Checklist Link. State Form ID: FIS 0260. StateAbbrv: MI. Insurance Type: Risk Retention Group. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Michigan&InsType=MIp-001_Report_of_RRG_Premium_and_Tax_%28Form_0260%29.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Office of Financial and Insurance Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Michigan&InsType=MI-111_Prem_Tax/MBT.htm&TableName=ICC. Contact Phone: 517-636-4657. Due by Postmark or Receive Date: . Paper Size: . Paper Color: . Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.michigan.gov/treasury/. Tuesday, July 30, 2013.

NE - Quarterly Report of SL Business

Premium Tax State Form ID: DOI_SL_QUARTERLY. StateAbbrv: NE. Insurance Type: Surplus Lines. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nebraska&InsType=NEp-001_Quarterly_Report_of_SL_Business.xls&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Nebraska Department of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nebraska&InsType=NE-111_Insurance_Homepage.htm&TableName=ICC. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Tuesday, July 30, 2013.

AZ - ICA Quarterly Tax Form (Administrative and Special Fund)

Premium Tax Please return the completed form with your check payable to Industrial Commission of Arizona for the total payment due and mail to: Industrial Commission of Arizona Attention: Tax Accountant 800 West Washington Street, Suite 301 Phoenix, Arizona 85007. State Form ID: 201 B. StateAbbrv: AZ. Insurance Type: Workers Compensation. Filing Period: Qtr 2. Link to State Form: . Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Industrial Commission of Arizona. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Arizona&InsType=AZ-111_ICA_Homepage.htm&TableName=ICC. Contact Email: taxes@ica.state.az.us. Contact Phone: 602-542-1836. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.ica.state.az.us/Administrative%20Support/Tax_Form_Files/InsCarrierQuarterly/forms/2010_InsCarrier_AF_Qtly_Information.pdf. Wednesday, July 31, 2013.

CO - Notice of Intent to Contribute to CoverColorado

Premium Tax This form is to be filed with the July 31st Quarterly Estimated Tax Form. StateAbbrv: CO. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Colorado&InsType=CO-111_Notice_of_Intent_to_Contribute_to_CoverColorado.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Colorado Division of Insurance, Corporate Affairs. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Colorado&InsType=CO-111_Insurance_Homepage.htm&TableName=ICC. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.dora.state.co.us/insurance/regs/B-2.6.pdf. Wednesday, July 31, 2013.

CO - Premium Taxes Homepage

Premium Tax See Checklist Link. StateAbbrv: CO. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Colorado&InsType=COp-111_Premium_Taxes_Homepage.htm&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Colorado Division of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Colorado&InsType=CO-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: copremiumtax@state.co.us. Due by Postmark or Receive Date: Receive Date. Filing Method: Electronic. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Link to Supporting Information: http://www.dora.state.co.us/insurance/annual/premc2.pdf. Wednesday, July 31, 2013.

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

NC - Quarterly Report of Premiums and Tax - RRG

Premium Tax See Checklist Link. State Form ID: RRG-03. StateAbbrv: NC. Insurance Type: Risk Retention Group. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthCarolina&InsType=NCp-001_Quarterly_Report_of_Premiums_and_Tax_-_RRG.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: North Carolina Department of Insurance, Financial Evaluation Division - Special Entities Section. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NorthCarolina&InsType=NC-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 919-807-6612. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, July 31, 2013.

NV - Quarterly Industrial Insurance Return

Premium Tax State Form ID: IIP. StateAbbrv: NV. Insurance Type: PC. Workers Compensation. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NVp-001_Quarterly_Industrial_Insurance_Return.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Nevada Department of Taxation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NV-111_Premium_Tax.htm&TableName=ICC. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, July 31, 2013.

NV - Quarterly Insurance Return

Premium Tax State Form ID: IPT. StateAbbrv: NV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NVp-111_Quarterly_Insurance_Return.pdf&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Nevada Department of Taxation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NV-111_Premium_Tax.htm&TableName=ICC. Contact Phone: 775-684-2000. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, July 31, 2013.

SD - Quarterly Premium Tax Voucher

Premium Tax Mail checks, payable to SD Division of Insurance, along with the voucher for quarterly tax payments to: South Dakota Remittance Center PO Box 5055 Sioux Falls, SD 57117-5055 OR South Dakota Remittance Center 300 S. Sycamore Ave STE #102 Sioux Falls, SD 57110. StateAbbrv: SD. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://dlr.sd.gov/insurance/companies/documents/quarterly_tax_voucher_2012.pdf. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: South Dakota Division of Insurance. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=SouthDakota&InsType=SD-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: luann.johnson@state.sd.us. Contact Phone: 605-773-3563. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, July 31, 2013.

UT - Insurance Premium Tax Quarterly Prepayment (Form TC-49)

Premium Tax DO NOT submit this form if no payment is due. Make check or money order payable to: Utah State Tax Commission. Return coupon and payment to: Utah State Tax Commission Insurance Premium Payment 210 N 1950 W Salt Lake City, UT 84134-0130. State Form ID: TC-670. StateAbbrv: UT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://tax.utah.gov/forms/current/tc-49pc.pdf. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Utah State Tax Commission. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Utah&InsType=UT-111_Premium_Tax.htm&TableName=ICC. Contact Email: taxmaster@utah.gov. Contact Phone: 501-538-3800. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, July 31, 2013.

WY - Quarterly Premium Tax Return

Premium Tax You MUST file this form even if your tax liability is zero. StateAbbrv: WY. Insurance Type: LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wyoming&InsType=WYp-111_Quarterly_Premium_Tax_Return.doc&TableName=ICC. Tax Filing Requirements: http://www.eagletm.com/Documentation/TaxFilingRequirements/2011/index.html. State Authority: Wyoming Insurance Department. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Wyoming&InsType=WY-111_Insurance_Homepage.htm&TableName=ICC. Contact Email: linda.johnson@wyo.gov. Contact Phone: 307-777-6884. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, July 31, 2013.

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

NJ - Annual Statement Filing Requirements - SL Alien

State Required Filings All filings must be submitted to: State of New Jersey Department of Banking and Insurance Surplus Lines Examination Office Attn: William Leach, Insurance Examiner Trenton, NJ 08625-0325. StateAbbrv: NJ. Insurance Type: PC. Surplus Lines. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewJersey&InsType=NJs-001_Annual_Statement_Filing_Requirements_-_SL_Alien.pdf&TableName=ICC. State Authority: New Jersey Department of Banking and Insurance, Office of Solvency Regulation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=NewJersey&InsType=NJ-111_Insurance_Homepage.htm&TableName=ICC. Contact: William Leach. Contact Email: william.leach@dobi.state.nj.us. Contact Phone: 609-292-5350 ext 50088. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, July 31, 2013.

NV - Quarterly Insurance Return

State Required Filings State Form ID: IPT. StateAbbrv: NV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 2. Link to State Form: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NVp-111_Quarterly_Insurance_Return.pdf&TableName=ICC. State Authority: Nevada Department of Taxation. Link to Filing Website: http://www.eagletm.com/StateMapRedirect/redirect.aspx?LinkType=9&Year=1&StAbbrv=Nevada&InsType=NV-111_Premium_Tax.htm&TableName=ICC. Contact: Jason O'Brien. Contact Email: obrien@tax.state.nv.us. Contact Phone: 775-684-2128. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Link To State Checklist Manager: http://www.eagletm.com/StateForms/SCM/SCMmap.html. Wednesday, July 31, 2013.