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
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.
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)
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.
Sunday, June 30, 2013.
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)
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.
Monday, July 1, 2013.
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)
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.
Monday, July 15, 2013.
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
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.
Monday, July 15, 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: 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)
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.
Monday, July 15, 2013.
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)
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.
Saturday, July 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.
Saturday, July 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.
Saturday, July 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.
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)
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.
Wednesday, July 31, 2013.
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)
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.
Wednesday, July 31, 2013.
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.