Insurance Compliance Center - Pro

form, report, insurance, annual, health, premium, filing, life, return, exhibit

Central Time

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

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

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

Monthly Insurance Surcharge Report (Form 74A118)

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

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

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

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

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

Wings Introduction - New Users

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

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

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

Insurance Company Renewal Information and Payment Voucher

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

Insurance Premium Tax Quarterly Prepayment (Form TC-670)

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

Insurance Premium Tax Return (Form TC-49)

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

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

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

Quarterly Report of SL Business

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

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

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

Self Insurer Tax Return (Form TC-420)

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

Accident and Health Survey

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

Administrative Zip Code Reporting Exhibit

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

Annual Renewal Fee - Captive

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

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

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

Anti-Fraud Annual Statistical Reporting Form

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

ATPA Annual Assessment (Form FIS 0055)

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

Biographical Affidavits

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

Business Only Pages

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

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

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

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

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

Certificate of Disclosure (Form E-178)

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

Certificate of Disclosure (Form E-178Captives)

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

Certified Copy of Current License or Certificate of Authority

Consumer Credit and Credit Scoring Report

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

Current List of Texas Surplus Lines Agents

Examination Report

Exhibit of Premiums and Losses (page 20)

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

Filing Requirements - SL

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

Foreign Surplus Lines Quarterly Policy Filing

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

Form B and C Insurance Holding Company System Registration Statement

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

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

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

Health Care Regulatory and Insurance Regulation Assessment - Supplemental Filing Form

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

Health Checklist

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

HMDI Corporations Checklist

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

HMO PEIA Rates

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

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

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

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

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

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

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

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

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

Holding Company Registration - Form B

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

Holding Company Registration - Form C

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

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

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

Insurance Fraud Report Form

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

LAH Checklist

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

Life Care Provider Annual Report (Form E-LIFECARE)

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

Medical Malpractice Claim Report (Form SFN 17118)

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

Medical Malpractice Claim Reporting Form and Statutes

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

MHCC User Fee Assessment Survey Login

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

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

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

NAIC IRIS Ratio Results

PC Checklist

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

Premium Growth Report (Form OIR-A1-1229)

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

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

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

Quarterly Financial Statement Filing

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

Quarterly Financial Statement Filing - Health

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

Quarterly Statements

Records Location Information (Form E-176)

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

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

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

Reporting Adverse Decisions and Greivances - Carrier Reporting Form

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

Residential Mortgage Loan Report (Form FAD108) - Excel

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

Signed Jurat

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

SL Annual Filing

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

SL Checklist - Foreign

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

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

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

State Filing Fees

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

State of Nevada Publication Form

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

State Page - LAH, PC

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

State Page 30 and Supp28 or Supp64

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

Statement Filing Fees

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

Supplement 28

Supplement 64

Three-Year Business Plan

Warranty Plans (Form OCI 27-002)

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

Wind and Hail Underwriting Association Report of Premiums Login

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

Accident & Health Policy Experience Exhibit

NAIC Filings If applicable. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to State Form: https://www2.naic.org/servlet/Index. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Thursday, April 1, 2010.

Adjustments to Life, Health & Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit

NAIC Filings If applicable. Insurance Type: LAH. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to State Form: https://www2.naic.org/servlet/Index. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Thursday, April 1, 2010.

Credit Insurance Experience Exhibit

NAIC Filings If applicable. Insurance Type: LAH, PC. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to State Form: https://www2.naic.org/servlet/Index. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Thursday, April 1, 2010.

Insurance Expense Exhibit

NAIC Filings Insurance Type: PC. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to State Form: https://www2.naic.org/servlet/Index. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Thursday, April 1, 2010.

Interest Sensitive Life Insurance Products Report

Investment Risks Interrogatories

NAIC Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to State Form: https://www2.naic.org/servlet/Index. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Thursday, April 1, 2010.

Life Supplement Life, Health & Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit

NAIC Filings Insurance Type: Health. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to State Form: https://www2.naic.org/servlet/Index. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Thursday, April 1, 2010.

Life Supplements Adjustments to Life, Health & Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit

NAIC Filings If applicable. Insurance Type: Health. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to State Form: https://www2.naic.org/servlet/Index. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Thursday, April 1, 2010.

Life, Health & Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit

NAIC Filings Insurance Type: LAH. Filing Period: Qtr 1. Due by Postmark or Receive Date: Receive Date. Filing Type: Supplement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to State Form: https://www2.naic.org/servlet/Index. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Thursday, April 1, 2010.

Long-Term Care Experience Reporting Forms

Management’s Discussion & Analysis

PC Supplement Insurance Expense Exhibit

All Classes Except Ocean Marine Life Title and Home Protection Tax Return (Form CDI FS-001)

Premium Tax Notary required. Send 1 Original and 2 photocopies with the CA Dept of Ins. Mailing. See supporting information link. Insurance Type: Health, PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: CDI FS-001. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/2009PCTaxReturn.xls. Link to Filing Website: www.insurance.ca.gov. Link to Supporting Information: Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/2009-PC-Instr-2.doc. State Authority: California Department of Insurance. Contact Phone: 213-346-6186. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Thursday, April 1, 2010.

Amended Insurance Tax Return - PDF

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: OR. Domestic/Foreign: Domestic, Foreign. State Form ID: 440-4760. Link to State Form: http://insurance.oregon.gov/forms/insurer/4760.pdf. Link to Filing Website: http://insurance.oregon.gov/. State Authority: Oregon Insurance Division. Contact Email: lynette.m.hadley@state.or.us. Contact Phone: 503-947-7046. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Thursday, April 1, 2010.

Comprehensive Health Insurance Pool

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NE. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.doi.ne.gov/prem_tax/chipfrm.pdf. Link to Filing Website: www.doi.ne.gov. State Authority: Nebraska Department of Insurance. Contact Email: Jim.Nixon@nebraska.gov. Contact Phone: 402-471-2201. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Foreign Insurer): 1. # of Copies to State (Domestic Insurer): 1. Thursday, April 1, 2010.

Continuation of Certificate of Authority

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: OR. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.insurance.oregon.gov. State Authority: Oregon Insurance Division. Contact Email: lynette.m.hadley@state.or.us. Due by Postmark or Receive Date: Postmark. Thursday, April 1, 2010.

Firefighters Pension Fund

Premium Tax Go to website, click on Forms, click on Insurance Premium Tax, form at the bottom of the page. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: GA. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.gfpf.org/Resources/InsForm2009.pdf. Link to Filing Website: http://www.gfpf.org. State Authority: Georgia Firefighter's Pension Fund. Contact Email: pensions@gfpf.org. Contact Phone: 770-388-5757. Paper Size: Legal. Thursday, April 1, 2010.

Home Protection Tax Return (Form CDI FS-004)

Premium Tax Notary required. File one (1) original of this return with the California Department of Insurance postmarked on or before April 1. Express delivery date by company will be accepted as the postmark date. See supporting information link. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: CDI FS-004. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/2009-Home-Protection-Tax-Return.xls. Link to Filing Website: www.insurance.ca.gov. Link to Supporting Information: Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/2009-Home-Protection-Instr-3.doc. State Authority: California Department of Insurance. Contact Phone: 213-346-6186. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Thursday, April 1, 2010.

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

Premium Tax Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: TX. Domestic/Foreign: Domestic, Foreign. State Form ID: 25-101. Link to State Form: http://www.window.state.tx.us/taxinfo/taxforms/25-101.pdf. Link to Filing Website: http://www.window.state.tx.us/taxinfo/taxforms/25-forms.html. State Authority: Texas State Comptroller. Contact Email: tax.help@cpa.state.tx.us. Contact Phone: 512-463-4600. Due by Postmark or Receive Date: Receive. Thursday, April 1, 2010.

Insurance Tax Return - PDF

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: OR. Domestic/Foreign: Domestic, Foreign. State Form ID: 440-3646. Link to State Form: http://insurance.oregon.gov/forms/insurer/3646.pdf. Link to Filing Website: http://www.insurance.oregon.gov. State Authority: Oregon Insurance Division. Contact Email: lynette.m.hadley@state.or.us. Contact Phone: 503-947-7046. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Payment Method: EFT Payment accepted. Paper Size: Letter. Paper Color: White. Thursday, April 1, 2010.

LAH Tax Return (Form CDI FS-002)

Premium Tax Notary required. Send 1 Original and 2 photocopies with the CA Dept of Ins. Mailing. See supporting information link. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: CDI FS-002. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/2009-Life-Tax-Return.xls. Link to Filing Website: www.insurance.ca.gov. Link to Supporting Information: Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/2008_Life_Instructions.doc AttachmentB: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/LifeAttachmentB.doc. State Authority: California Department of Insurance. Contact Phone: 213-346-6186. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Thursday, April 1, 2010.

LAH Tax Return Attachment A

Premium Tax Notary required. Send 1 Original and 2 photocopies with the CA Dept of Ins. Mailing. See supporting information link. Insurance Type: LAH. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: CDI FS-002. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/2009-Life-Attachment-A.xls. Link to Filing Website: www.insurance.ca.gov. Link to Supporting Information: Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/2008_Life_Instructions.doc AttachmentB: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/LifeAttachmentB.doc. State Authority: California Department of Insurance. Contact Phone: 213-346-6186. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Thursday, April 1, 2010.

Ocean Marine Tax Report

Premium Tax Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: NJ. Domestic/Foreign: Domestic, Foreign. State Form ID: PC. Link to State Form: http://www.state.nj.us/treasury/taxation/pdf/other_forms/oceanmarinetaxrpt08.pdf. Link to Filing Website: http://www.state.nj.us/treasury/taxation/. State Authority: New Jersey Division of Taxation. Contact Email: nj.taxation@treas.state.nj.us. Contact Phone: 609-292-6400. Due by Postmark or Receive Date: Receive. Thursday, April 1, 2010.

Premium Tax Voucher - 1st Quarter Prepayment (Form CIA T-4)

Premium Tax Notary required. Send 1 Original and 2 photocopies with the CA Dept of Ins. Mailing. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: CIA T-4. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/Insurer_1st_Qtr_Prepayment_Voucher.xls. Link to Filing Website: www.insurance.ca.gov. State Authority: California Department of Insurance. Contact Phone: 213-346-6186. Due by Postmark or Receive Date: Receive. Thursday, April 1, 2010.

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

Premium Tax Notary required. Send 1 Original and 2 photocopies with the CA Dept of Ins. Mailing. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: CIA T-4A. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/tax-forms-instruct-and-info/2008/upload/Insurer2nd_3rd_4thQtrPrepaymentVoucher.xls. Link to Filing Website: www.insurance.ca.gov. State Authority: California Department of Insurance. Contact Phone: 213-346-6186. Due by Postmark or Receive Date: Receive. Thursday, April 1, 2010.

Producer Controlled Annual Report

Premium Tax Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: NE. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.doi.ne.gov/prem_tax/pcafrm.pdf. Link to Filing Website: www.doi.ne.gov. State Authority: Nebraska Department of Insurance. Contact Email: Jim.Nixon@nebraska.gov. Contact Phone: 402-471-2201. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Foreign Insurer): 1. # of Copies to State (Domestic Insurer): 1. Thursday, April 1, 2010.

Retaliatory Tax

Premium Tax Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: OR. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.insurance.oregon.gov. State Authority: Oregon Department of Consumer and Business Services. Contact Email: lynette.m.hadley@state.or.us. Contact Phone: 503-947-7046. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Thursday, April 1, 2010.

Risk Retention Tax Packet - PDF

Premium Tax Insurance Type: Risk Retention Group. Filing Period: Qtr 1. StateAbbrv: OR. Domestic/Foreign: Domestic, Foreign. State Form ID: 440-0898. Link to State Form: http://insurance.oregon.gov/forms/insurer/0898.pdf. Link to Filing Website: http://www.insurance.oregon.gov. State Authority: Oregon Insurance Division. Contact Email: lynette.m.hadley@state.or.us. Contact Phone: 503-947-7046. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Payment Method: EFT Payment accepted. Paper Size: Letter. Paper Color: White. Thursday, April 1, 2010.

SL Statement Of Taxable Premiums Received (Form SFN 17419)

Premium Tax Applies to all licensed surplus lines producers. File even if gross premium is 0. North Dakota Insurance Department 600 E. Boulevard Avenue Dept. 401 Bismarck, ND 58505-0320. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: ND. Domestic/Foreign: Domestic. State Form ID: SFN 17419. State Authority: North Dakota Insurance Department. Thursday, April 1, 2010.

Unauthorized Insurer Business Written Report - SL and RRG

Premium Tax Insurance Type: PC, Surplus Lines, Risk Retention Group. Filing Period: Qtr 1. StateAbbrv: SD. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.sd.us/drr2/reg/insurance/companies/documents/surpluslinesinsurerandriskretentiongroups.pdf. Link to Filing Website: http://www.state.sd.us/drr2/reg/insurance/. State Authority: South Dakota Division of Insurance. Contact Email: luann.johnson@state.sd.us. Contact Phone: 605-773-3563. Due by Postmark or Receive Date: Postmark. Thursday, April 1, 2010.

Accident Prevention Services Annual Report (Form HS-31-C)

State Required Filings Calendar year is defined as January 1 - December 31. This form may be obtained from the Accident Prevention Services Section of the Health and Safety Division, Arkansas Workers’ Compensation Commission. Note: Complete one form for each company or sister company in the insurance group. Return the original (copies are not acceptable). A separate report must be submitted for each sister company. Complete all blanks. Do not use “N/A” or “not applicable.” Authorized signature of insurance company’s designated representative. Insert date the report was completed by the designated representative. Insurance Type: PC, Workers Compensation. Filing Period: Qtr 1. StateAbbrv: AR. Domestic/Foreign: Domestic, Foreign. State Form ID: HS-31-C. Link to State Form: http://www.awcc.state.ar.us/revisedforms/formhs-31-c.pdf. Link to Filing Website: http://www.awcc.state.ar.us/. State Authority: Arkansas Workers' Compensation Commission. Contact Phone: 501-682-3930 or 800-622-4472. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Thursday, April 1, 2010.

Accountable Health Plan Small Employer Base Premium Rates and Index Rates

State Required Filings Health: See Note X LAH & PC: See Note T Must be filed if you are an approved Accountable Health Plan. ARS § 20-2311(G). DO NOT send in Annual Statement package. Mail To: Arizona Department of Insurance ATTN: Life and Health Division 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.id.state.az.us/taxforms.html. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-2393. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Actuarial Certification

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Filing Method: Electronic. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Actuarial Certification of Rates for Small Employer Health Benefits Plans

Annual Data Requirement Electronic Filing

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Domestic. Link to Filing Website: http://www.ins.state.ny.us/ny07hmo.htm. State Authority: New York Insurance Department. Contact Email: mscharff@ins.state.ny.us. Contact Phone: 212-480-5060. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Annual Form B & Form C filing

State Required Filings If Applicable: NJSA17:27A3. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: NJ. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.state.nj.us. State Authority: New Jersey Department of Banking and Insurance, Office of Solvency Regulation. Contact Email: admissions&selfinsurance@dobi.state.nj.us. Contact Phone: 609-292-7272 ext 50099. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): xxx. Thursday, April 1, 2010.

Annual Form B & Form C filing

State Required Filings NJSA 27A3(a). Insurance Type: LAH, PC. Filing Period: Qtr 1. StateAbbrv: NJ. Domestic/Foreign: Domestic. Link to Filing Website: www.state.nj.us. State Authority: New Jersey Department of Banking and Insurance, Office of Solvency Regulation. Contact Email: admissions&selfinsurance@dobi.state.nj.us. Contact Phone: 609-292-7272 ext 50099. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Annual Information Statement - Attorney In Fact for Reciprocal Insurer (Form AIS-RE)

State Required Filings Department of Insurance 45 Fremont Street 24th Floor San Francisco, CA 94105. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: AIS-RE. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/corp-apps-and-info/annualinfostat-ammendedca/upload/RecipInfoStmt2009.doc. Link to Filing Website: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/corp-apps-and-info/annualinfostat-ammendedca/index.cfm. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/corp-apps-and-info/annualinfostat-ammendedca/index.cfm. State Authority: State of California Department of Insurance. Contact Phone: 415-538-4154. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Thursday, April 1, 2010.

Annual Report - Contracts Issued and Outstanding (Form OIR-A2-949)

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. State Form ID: OIR-A2-949. Link to State Form: http://www.floir.com/pdf/OIR-A2-949.pdf. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Annual Report - Damage Claims for Medical Injury (Form OIR-A2-950)

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. State Form ID: OIR-A2-950. Link to State Form: http://www.floir.com/pdf/OIR-A2-950.pdf. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Filing Method: Electronic. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Annual Report Filing Fees - HMO (Form OIR-A2-1083)

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. State Form ID: OIR-A2-1083. Link to State Form: http://www.floir.com/pdf/OIR-A2-1083.pdf. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy, Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Assessable Premium Report - LAH

State Required Filings Foreign Companies: This report is to be filed directly with the Idaho Life & Health Insurance Guaranty Association NOT with the Idaho Department of Insurance. Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: ID. Domestic/Foreign: Domestic, Foreign. State Form ID: INS-PTX-LHGA. Link to State Form: http://www.idlifega.org/documents/Life%20Premium%20Form4.pdf. Link to Filing Website: www.doi.idaho.gov. State Authority: Idaho Life and Health Insurance Guaranty Association. Contact Email: ckinch@idlifega.org. Contact Phone: 208-378-9510. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Assigned Risk Plan Report

State Required Filings R.I.G.L. §31-33-8. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: RI. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.dbr.state.ri.us/. State Authority: Rhode Island Department of Business Regulation - Insurance Division. Contact Email: Robert_Myers@dbr.state.ri.us. Contact Phone: 401-222-2223. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

CA Supplement to MDA (NAIC) Report (Form FAD109) - Excel

State Required Filings MS-Excel and Adobe PDF. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: FAD109. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/forms/upload/FAD109-Ca-MDA.xls. Link to Filing Website: www.insurance.ca.gov. State Authority: California Department of Insurance, Financial Analysis Division, Financial Records Unit. Contact Email: Financial_Records@Insurance.CA.Gov. Contact Phone: 213-346-6423. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to NAIC (Foreign Insurer): 0. Paper Size: Select Entire workbook, Letter size; Orientation: Portrait. Thursday, April 1, 2010.

California Special Interrogatory - Mortgage Guaranty (Form FAD141)

State Required Filings MS-Excel and Adobe PDF See Appendix A Effective for 2007 filings. You are not required to file an electronic copy of a document with the California State Department of Insurance if there is no entry in column 7 for the document in question. For Example: You are not required to make an electronic filing with the California Department of Insurance for the Annual Statement but you are required to do so for the Actuarial Opinion Summary. Submit an electronic copy (in addition to required hard copy filings) of the documents on a single CD, using the formats prescribed in column 7 of the checklist. See APPENDIX A for further instructions on electronic filing requirement. Mail completed forms to; State of California Department of Insurance Financial Analysis Division Attn: Financial Records Unit 300 S. Spring Street, 13th Floor – South Tower Los Angeles, CA 90013. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: CA. Domestic/Foreign: Domestic, Foreign. State Form ID: FAD141. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/forms/upload/PCFad141CASpecialInterNotesP1P2.xls. Link to Filing Website: http://www.insurance.ca.gov. State Authority: California Department of Insurance, Financial Analysis Division, Financial Records Unit. Contact Email: Financial_Records@Insurance.CA.Gov. Contact Phone: 213-346-6423. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to NAIC (Foreign Insurer): 0. Paper Size: Select Entire Workbook, Legal size Orientation: Page 1,3-4 Portrait; Page 2 Landscape. Thursday, April 1, 2010.

Ceded Reinsurance Report

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

Certification of Broker Controlled Insurers

State Required Filings Every domestic property and casualty insurer licensed to transact business in Pennsylvania is required to review Article XIII of the Insurance Company Law (40 P.S. §§ 991.1301-1305) to determine if it is subject to the provisions of that article which sets forth the requirements that must be met by broker controlled property and casualty insurers. Please be advised that each company subject to the law’s requirements must complete and file a certification form and actuarial opinion on or before April 1st of each year. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: PA. Domestic/Foreign: Domestic. Link to State Form: http://www.ins.state.pa.us/ins/LIB/ins/companies/statement/brokerfm.pdf. Link to Filing Website: www.ins.state.pa.us. State Authority: Pennsylvania Insurance Department - Financial Analysis Division. Contact Email: ra-in-analysis@state.pa.us. Contact Phone: 717-787-5890. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Certification of Preferred Provider Plan Same Service Provisions (Form OCI 26-112)

State Required Filings Insurance Type: Health. Filing Period: Annual. StateAbbrv: WI. State Form ID: OCI 26-112. Link to State Form: http://oci.wi.gov/ociforms/26-112.pdf. Link to Filing Website: http://oci.wi.gov. State Authority: Wisconsin Office of the Commissioner of Insurance. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Thursday, April 1, 2010.

Copy of Current Provider Directory, Current Certificates of Coverage & Current Member Handbook for each line of business

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: MI. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.michigan.gov/dleg/0,1607,7-154-10555---,00.html. Link to Supporting Information: Notes: http://www.michigan.gov/documents/cis_ofis_hmo_book_2003_80217_7.pdf. State Authority: Michigan Department of Labor & Economic Growth. Contact Email: finleym@michigan.gov. Contact Phone: 517-241-4490. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): xxx. Thursday, April 1, 2010.

Credit Insurance Annual Report

State Required Filings MN Stat. 62B.07 See Note R This form is not a required filing for surplus lines companies. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: MN. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.mn.us/mn/externalDocs/Commerce/Authorized_Prop_and_Casualty_Insurers_111403103105_AuthorizedPandC.pdf. Link to Filing Website: www.insurance.mn.gov. State Authority: Minnesota Department of Commerce, Financial Examinations-Insurance. Contact Email: Julia.Philips@state.mn.us. Contact Phone: 651-296-8949. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Credit Life Disability and Unemployment Report (Form A)

State Required Filings Health: See Note X LAH & PC: See Note T Must be filed if you write credit insurance business in Arizona. A.A.C. R20-6-604.07. DO NOT send in Annual Statement package. Mail To: Arizona Department of Insurance ATTN: Life and Health Division 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.id.state.az.us/forms/life_and_health_credit_form_a.pdf. Link to Filing Website: http://www.id.state.az.us/taxforms.html. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-2393. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Credit Property Experience Report (Form B)

State Required Filings Health: See Note X LAH & PC: See Note T Must be filed if you write credit insurance business in Arizona. A.A.C. R20-6-604.07. DO NOT send in Annual Statement package. Mail To: Arizona Department of Insurance ATTN: Life and Health Division 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AZ. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.id.state.az.us/publications/Credit_Property_Form_B.pdf. Link to Filing Website: http://www.id.state.az.us/taxforms.html. State Authority: Arizona Department of Insurance - Financial Affairs Division. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-2393. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Downstream Risk Arrangement Disclosure

State Required Filings Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: ME. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.maine.gov/insurance/. State Authority: Maine Bureau of Insurance, Financial Analysis Division. Contact Email: kendra.l.godbout@maine.gov. Contact Phone: 207-684-8495. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Earthquake Market Analysis

State Required Filings The form is to be emailed to Becky.Harrington@arkansas.gov. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: AR. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.insurance.arkansas.gov/PandC/P&CForms/EQReportingFormed08.xls. Link to Filing Website: http://insurance.arkansas.gov/PandC/Datareports.htm. State Authority: Arkansas Insurance Department. Contact Email: becky.harrington@arkansas.gov. Contact Phone: 501-371-2800. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Thursday, April 1, 2010.

Electronic Filing Authenticity Affidavit (Form INS7240)

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: OH. Domestic/Foreign: Domestic. State Form ID: IN S7240. Link to State Form: https://secured.insurance.ohio.gov/Forms/INS7240.pdf. Link to Filing Website: http://www.ohioinsurance.gov. State Authority: Ohio Department of Insurance, Office of Financial Regulation Services. Contact Email: taxes@ins.state.oh.us. Contact Phone: 614-644-2658. Due by Postmark or Receive Date: Receive. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Evidence of Adequate Insurance Compliance with Rule 690-191-069

Health Benefit Plan Report Form

State Required Filings (Senate Bill 501) See Note FF This report is to be filed electronically on or before April 1. See Health Benefit Plan Report Instruction Guidelines. Direct all inquiries to: Gary Holliday Department of Consumer & Business Services Market Surveillance-5 P.O. Box 14480 Salem, OR 97309-0405. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: OR. Link to State Form: https://www4.cbs.state.or.us/exs/ins/multifile/. Link to Filing Website: http://egov.oregon.gov/DCBS/. Link to Supporting Information: Instructions: http://www.cbs.state.or.us/external/ins/forms/insurer/health-benefit-plan-report_instructions.pdf https://www4.cbs.state.or.us/exs/ins/multifile/. State Authority: Oregon Department of Consumer and Business Services. Contact Email: ins.mrktsurv@state.or.us. Contact Phone: 503-947-7268. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Health Plan Financial and Statistical Report (HPFSR)

State Required Filings Send completed file as an attachment to demreport@health.state.mn.us The HPFSR report, sent by email as an Excel file, may be password protected before it is sent. Use this password: Gu@CR7E!iB and by navigating the Excel menu to the Tools/Options/Security tab you can apply this password to your file. Every company also needs to send a copy of the signed first page as a scanned PDF file, attached to the email with the HPFSR form (or you may send the first page by fax to 651-201-5179, attn HEP/Catherine). This physical signature is required for all HPFSR filings, even if there is zero health care premium for the company to report in 2007. Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: MN. Domestic/Foreign: Domestic, Foreign. State Form ID: HPFSR. Link to State Form: http://www.health.state.mn.us/divs/hpsc/dap/cdireports/grppurch/hpfsr09.xls. Link to Filing Website: http://www.health.state.mn.us/. State Authority: Minnesota Department of Health. Contact Email: catherine.malave@health.state.mn.us. Contact Phone: 651-201-3576. Filing Method: Electronic. Thursday, April 1, 2010.

HMO Checklist

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.floir.com/mc/Documents/HMOFilingReq.doc. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): 1. Thursday, April 1, 2010.

Home Protection Management and Discussion Analysis

State Required Filings Insurance Type: PC. Filing Period: Annual. StateAbbrv: CA. Domestic/Foreign: Domestic. State Form ID: FAD350. Link to Filing Website: http://www.insurance.ca.gov. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/2008/upload/HP_Ltr_MDA_HP.doc. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to NAIC (Foreign Insurer): 0. Thursday, April 1, 2010.

Home Protection Management and Discussion Analysis

State Required Filings Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: CA. Link to Filing Website: http://www.insurance.ca.gov/. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/2008/upload/HP_Ltr_MDA_HP.doc. State Authority: California Department of Insurance. Due by Postmark or Receive Date: Postmark. Thursday, April 1, 2010.

Insurance Holding Company System Annual Registration Statement

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: KY. Domestic/Foreign: Domestic. Link to Filing Website: http://doi.ppr.ky.gov/kentucky/quickLink.asp?DIVID=6. State Authority: Kentucky Department of Insurance, Financial Standards and Examination Division. Contact Email: KOIFinancialStandardsMail@ky.gov. Contact Phone: 502-564-6082. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Insurer Profile Questionnaire

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: IN. Domestic/Foreign: Domestic. Link to State Form: http://www.in.gov/idoi/pdf/Insurerprofile2007.pdf. Link to Filing Website: www.in.gov. State Authority: Indiana Department of Insurance (IDOI), Financial Services. Contact Email: sglassburn@idoi.in.gov. Contact Phone: 317-232-5692. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): N/A. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Life, Health & Annuity Guaranty Assessment Base Reconciliation Exhibit & Adjustments

State Required Filings Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: ID. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.idlifega.org/. State Authority: Idaho Life and Health Insurance Guaranty Association. Contact Email: ckinch@idlifega.org. Contact Phone: 208-378-9510. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): See Note T. Thursday, April 1, 2010.

Liquor Liability Report

State Required Filings (R.I.G.L. §3-14-14). Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: RI. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.dbr.state.ri.us/. State Authority: Rhode Island Department of Business Regulation - Insurance Division. Contact Email: Ken_DiLeone@dbr.state.ri.us. Contact Phone: 401-222-5477. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Long Term Care Experience

State Required Filings Prior to submitting the report, you must change the paper size to legal (8 1/2 x 14) and the orientation to landscape. Insurance Type: Health. Filing Period: Qtr 1. StateAbbrv: WI. Domestic/Foreign: Domestic, Foreign. State Form ID: OCI 26-301. Link to State Form: http://oci.wi.gov/ociforms/ltcrptforms.htm. Link to Filing Website: http://oci.wi.gov/. State Authority: Wisconsin Office of the Commissioner of Insurance. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Paper Size: Legal. Thursday, April 1, 2010.

Long Term Care Survey

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: CO. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.dora.state.co.us/survey/longtermcare08.htm. Link to Filing Website: http://www.dora.state.co.us/. State Authority: Colorado Division of Insurance. Contact Email: carol.obryan@dora.state.co.us. Contact Phone: 303-894-2198. Filing Method: Electronic. Thursday, April 1, 2010.

Management Discussion & Analysis

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: AL. Domestic/Foreign: Domestic. Link to Filing Website: https://aldoi.gov/Companies/Forms.aspx. State Authority: Alabama Department of Insurance. Contact Email: Ann.Strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. Thursday, April 1, 2010.

Management Discussion and Analysis

State Required Filings Insurance Type: Reinsurance. Filing Period: Qtr 1. StateAbbrv: CT. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.ct.gov/cid. Link to Supporting Information: Bulletin: http://www.ct.gov/cid/lib/cid/BullFS4AR-08.pdf. State Authority: Connecticut Insurance Department. Contact Email: cid.financial@ct.gov. Contact Phone: 860-297-3814. Due by Postmark or Receive Date: Postmark. Thursday, April 1, 2010.

Management Discussion and Analysis

State Required Filings See supporting information link. Insurance Type: Risk Retention Group. Filing Period: Qtr 1. StateAbbrv: PA. Domestic/Foreign: Foreign. Link to Filing Website: http://www.ins.state.pa.us/. Link to Supporting Information: Instructions: http://www.ins.state.pa.us/ins/lib/ins/companies/RRG_annual_filing_requirements_for_internet.pdf. State Authority: Pennsylvania Insurance Department. Contact Email: ra-in-company@state.pa.us. Contact Phone: 717-787-2735. Thursday, April 1, 2010.

Management Discussion and Analysis Transmittal (Form E-MDA)

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

Medicare Supplement Experience

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: WI. State Form ID: OCI 26-300. Link to State Form: http://oci.wi.gov/ociforms/medrptforms.htm. Link to Filing Website: http://oci.wi.gov/. State Authority: Wisconsin Office of the Commissioner of Insurance. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to State (Foreign Insurer): xxx. # of Copies to NAIC (Domestic Insurer): EO. Paper Size: Legal (8 1/2 x 14). Thursday, April 1, 2010.

Medicare Supplement Insurance Experience Report (Form MO 375-0307)

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: MO. Domestic/Foreign: Domestic, Foreign. State Form ID: MO 375-0307. Link to State Form: http://insurance.mo.gov/industry/forms/375-0307.pdf. Link to Filing Website: http://insurance.mo.gov/. State Authority: Missouri Department of Insurance. Contact Email: Mary.Moon@insurance.mo.gov. Contact Phone: 573-526-5001. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Thursday, April 1, 2010.

Motor Vehicle Annual Report - Memorandum

State Required Filings To be filed by all insurers authorized to write motor vehicle insurance in Hawaii. See Notes A,T. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: HI. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://hawaii.gov/dcca/ins/insurers/rate_policy/mv_forms/ins_mvf_annual_report.pdf. Link to Filing Website: www.hawaii.gov. State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division. Contact Email: insrpaPC@dcca.hawaii.gov. Contact Phone: 808-586-2809. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Net Worth Deposit and Designated Reserve Calculations - HMO

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: VT. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.bishca.state.vt.us. State Authority: Vermont Insurance Division - Department of Banking, Insurance, Securities and Health Care Administration. Contact Email: CompLic@bishca.state.vt.us. Contact Phone: 802-828-0184. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): xxx. Thursday, April 1, 2010.

NJ Small Employer and Individual Health Benefits Program

State Required Filings Exhibits CC and K are required of all carriers that report accident and health premiums in NJ. SEH due 3/1, IHC due 4/1. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: NJ. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.nj.us/dobi/division_insurance/ihcseh/annualfilingrequirements.pdf. Link to Filing Website: www.state.nj.us. State Authority: New Jersey Department of Banking and Insurance, IHC and Small Employer Health Benefits Program. Contact Email: ellen.derosa@dobi.state.nj.us. Contact Phone: 609-633-1882 ext 50302. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Prescription Drug Purchases Report

State Required Filings Send completed file as an attachment to demreport@health.state.mn.us Only those health plan companies with drug purchases and total health care premium revenue for Minnesota residents over $3 million in 2007 are required to submit this report. Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: MN. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.health.state.mn.us/divs/hpsc/dap/cdireports/drugrpt/drug09.xls. Link to Filing Website: http://www.health.state.mn.us/. State Authority: Minnesota Department of Health. Contact Email: catherine.malave@health.state.mn.us. Contact Phone: 651-201-3576. Filing Method: Electronic. Thursday, April 1, 2010.

Producer Controlled Insurance Report

State Required Filings Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: NJ. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.nj.us/dobi/division_insurance/pdfs/proconrpt.pdf. Link to Filing Website: www.state.nj.us. Link to Supporting Information: Letter: http://www.state.nj.us/dobi/division_insurance/pdfs/proconltr.pdf. State Authority: New Jersey Department of Banking and Insurance, Office of Solvency Regulation. Contact Email: admissions&selfinsurance@dobi.state.nj.us. Contact Phone: 609-292-7272 ext. 50107. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Thursday, April 1, 2010.

Quarterly Supplement - Prepaid Expenses (Schedule Qtr D)

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. State Form ID: Qtr-D. Link to State Form: http://www.floir.com/pdf/qtr_d.pdf. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Link to Supporting Information: Forms: www.floir.com. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy, Electronic. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Quarterly Supplement - Surplus Notes (Schedule Qtr G)

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. State Form ID: Qtr-G. Link to State Form: http://www.floir.com/pdf/qtr_g.pdf. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Link to Supporting Information: Forms: www.floir.com. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy, Electronic. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Related Parties Summary

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

Report of Assessable Ocean and Inland Marine Premium (Form R09)

State Required Filings Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: VA. Domestic/Foreign: Domestic, Foreign. State Form ID: R09. State Authority: Virginia Bureau of Insurance, Financial Regulation Division. Contact Email: karen.traylor@scc.virginia.gov. Contact Phone: 617-227-7020. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): n/a. Thursday, April 1, 2010.

Report of Gross Annual Premiums & Enrollment Data

State Required Filings Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. State Form ID: OIR-B2-1094. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. State Authority: Florida Office of Insurance Regulation. Contact Phone: 850-413-3800. Filing Method: Electronic. Thursday, April 1, 2010.

Report on the Operation of the Quality Assurance Program & Grievance Procedure - HMO

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: VT. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.bishca.state.vt.us. State Authority: Vermont Insurance Division - Department of Banking, Insurance, Securities and Health Care Administration. Contact Email: CompLic@bishca.state.vt.us. Contact Phone: 802-828-2917. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): xxx. Thursday, April 1, 2010.

SAMPLE Producer Controlled Insurer Reporting Form

State Required Filings Any insurer that is not a “controlled insurer” as defined in the KANSAS BUSINESS TRANSACTED WITH PRODUCER CONTROLLED INSURER ACT does not need to complete this form. A separate reporting form must be submitted for each controlling producer. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: KS. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.ksinsurance.org/industry/company/co_docs/taxforms/Watermarked_Producer_Controlled_Insurer_Reporting_Form09.pdf. Link to Filing Website: http://www.ksinsurance.org/. State Authority: Kansas Department of Insurance. Contact Email: disaacs@ksinsurance.org. Contact Phone: 785-296-3428. Due by Postmark or Receive Date: Receive. Thursday, April 1, 2010.

SL Alien Insurers Renewal

State Required Filings Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: MT. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://sao.mt.gov/forms/exams/2009annuals/Surplus%20Lines%20-%20Alien%20Insurers%20Renewal.pdf. Link to Filing Website: http://sao.mt.gov/. State Authority: Montana Insurance Department, Examinations Bureau. Contact Email: csi@mt.gov. Contact Phone: 406-444-2040. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Thursday, April 1, 2010.

SL Foreign Insurers Renewal

State Required Filings Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: MT. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://sao.mt.gov/forms/exams/2009annuals/Surplus%20Lines%20-%20Foreign%20Insurers%20Renewal.pdf. Link to Filing Website: http://sao.mt.gov/. State Authority: Montana Insurance Department, Examinations Bureau. Contact Email: csi@mt.gov. Contact Phone: 406-444-2040. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Thursday, April 1, 2010.

SL Renewal Information - Foreign

State Required Filings Annual Statement Actuarial Opinion Audited Financial Statement Annual Renewal Fee Annual Statement Filing Fee Management Discussion and Analysis Certificate of Deposit Certificate of Compliance. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: TN. Domestic/Foreign: Foreign. Link to State Form: http://tn.gov/commerce/insurance/documents/SLforeignrenewal012609.pdf. Link to Filing Website: http://tn.gov/commerce/insurance/. State Authority: Department of Commerce and Insurance. Contact Phone: 615-741-1633. Due by Postmark or Receive Date: Receive. Thursday, April 1, 2010.

State Filing Fees

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: RI. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: http://www.dbr.state.ri.us/. State Authority: Rhode Island Department of Business Regulation - Insurance Division. Contact Email: Ken_DiLeone@dbr.state.ri.us. Contact Phone: 401-222-5477. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

State of FL Electronic Filing

State Required Filings Insurance Type: Health, HMO. Filing Period: Qtr 1. StateAbbrv: FL. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Link to Filing Website: www.floir.com. State Authority: Florida Office of Insurance Regulation. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. # of Copies to State (Domestic Insurer): REFS. # of Copies to State (Foreign Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Supplemental Assessable Premium Report - Domestic

State Required Filings Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: ID. Domestic/Foreign: Domestic. Link to State Form: http://www.idlifega.org/documents/Domestic%20Life%20Premium%20Form3.pdf. Link to Filing Website: www.doi.idaho.gov. State Authority: Idaho Department of Insurance. Contact Email: martha.hopper@doi.idaho.gov. Contact Phone: 208-334-4315. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. Thursday, April 1, 2010.

Supplemental Data Input

State Required Filings Insurance Type: Health, LAH. Filing Period: Qtr 1. StateAbbrv: WA. Domestic/Foreign: Domestic, Foreign. Link to State Form: https://fortress.wa.gov/oic/hcis/login.aspx. Link to Filing Website: www.insurance.wa.gov. State Authority: Washington State Insurance Commissioner. Contact Email: ASFI@oic.wa.gov. Contact Phone: 360-725-7200 Contact ONCE and wait for a response. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. Thursday, April 1, 2010.

Supplemental Health Insurance Report - PDF

State Required Filings Bulletin 286A Supplemental Health Bulletin. See Note O Filed separately from the annual statement Applies to all companies writing or renewing Health. NULL reports need not be submitted. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: ME. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.maine.gov/pfr/insurance/forms/pdf/SuppHealthPremiumForm.pdf. Link to Filing Website: http://www.maine.gov/insurance/. Link to Supporting Information: http://www.maine.gov/pfr/insurance/bulletins/286a.htm. State Authority: Maine Bureau of Insurance, Financial Analysis Division. Contact Email: Bradford.L.Brown@maine.gov. Contact Phone: 207-624-8478. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Trust Fund Certification

State Required Filings Eligible Alien Surplus Lines Insurers. See supporting information link. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: MN. Link to Filing Website: www.insurance.mn.gov. Link to Supporting Information: Filing requirements: http://www.state.mn.us/mn/externalDocs/Commerce/Alien_Surplus_Lines_111403013006_AlienSurplus.pdf. State Authority: Minnesota Department of Commerce. Contact Email: commerce@state.mn.us. Contact Phone: 651-296-4026. Due by Postmark or Receive Date: Receive. Thursday, April 1, 2010.

Unauthorized Insurers Checklist

State Required Filings Please submit this Checklist with the following: • Unauthorized Insurer Business Written & Premium Tax Report • Schedule T • South Dakota State Page. Insurance Type: Health, LAH, PC. Filing Period: Qtr 1. StateAbbrv: SD. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.state.sd.us/drr2/reg/insurance/companies/Unauthorized%20Insurers%20Checklist.pdf. Link to Filing Website: http://www.state.sd.us/drr2/reg/insurance/index.html. State Authority: South Dakota Division of Insurance. Contact Email: insurance@state.sd.us. Contact Phone: 605-773-3563. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Thursday, April 1, 2010.

WC Schedule (Form C-1)

State Required Filings Insurance Type: PC, Workers Compensation. Filing Period: Qtr 1. StateAbbrv: MA. Domestic/Foreign: Foreign. State Form ID: C-1. Link to State Form: http://www.mass.gov/Eoca/docs/doi/Companies/forms/FormC1.PDF. Link to Filing Website: www.mass.gov. State Authority: Commonwealth of Massachusetts, Office of Consumer Affairs and Business Regulation, Division of Insurance. Contact Email: robert.dibiasio@state.ma.us. Contact Phone: 617-521-7486. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Thursday, April 1, 2010.

Management Discussion and Analysis

State Required Filings See supporting information link. Insurance Type: PC, Surplus Lines. Filing Period: Qtr 1. StateAbbrv: NY. Domestic/Foreign: Foreign. Link to Filing Website: http://www.elany.org/. Link to Supporting Information: Instructions: http://www.elany.org/lexicon-click.aspx?LT=0&H=16&T=373&D=D369. State Authority: Excess Line Association of New York (ELANY). Contact Email: rschlesinger@elany.org. Contact Phone: 646-292-5575. Saturday, April 10, 2010.

Medical Malpractice Closed Claim Report

State Required Filings See supporting information link. Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: OK. Domestic/Foreign: Domestic, Foreign. Link to State Form: http://www.ok.gov/oid/documents/2009%20med%20mal%20closed%20claim%20report.xls. Link to Filing Website: http://www.ok.gov/oid/. Link to Supporting Information: http://www.ok.gov/oid/documents/Bulletin%20PC%202009-01%20Medical%20Malpractice.pdf. State Authority: Oklahoma Insurance Department. Contact Email: greg.lawson@oid.ok.gov. Contact Phone: 405-521-3966. Due by Postmark or Receive Date: Receive. Saturday, April 10, 2010.

Special Call for Medical Malpractice Insurance Data

State Required Filings Insurance Type: PC. Filing Period: Qtr 1. StateAbbrv: IL. Domestic/Foreign: Domestic, Foreign. Link to Filing Website: www.idfpr.com. State Authority: Illinois Department of Financial & Professional Regulation, Division of Insurance. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-524-7494. Due by Postmark or Receive Date: Verify with state. Filing Method: Hard Copy. Monday, April 12, 2010.