Insurance Compliance Center - Pro

MO - Insurance Producers Report (Form MO 375-0110)

10 Feb 2012 06:00:00 GMT

Friday, February 10, 2012

Mail report to:

Missouri Department of Insurance, Financial Institutions & Professional Registration
Attn: Premium Tax Section
P.O. Box 690
Jefferson City, MO 65102

State Form ID: 375-0110
StateAbbrv: MO
Insurance Type: Health, LAH, PC
Filing Period: Annual
Link to State Form: www.eagletm.com…
Tax Filing Requirements: www.eagletm.com…
State Authority: Missouri Department of Insurance, Financial Institutions and Professional Regulation
Link to Filing Website: www.eagletm.com…
Contact Phone: 573-526-4986 or 573-751-1929
Due by Postmark or Receive Date: Postmark
Domestic/Foreign: Domestic, Foreign
Link To State Checklist Manager: www.eagletm.com…

HI - Quarterly Net Solvency Report

14 Feb 2012 06:00:00 GMT

Tuesday, February 14, 2012

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

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

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

See Checklist Link

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

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

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

See Checklist Link

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

MN - Fire Safety Surcharge (Form IG261)

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

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

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

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

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

Make check payable to Minnesota Revenue and mail to:

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

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

MN - Semiannual Statement of SL Insurance (Form IG260)

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

Mail to:

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

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

MN - SL Return Payment (Form PV53)

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

NE - Annual Report of SL Business

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

NE - Quarterly Report of SL Business

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

Every 15th of the month, when applicable.

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

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

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

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

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

Make checks payable to:

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

Please annotate Drivers Ed Fee DEF.

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

HI - Motor Vehicle Quarterly Report - Memorandum

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

IL - Illinois Mine Subsidence Insurance Fund

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

NY - Motor Vehicle Law Enforcement Fee (MVLEF)

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

Returns to be mailed to:

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

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

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

NY - PC Insurance Security Fund Quarterly Report

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

Returns to be mailed to:

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

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

NY - WC Security Fund Quarterly Report

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

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

OR - Health Enrollment Report Form

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

This report is to be filed on a quarterly basis.

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

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

OR - Health Premium Assessment Report

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

OR - WC Premium Assessment Report

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

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

SD - Risk Pool Report of Covered Lives

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

OR fax: 605-773-5369

DO NOT send a payment with this form.

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

TX - Call for Fourth Quarter WC Experience Bulletin Form

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

UT - Renewal Instructions - RRG

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

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

UT - Renewal Instructions - SL

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

WI - Annual Actuarial Filing Request

15 Feb 2012 06:00:00 GMT

Wednesday, February 15, 2012

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

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

20 Feb 2012 06:00:00 GMT

Monday, February 20, 2012

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

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

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

Express Mail or In Person:

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

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

HI - Premium Tax Statement - Monthly (Form 323)

20 Feb 2012 06:00:00 GMT

Monday, February 20, 2012

See Checklist Link

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

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

20 Feb 2012 06:00:00 GMT

Monday, February 20, 2012

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

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

KY - Monthly Insurance Surcharge Report (Form 74A118)

20 Feb 2012 06:00:00 GMT

Monday, February 20, 2012

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

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

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

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

If sending via US Mail:

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

If sending via courier service:

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

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

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

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

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

WV - Statement of Premiums - RPG

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

Mailing Address:

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

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

AR - Accredited Reinsurer Renewal Information

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

Submit application to:

Arkansas Insurance Department

Finance Division

1200 West Third Street

Little Rock, AR 72201-1904

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

AR - Trusteed Reinsurer Renewal Information

28 Feb 2012 06:00:00 GMT

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

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

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

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

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

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

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

ID - Continuation Fee Statement - Trusteed Reinsurer

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

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

VT - Domestic RRG and Association Captives Checklist

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

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

VT - Foreign RRG and RPG Checklist

28 Feb 2012 06:00:00 GMT

Tuesday, February 28, 2012

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

NAIC - Actuarial Opinion on Non-guaranteed Elements

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

As required in interrogatory #3 to Exhibit 5

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

NAIC - Actuarial Opinion on Participating & Non-Participating Policies

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

NAIC - Annual Statement Filing

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

NAIC - Annual Statement Filing Fee

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

NAIC - Financial Guaranty Insurance Exhibit

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

If applicable

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

NAIC - Life Supplement

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

If applicable

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

NAIC - Medicare Part D Coverage Supplement

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

NAIC - Medicare Supplement Insurance Experience Exhibit

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

If applicable

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

NAIC - Premiums Attributed to Protected Cells Exhibit

01 Mar 2012 06:00:00 GMT

NAIC - Property & Casualty Supplement

01 Mar 2012 06:00:00 GMT

NAIC - Reinsurance Attestation Supplement

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

NAIC - Reinsurance Summary Supplemental Filing for General Interrogatory 9

01 Mar 2012 06:00:00 GMT

NAIC - Risk-Based Capital Report

01 Mar 2012 06:00:00 GMT

NAIC - Separate Accounts Statement Filing

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

If applicable

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

NAIC - Statement of Actuarial Opinion

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

NAIC - Supplemental Schedule O

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

If applicable

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

NAIC - Trusteed Surplus Statement

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

If applicable

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

NAIC - Workers’ Compensation Carve-Out Supplement

01 Mar 2012 06:00:00 GMT

AK - Annual Premium Tax Payment

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

AL - Audit & Exam Transmittal Form

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

AL - Captive Insurer Tax Form

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

AL - Credit Allocation Worksheet

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

AL - Documentation for Premium Tax Return

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

AL - Domestic HMO Annual

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Postal Service:

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

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

AL - Domestic LAH Annual

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

AL - Domestic PC Annual

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

AL - Foreign Casualty Annual

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

AL - Foreign HMO Annual

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Postal Service:

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

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

AL - Foreign LAH Annual

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

AL - Foreign Property Annual

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

AL - Offices Facilities Credit Worksheet

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

The worksheet should be filed only if credit is taken.

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

AL - Retaliatory Tax Statement

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Postal Service:

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

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

AL - Risk Retention Companies Annual

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Postal Service:

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

AR - Insurance Carrier Worksheet for WC Premium Taxes

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

AZ - Annual Fees Report (Form E-ANNUALFEES)

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Mail completed form to:

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Mail completed form to:

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

AZ - SL Semi-Annual Tax Report

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

AZ - Survey of Arizona Domestic Insurers

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

CO - Premium Taxes Homepage

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

See Checklist Link

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

CT - HCC Tax Return (Form 207 HCC)

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Complete this form in blue or black ink only.

Attach the completed Form 207I to:

Form 207;
Form 207F; or
Form 207 HCC

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

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

DC - HMO Insurance Tax Return

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

DC - LAH Guaranty Fund Form

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

DC - LAH Insurance Tax Return

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

DC - PC Insurance Tax Return

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

DC - RRG Insurance Tax Return

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

DE - Annual Tax and Fees Report - Captive

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

DE - Annual Tax and Fees Report - Domestic

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

DE - Annual Tax and Fees Report - Foreign

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

DE - Annual Tax and Fees Report - Health

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Mail to:

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Mail to:

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

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

DE - Annual Tax and Fees Report - RPG

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

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

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Mail your completed DR-908 and payment to:

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

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

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

01 Mar 2012 06:00:00 GMT

Thursday, March 1, 2012

Mail to:

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

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