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Captive Estimated Tax Vouchers 3 and 4

Premium Tax StateAbbrv: OK. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.ok.gov/oid/documents/CAPTIVE.pdf. State Authority: Oklahoma Insurance Department. Link to Filing Website: http://www.ok.gov/. Contact Email: rachael.nalliah@oid.ok.gov. Contact Phone: 405-521-3966. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Wednesday, September 15, 2010.

Declaration of Estimated License Tax and Estimated Assessment 3rd Qrt

Premium Tax Please make check payable to: TREASURER OF VIRGINIA and send it, along with this form to: WACHOVIA BANK/STATE CORPORATION COMMISSION TAA INSURANCE 2 P. O. BOX 759064 BALTIMORE, MD 21275-9064 DO NOT USE THE ANNUAL "PAYMENT VOUCHER". StateAbbrv: VA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.scc.virginia.gov/division/boi/webpages/inspagedocs/instaxdecqtr32010.pdf. Link to Supporting Information: Instructions: http://www.scc.virginia.gov/division/boi/webpages/boiinstaxformdownload.htm. State Authority: Virginia Bureau of Insurance. Link to Filing Website: http://www.scc.virginia.gov/division/boi/webpages/boiinstaxinsurancecoinfo.htm. Contact Email: Joyce.Jones@scc.virginia.gov. Contact Phone: 804-371-9096. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Electronic. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Estimated Premium Tax - Quarterly

Premium Tax Treasurer to sign Annual Form. Must be typewritten. All items must be mailed U.S. mail, Postal Express, Priority Mail or Certified Mail is also accepted. StateAbbrv: IN. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.in.gov/idoi/files/Quarterly_Estimated_Tax_Return.pdf. State Authority: Indiana Department of Insurance. Link to Filing Website: www.in.gov/idoi. Contact Phone: 317-232-1993. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Estimated Premiums Tax Payment Coupon - Domestic

Premium Tax State Form ID: 207ESA, 207ESB, 207ESC, 207ESD. StateAbbrv: CT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.ct.gov/drs/lib/drs/forms/2010forms/publicserv/form207es.pdf. State Authority: Department of Revenue Services, State of Connecticut. Link to Filing Website: http://www.ct.gov/drs/site/default.asp. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Wednesday, September 15, 2010.

Estimated Premiums Tax Payment Coupon - Foreign and Nonresident

Premium Tax State Form ID: 207FESA, 207FESB, 207FESC, 207FESD. StateAbbrv: CT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.ct.gov/drs/lib/drs/forms/2010forms/publicserv/form207fes.pdf. State Authority: Department of Revenue Services, State of Connecticut. Link to Filing Website: http://www.ct.gov/drs/site/default.asp. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Foreign. Wednesday, September 15, 2010.

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

Premium Tax NY has fire tax due reported by municipality for PC cos. State Form ID: CT-400-MN. StateAbbrv: NY. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.tax.state.ny.us/pdf/current_forms/ct/ct400mn_fill_in.pdf. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct400i_409.pdf Pay electronically: www.nystax.gov. State Authority: New York Department of Taxation and Finance. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

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

Premium Tax See supporting information link. State Form ID: IB-63. StateAbbrv: NC. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.dornc.com/downloads/ib63.pdf. Link to Supporting Information: Instructions: http://www.dor.state.nc.us/downloads/forms_insurance.php?url=ib63.pdf. State Authority: North Carolina Department of Revenue. Link to Filing Website: http://www.dor.state.nc.us. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

HCC Estimated Tax Payment Coupon

Premium Tax Complete in blue or black ink only. State Form ID: 207 HCC ESB. StateAbbrv: CT. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://www.ct.gov/drs/lib/drs/forms/2010forms/publicserv/form207hcces.pdf. State Authority: Department of Revenue Services, State of Connecticut. Link to Filing Website: http://www.ct.gov/drs/site/default.asp. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-5962. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Health Insurers Estimated Tax Vouchers 3 and 4

Premium Tax StateAbbrv: OK. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.ok.gov/oid/documents/FIN_08_Other_HMO.pdf. State Authority: Oklahoma Tax Commission. Link to Filing Website: http://www.ok.gov/oid/. Contact Email: macyrobinson@insurance.state.ok.us. Contact Phone: 405-521-3966. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

HMO and MCO Quarterly Premium Tax Form

Premium Tax See instructions on form. State Form ID: MIA/HMO/MCO/Est/2005. StateAbbrv: MD. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/HMO&MCO2008QuarterlyForm.pdf. Link to Supporting Information: EFT Instructions: http://www.mdinsurance.state.md.us/sa/documents/EFTInstructions-form02-09.pdf. State Authority: Maryland Insurance Administration. Link to Filing Website: http://www.mdinsurance.state.md.us/sa/jsp/insurer/premiumTax/PremiumTaxMain.jsp. Contact Phone: 410-468-4000. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Insurance Estimated Tax - HMO (Form M27)

Premium Tax State Form ID: M27. StateAbbrv: MN. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://www.taxes.state.mn.us/taxes/special/insurance/forms/m27_web.pdf. Link to Supporting Information: Instructions: http://www.taxes.state.mn.us/taxes/special/insurance/instructions/m27_inst.pdf. State Authority: Minnesota Department of Revenue. Link to Filing Website: http://www.taxes.state.mn.us/. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-297-1772. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Insurance Estimated Tax (Form M19)

Premium Tax See supporting information link. State Form ID: M19, On-line. StateAbbrv: MN. Insurance Type: LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.taxes.state.mn.us/taxes/special/insurance/forms/m19_web.pdf. Link to Supporting Information: Instructions: http://www.taxes.state.mn.us/taxes/special/insurance/instructions/insurance_est_inst.pdf. State Authority: Minnesota Department of Revenue. Link to Filing Website: http://www.taxes.state.mn.us/. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-297-1772. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

LAH Estimated Tax Voucher 3 and 4

Premium Tax State Form ID: Voucher 3 & 4. StateAbbrv: OK. Insurance Type: LAH. Filing Period: Qtr 3. Link to State Form: http://www.ok.gov/oid/documents/FIN_08_Dom_LifeHealth.pdf. State Authority: Oklahoma Tax Commission. Link to Filing Website: http://www.ok.gov/oid/. Contact Email: macyrobinson@insurance.state.ok.us. Contact Phone: 405-521-3966. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

PC Estimated Tax Voucher 3 and 4

Premium Tax State Form ID: Voucher 3 & 4. StateAbbrv: OK. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.ok.gov/oid/documents/FIN_08_Dom-PNC.pdf. State Authority: Oklahoma Tax Commission. Link to Filing Website: http://www.ok.gov/oid/. Contact Email: macyrobinson@insurance.state.ok.us. Contact Phone: 405-521-3966. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

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

Premium Tax See supporting information link. State Form ID: OCI 27-013. StateAbbrv: WI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: https://ociaccess.oci.wi.gov/PTaxWebModule/jsp/premtax2.oci. Link to Supporting Information: Instructions: http://oci.wi.gov/ociforms/premtax.htm. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://oci.wi.gov/ociforms.htm. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Privilege and Retaliatory Tax Installment (Form PRT1)

Premium Tax Need Corp Income and Replacement tax paid or Unitary form. IL has Municipal Fire Tax Reporting for PC cos. State Form ID: PRT1. StateAbbrv: IL. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://insurance.illinois.gov/form/tax2009/privrettaxinstallment.pdf. State Authority: Illinois Department of Financial and Professional Regulation. Link to Filing Website: www.idfpr.com. Contact Email: DOI.Director@illinois.gov. Contact Phone: 217-782-4515. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

PT Prepayment Statement

Premium Tax State Form ID: Billed by State. StateAbbrv: OR. Insurance Type: LAH. PC. Filing Period: Qtr 3. State Authority: Oregon Insurance Division. Link to Filing Website: http://www.insurance.oregon.gov. 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. Wednesday, September 15, 2010.

Qtrly Payment Worksheet

Premium Tax Credits less than $1,000 are to be taken in full. StateAbbrv: WA. Insurance Type: LAH. PC. Filing Period: Qtr 3. Link to State Form: https://fortress.wa.gov/oic/onlineservices/Login.aspx?module=TAX. State Authority: Washington State Office of the Insurance Commissioner. Link to Filing Website: https://fortress.wa.gov/. Contact Email: taxes@oic.wa.gov. Contact Phone: 360-725-7032. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Quarterly Estimated Prepayment Installments

Premium Tax Make check payable to: IDAHO DEPARTMENT OF INSURANCE REQUIRED: Separate payments for each company. Signature and title of officer. Payments of $100,000 or more MUST be paid by Electronic Funds Transfer-Automated Clearing House method. To get forms and information to sign up for Electronic Funds payments contact: Kathy.Miller@doi.idaho.gov Indicate if payment is sent by Electronic Fund Transfer (EFT) under line A3. Due to recent budget cuts, the call-in ACH Debit payment option for Idaho State Premium Tax has been eliminated. Please be advised that you will no longer be able use the call-in system to request an automated payment to the Idaho Department of Insurance (tax type 07170). The system will be deactivated as of June 30, 2010 . For payment information contact Kathy Miller or call (208)334-4282. State Form ID: INS-PTX-QP1. StateAbbrv: ID. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.doi.idaho.gov/Company/QP1_3.pdf. Link to Supporting Information: http://www.doi.idaho.gov/Company/Ippt.pdf. State Authority: Idaho Department of Insurance. Link to Filing Website: http://www.doi.idaho.gov/Company/premiumtax.aspx. Contact Email: Kathy.Miller@doi.idaho.gov. Contact Phone: 208-334-4282. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Payment Method: Check, EFT. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

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

Premium Tax State Form ID: SAI-22. StateAbbrv: MT. Insurance Type: Health. LAH. Filing Period: Qtr 3. Link to State Form: http://sao.mt.gov/forms/exams/2010%20Annuals/SAI%2022%20-%202010%20Life%20Company%20Quarterly%20Premium%20Tax%20Prepayment.pdf. State Authority: Montana State Auditor's Office. Link to Filing Website: http://sao.mt.gov/forms/exams/annuals.asp. Contact Email: csi@mt.gov. Contact Phone: 406-444-2040. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

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

Premium Tax State Form ID: SAI-23. StateAbbrv: MT. Insurance Type: Health. PC. Filing Period: Qtr 3. Link to State Form: http://sao.mt.gov/forms/exams/2010%20Annuals/SAI%2023%20-%202010%20PropCasualty%20Company%20Quarterly%20Premium%20Tax%20Prepayment.pdf. State Authority: Montana State Auditor's Office. Link to Filing Website: http://sao.mt.gov/forms/exams/annuals.asp. Contact Email: csi@mt.gov. Contact Phone: 406-444-2040. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Quarterly Premium Tax Prepayment (Form WFT-9)

Premium Tax Notary required. 2 officers to sign. State Form ID: WFT-9. StateAbbrv: DE. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.delawareinsurance.gov/departments/documents/PremiumTax/2009/PDF/WFT-9.pdf. State Authority: Delaware Department of Insurance. Link to Filing Website: http://www.delawareinsurance.gov/departments/documents/PremiumTax/2008/PDF/09WFT-9.pdf. Contact Email: Ann.Fletcher@state.de.us. Contact Phone: 302-674-7300. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Quarterly Premium Tax Return

Premium Tax State Form ID: Qtrlyform. StateAbbrv: NE. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.doi.ne.gov/prem_tax/quarter.pdf. State Authority: Nebraska Department of Insurance. Link to Filing Website: http://www.doi.ne.gov. Contact Email: Martha.Hettenbaugh@nebraska.gov. Contact Phone: 402-471-2201. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Quarterly Tax Form

Premium Tax Notary required on hard copy filings. State Form ID: MIA/P/601. StateAbbrv: MD. Insurance Type: LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/Quarterly2008.pdf. Link to Supporting Information: EFT Instructions: http://www.mdinsurance.state.md.us/sa/documents/EFTInstructions-form02-09.pdf. State Authority: Maryland Insurance Administration. Link to Filing Website: http://www.mdinsurance.state.md.us/sa/jsp/insurer/premiumTax/PremiumTaxMain.jsp. Contact Phone: 410-468-4000. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

RRG Estimated Tax Vouchers 3 and 4

Premium Tax StateAbbrv: OK. Insurance Type: Risk Retention Group. Filing Period: Qtr 3. Link to State Form: http://www.ok.gov/oid/documents/FIN_08_RRG.pdf. State Authority: Oklahoma Tax Commission. Link to Filing Website: http://www.ok.gov/oid/. Contact Email: macyrobinson@insurance.state.ok.us. Contact Phone: 405-521-3966. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

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

Premium Tax See supporting information link. State Form ID: CT-222. StateAbbrv: NY. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.tax.state.ny.us/pdf/2009/corp/ct222_2009.pdf. Link to Supporting Information: Instructions: http://www.tax.state.ny.us/pdf/2009/corp/ct222i_2009.pdf. State Authority: New York Department of Taxation and Finance. Link to Filing Website: http://www.tax.state.ny.us/forms/corp_ins_forms.htm. Contact Phone: 518-485-6027. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Covered Lives Report Form

State Required Filings StateAbbrv: MD. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/MIA-OCACoveredLivesForm-070109.pdf. Link to Supporting Information: Instructions: http://www.mdinsurance.state.md.us/sa/documents/MIA-OCACoveredLivesInstruction-052009.pdf FAQs: http://www.mdinsurance.state.md.us/sa/documents/MIA-OCACoveredLivesFAQ-052009.pdf. State Authority: Maryland Insurance Administration. Link to Filing Website: http://www.mdinsurance.state.md.us/. Contact Email: OCA-Reports@mdinsurance.state.md.us. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Disclosure of Material Transactions (Form FAD26) - Excel

State Required Filings Every 15th of the month, when applicable. All required documents must be submitted online with (OASIS) Online Assistance System for Insurer Submittal. In addition, please submit a paper copy of pages containing original signatures by the reporting deadline to: California Department of Insurance Financial Analysis Division-Financial Records 300 South Spring Street, 13th Floor, South Tower Los Angeles, CA 90013. State Form ID: FAD26. StateAbbrv: CA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/forms/upload/FAD026-ABC_Disclosure_Material_Tranactions.xls. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/annualnotices/disclosure.cfm. State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit. Link to Filing Website: http://www.insurance.ca.gov/. Contact: 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. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Foreign Insurer): 0. Paper Size: Letter size; Orientation: Portrait. Wednesday, September 15, 2010.

Loss Experience Report

State Required Filings State Form ID: ndoi-401. StateAbbrv: NV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://doi.state.nv.us/Form-CF-LossExperRpt(NRS%20680A290).pdf. State Authority: Nevada Division of Insurance. Link to Filing Website: doi.state.nv.us. Contact Email: esummers@doi.state.nv.us. Contact Phone: 775-687-4270 ext 249. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Wednesday, September 15, 2010.

Motor Vehicle Law Enforcement Fee (MVLEF)

State Required Filings Check for amount due should accompany return and be made payable to the Superintendent of Insurance. Returns to be mailed to: Superintendent of Insurance New York State Insurance Department Attn: Taxes & Accounts One Commerce Plaza Albany, New York 12257 Insurers may file and remit fees on-line through the Department’s website. StateAbbrv: NY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.ins.state.ny.us/insurers/property/ta/ta016_052009.pdf. Link to Supporting Information: http://www.ins.state.ny.us./circltr/2009/cl2009_13.htm. State Authority: New York State Insurance Department. Link to Filing Website: http://www.ins.state.ny.us/nyins.htm. Contact Email: billing@ins.state.ny.us. Wednesday, September 15, 2010.

Rate Adjustment and Second Injury Fund Assessment Transmittal Form

State Required Filings Make checks payable to the Illinois State Treasurer. Please return the attached transmittal form with payment to: Fiscal Office Illinois Workers’ Compensation Commission 100 W. Randolph St Ste 8-329 Chicago, IL 60601. StateAbbrv: IL. Insurance Type: PC. Workers Compensation. Filing Period: Qtr 3. Link to State Form: http://www.iwcc.il.gov/RAFSIFFORM.doc. Link to Supporting Information: http://www.iwcc.il.gov/RAF-SIF-Letter.doc. State Authority: Illinois Workers' Compensation Commission. Link to Filing Website: www.iwcc.il.gov/funds.htm. Contact: Robert Kern. Contact Email: robert.kern@illinois.gov. Contact Phone: 312-814-1647. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Wednesday, September 15, 2010.

Schedule of Company Fees Taxes and Deposits

State Required Filings Mailing address for filing fees: Bank Lock Box Indiana Department of Insurance PO Box 636 Indianapolis, IN 46206-0636 All items must be mailed US mail. Postal Express, Priority Mail & Certified Mail is also accepted. StateAbbrv: IN. Insurance Type: Health. HMO. LAH. PC. Risk Retention Group. Filing Period: Qtr 3. Link to State Form: http://www.in.gov/idoi/files/Schedule_of_fees_taxes_deposits.pdf. State Authority: Indiana Department of Insurance. Link to Filing Website: http://www.in.gov/idoi/2369.htm. Contact Phone: 317-232-1993. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Wednesday, September 15, 2010.

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

Premium Tax The monthly return shall be filed and any tax then due shall be paid no later than the twentieth day of the following month. You may file your GRT form by mail at the following address: Department of Revenue and Taxation Taxpayer Services Division P.O. Box 23607 GMF, Guam 96921. StateAbbrv: GU. Filing Period: Monthly. Link to State Form: https://www.guamtax.com/forms/GRT1.pdf. Link to Supporting Information: https://www.guamtax.com/forms/GRTi.pdf. State Authority: Department of Revenue and Taxation. Link to Filing Website: http://www.govguamdocs.com/revtax/index_revtax.htm. Contact Email: grt@revtax.gov.gu. Contact Phone: 671-635-1835/6. Monday, September 20, 2010.

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

Premium Tax Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address:Kentucky Department of Revenue 501 High Street Frankfort, KY 40601. State Form ID: 74A117. StateAbbrv: KY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://revenue.ky.gov/NR/rdonlyres/DD594E1A-9FE8-47D8-9E71-14B86DCAD15D/0/74A117.pdf. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://revenue.ky.gov/forms/curyrfrms.htm. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Monday, September 20, 2010.

Monthly Insurance Surcharge Report (Form 74A118)

Premium Tax Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address:Kentucky Department of Revenue 501 High Street Frankfort, KY 40601. State Form ID: 74A118. StateAbbrv: KY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://revenue.ky.gov/NR/rdonlyres/9A1D4D5E-A11C-42D5-872B-C260AC77891F/0/74A118.pdf. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://revenue.ky.gov/forms/curyrfrms.htm. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Monday, September 20, 2010.

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

Premium Tax State Form ID: GID-FO-PT-2. StateAbbrv: GA. Insurance Type: Risk Retention Group. Filing Period: Qtr 3. 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. State Authority: Departments of Revenue, Insurance and Community Affairs. Link to Filing Website: http://www.gainsurance.org/home.aspx. Contact Email: premiumtax@oci.ga.gov. Contact Phone: 404-656.7553. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Monday, September 20, 2010.

Quarterly Premium Tax Return (Form GID-12A)

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. State Form ID: GID-012A-PT. StateAbbrv: GA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.gainsurance.org/ExternalResources/Forms/GID%20Forms/GID-012A-07.pdf. Link to Supporting Information: Reminder: http://www.gainsurance.org/PremiumTax/Reminder-LicensedCompanies.aspx. State Authority: Departments of Revenue, Insurance and Community Affairs. Link to Filing Website: http://www.gainsurance.org/home.aspx. 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. Domestic/Foreign: Domestic. Foreign. Paper Size: Letter. Paper Color: White. Monday, September 20, 2010.

Live Session Health, LAH and P&C 2010 NAIC Annual Updates

EagleTM Events This session highlights the proposed NAIC updates to the 2010 Annual Statement Filing. We’ll present revisions to the 2010 Annual Statement that have been adopted by the NAIC, including those adopted at the 2010 Summer Meeting. ETM Product: Wings. EagleTM Event Type: IBE Session. Pricing: Contact an EagleTM sales representative at sales@byetm.com for available discounts. Presenter: Randy. Contact ETM by phone: 800-975-3245. Contact ETM by e-mail: support@byetm.com. Friday, September 24, 2010, 10:00 AM – 11:00 AM.

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

Premium Tax State Form ID: INS-2. StateAbbrv: ME. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.maine.gov/revenue/forms/insurance/2010/10_INS-2.pdf. State Authority: Maine Department of Administrative and Financial Services. Link to Filing Website: http://www.maine.gov/revenue/forms/insurance/2009.htm. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Thursday, September 30, 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. StateAbbrv: NE. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.doi.ne.gov/surplus_lines/DOI_SL_QUARTERLY.xls. State Authority: Nebraska Department of Insurance. Link to Filing Website: www.doi.ne.gov. Contact Email: Jim.Nixon@nebraska.gov. Contact Phone: 402-471-2201. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Thursday, September 30, 2010.

Earthquake Probable Maximum Loss Questionnaire - Form A

State Required Filings For companies that have data to report on Form A or Form B, we ask that you download the Excel files of the forms from our website. If you have any problems downloading the files, call the Rate Specialist Bureau Staff at 213-346-6731. Fill out the form using the downloaded file and the Signature Page and email them to: RSBeqpml@insurance.ca.gov. We are no longer requiring companies to print out the reporting forms. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009FormA.xls. Link to Supporting Information: Cover Letter: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009CoverLetter.pdf Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009Instructions.pdf EQ Zip Code List: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/Zip2008Feb09EqkZonesforRpt.xls. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.insurance.ca.gov/. Contact: Rate Specialist Bureau. Contact Email: rsb@insurance.ca.gov. Contact Phone: 213-346-6556. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Paper Size: 8 ½”x14”. Thursday, September 30, 2010.

Earthquake Probable Maximum Loss Questionnaire - Form B

State Required Filings For companies that have data to report on Form A or Form B, we ask that you download the Excel files of the forms from our website. If you have any problems downloading the files, call the Rate Specialist Bureau Staff at 213-346-6731. Fill out the form using the downloaded file and the Signature Page and email them to: RSBeqpml@insurance.ca.gov. We are no longer requiring companies to print out the reporting forms. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009FormB.xls. Link to Supporting Information: Cover Letter: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009CoverLetter.pdf Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009Instructions.pdf EQ Zip Code List: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/Zip2008Feb09EqkZonesforRpt.xls. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.insurance.ca.gov/. Contact: Rate Specialist Bureau. Contact Email: rsb@insurance.ca.gov. Contact Phone: 213-346-6556. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Paper Size: 8 ��x14�. Thursday, September 30, 2010.

Earthquake Probable Maximum Loss Questionnaire - Form X

State Required Filings This special form is for reporting by the primary (ceding) insurers to the assuming reinsurers and should be sent by the ceding insurer to each assuming reinsurer. Do not send to the California Department of Insurance. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/EQPMLFormX2009.pdf. Link to Supporting Information: Cover Letter: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009CoverLetter.pdf Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009Instructions.pdf EQ Zip Code List: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/Zip2008Feb09EqkZonesforRpt.xls. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.insurance.ca.gov/. Contact: Rate Specialist Bureau. Contact Email: rsb@insurance.ca.gov. Contact Phone: 213-346-6556. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Paper Size: 8 ��x14�. Thursday, September 30, 2010.

Earthquake Probable Maximum Loss Questionnaire - Signature Page

State Required Filings Companies which had no Earthquake Insurance in force under any form on December 31, 2009, may satisfy the reporting requirement by so indicating at our Signature Page. You can save/scan the completed Signature Page to a PDF file and email it to: RSBeqpml@insurance.ca.gov. If you are unable to scan the Signature Page back to a PDF file, you can mail it to: California Department of Insurance Rate Specialist Bureau 300 South Spring Street, 14th Floor Los Angeles, CA 90013. StateAbbrv: CA. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/EQ2009SignaturePage.pdf. Link to Supporting Information: Cover Letter: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009CoverLetter.pdf Instructions: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/PML2009Instructions.pdf EQ Zip Code List: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/rsb-forms/2009/upload/Zip2008Feb09EqkZonesforRpt.xls. State Authority: California Department of Insurance, Rate Specialist Bureau. Link to Filing Website: http://www.insurance.ca.gov/. Contact: Rate Specialist Bureau. Contact Email: rsb@insurance.ca.gov. Contact Phone: 213-346-6556. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Paper Size: 8 ½”x14”. Thursday, September 30, 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. State Form ID: SFN 17118. StateAbbrv: ND. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.nd.gov/eforms/Doc/sfn17118.pdf. State Authority: North Dakota Insurance Department. Link to Filing Website: www.nd.gov. Contact Email: insurance@nd.gov. Contact Phone: 701-328-3328. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Thursday, September 30, 2010.

Medical Malpractice Claim Reporting Form and Statutes

State Required Filings Mail reports to: Division of Insurance 445 E Capitol Pierre, South Dakota 57501. StateAbbrv: SD. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.state.sd.us/drr2/forms/Insurance/nonE1884V1-MedicalMalpracticeClaimReportingForm.pdf. State Authority: South Dakota Division of Insurance. Link to Filing Website: www.state.sd.us. Contact Email: insurance@state.sd.us. Contact Phone: 605-773-3563. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Thursday, September 30, 2010.

Premium Growth Report (Form OIR-A1-1229)

State Required Filings State Form ID: OIR-A1-1229. StateAbbrv: FL. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.floir.com/pdf/OIR-A1-1229.pdf. Link to Supporting Information: http://www.floir.com/pdf/NotesInstructionsA-KPC.pdf. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.floir.com/pdf/NotesInstructionsA-KPC.pdf. Contact Email: Helen.Westberry@floir.com. Contact Phone: 850-413-5212. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): REFS. Thursday, September 30, 2010.

Service Area Update - HMO

State Required Filings StateAbbrv: WI. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://oci.wi.gov/ociforms/22-060.pdf. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://oci.wi.gov/. Contact: Yvonne Sherry. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 2. Thursday, September 30, 2010.

Market Conduct Annual Statement

NAIC Filings Companies update contact information with NAIC; states update contact and submission information with NAIC. Insurance Type: Health. LAH. PC. Filing Period: Qtr 1. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to Filing Website: http://www.naic.org/. Friday, October 1, 2010.

Estimated Insurance Premiums Tax (Form 74A110)

Premium Tax KY has qtrly municipal tax. State Form ID: 74A110. StateAbbrv: KY. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://revenue.ky.gov/NR/rdonlyres/3F8FDB01-C710-4ED4-9AFD-D884A05FA20A/0/74A1101209.pdf. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://revenue.ky.gov/forms/curyrfrms.htm. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Friday, October 1, 2010.

Assessment for the Fund for Insurance Administration and Enforcement

State Required Filings Contact Lin Riippi if you have not received an invoice by 2/15. StateAbbrv: NV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to Supporting Information: Assessment schedule: http://doi.state.nv.us/checklist/AssessmentlFeeChart_7-7-09.pdf Fee chart: http://doi.state.nv.us/checklist/RenewalFeeChart_09PD_1-20.pdf. State Authority: Nevada Division of Insurance. Link to Filing Website: http://doi.state.nv.us/. Contact Email: lriippi@doi.state.nv.us. Contact Phone: 775-687-4270. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Friday, October 1, 2010.

Designation of CPA and Accountant’s Appointment Letter

State Required Filings StateAbbrv: NC. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. State Authority: North Carolina Department of Insurance, Financial Evaluation Division, Financial Examination Section. Link to Filing Website: www.ncdoi.com. Contact Email: steve.johnson@ncdoi.gov. Contact Phone: 919-807-6614. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. Friday, October 1, 2010.

Estimated Quarterly Premium Tax Report (Form 306)

Premium Tax State Form ID: 306. StateAbbrv: NM. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.nmprc.state.nm.us/insurance/financialaudit/pdf/QuarterlyForm306.pdf. Link to Supporting Information: Instructions: http://www.nmprc.state.nm.us/insurance/financialaudit/pdf/PremiumTaxInstructions.pdf. State Authority: New Mexico Public Regulation Commission. Link to Filing Website: http://www.nmprc.state.nm.us/cls.htm. Contact Phone: 505-827-4433. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Friday, October 15, 2010.

Installment Payment - HMO (Form IB-66)

Premium Tax State Form ID: IB-66. StateAbbrv: NC. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.dor.state.nc.us/downloads/ib66.pdf. Link to Supporting Information: Instructions: http://www.dor.state.nc.us/downloads/forms_insurance.php?url=ib66.pdf. State Authority: North Carolina Department of Revenue. Link to Filing Website: http://www.dor.state.nc.us. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Friday, October 15, 2010.

Installment Payment - LAH (Form IB-16)

Premium Tax State Form ID: IB-16. StateAbbrv: NC. Insurance Type: LAH. Filing Period: Qtr 3. Link to State Form: http://www.dor.state.nc.us/downloads/ib16.pdf. State Authority: North Carolina Department of Revenue. Link to Filing Website: http://www.dor.state.nc.us. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Friday, October 15, 2010.

Installment Payment - PC (Form IB-36)

Premium Tax State Form ID: IB-36. StateAbbrv: NC. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.dor.state.nc.us/downloads/ib36.pdf. State Authority: North Carolina Department of Revenue. Link to Filing Website: http://www.dor.state.nc.us. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Friday, October 15, 2010.

MBT Quarterly Return (Form 4548)

Premium Tax See supporting information link. State Form ID: 4548. StateAbbrv: MI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.michigan.gov/documents/taxes/4548_305502_7.pdf. Link to Supporting Information: Instructions: http://www.michigan.gov/documents/taxes/4548_Instr_305503_7.pdf. State Authority: Michigan Department of Treasury. Link to Filing Website: http://www.michigan.gov/taxes/. Contact Phone: 517-636-4657. Paper Size: Legal. Friday, October 15, 2010.

Premium Installment Payment and Instructions (Form DR-907)

Premium Tax FL has municipal tax/fees. PC cos need specific premium breakout for PT return filing, Sch XVII and XVIII from MuniTax/Positax. State Form ID: DR-907. StateAbbrv: FL. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://dor.myflorida.com/dor/forms/2010/dr907.pdf. State Authority: Florida Department of Revenue. Link to Filing Website: http://dor.myflorida.com/dor/forms/download/!insurance.html. Contact Phone: 860-352-3671. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Friday, October 15, 2010.

PT Prepayment

Premium Tax State Form ID: Billed By State. StateAbbrv: OH. Insurance Type: LAH. PC. Filing Period: Qtr 3. State Authority: Ohio Department of Insurance. Link to Filing Website: http://www.ohioinsurance.gov/. Contact Email: taxes@ins.state.oh.us. Contact Phone: 614-752-8483. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Friday, October 15, 2010.

Quarterly Tax Statement (Form 1071)

Premium Tax Notary required on annual form. Form 1061 and 1076 premium total must equal. LA has municipal tax/fees collected by LAMATS except for few municipalities. StateAbbrv: LA. Insurance Type: LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.ldi.la.gov/Documents/FinancialSolvency/Surplus_Lines/Form1071.pdf. State Authority: Louisiana Department of Insurance. Link to Filing Website: http://www.ldi.state.la.us/FinancialSolvency/Surplus_Lines/admitted.htm. Contact Email: taxdivision@ldi.state.la.us. Contact Phone: 225-342-5825. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Friday, October 15, 2010.

WC Multiple Injury Trust Fund

Premium Tax State Form ID: WC-10. StateAbbrv: OK. Insurance Type: PC. Workers Compensation. Filing Period: Qtr 3. Link to State Form: http://www.tax.ok.gov/wcforms/WC-10-10.pdf. State Authority: Oklahoma Tax Commission. Link to Filing Website: http://www.tax.ok.gov/oktax/. Contact Email: macyrobinson@insurance.state.ok.us. Contact Phone: 405-521-3966. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Friday, October 15, 2010.

Disclosure of Material Transactions (Form FAD26) - Excel

State Required Filings Every 15th of the month, when applicable. All required documents must be submitted online with (OASIS) Online Assistance System for Insurer Submittal. In addition, please submit a paper copy of pages containing original signatures by the reporting deadline to: California Department of Insurance Financial Analysis Division-Financial Records 300 South Spring Street, 13th Floor, South Tower Los Angeles, CA 90013. State Form ID: FAD26. StateAbbrv: CA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/forms/upload/FAD026-ABC_Disclosure_Material_Tranactions.xls. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/annualnotices/disclosure.cfm. State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit. Link to Filing Website: http://www.insurance.ca.gov/. Contact: 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. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Foreign Insurer): 0. Paper Size: Letter size; Orientation: Portrait. Friday, October 15, 2010.

Fire Insurance Fee Form

State Required Filings Check should accompany the return, payable to the Superintendent of Insurance of the State of New York. Completed return and remittance should be forwarded to: New York State Insurance Department One Commerce Plaza Albany, New York 12257. StateAbbrv: NY. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.ins.state.ny.us/insurers/property/ta/ta028.pdf. Link to Supporting Information: http://www.ins.state.ny.us./circltr/1982/cl1982_19.htm. State Authority: New York Insurance Department. Link to Filing Website: http://www.ins.state.ny.us/nyins.htm. Friday, October 15, 2010.

Motor Vehicle Law Enforcement Fee (MVLEF)

State Required Filings Check for amount due should accompany return and be made payable to the Superintendent of Insurance. Returns to be mailed to: Superintendent of Insurance New York State Insurance Department Attn: Taxes & Accounts One Commerce Plaza Albany, New York 12257 Insurers may file and remit fees on-line through the Department’s website. StateAbbrv: NY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.ins.state.ny.us/insurers/property/ta/ta016_052009.pdf. Link to Supporting Information: http://www.ins.state.ny.us./circltr/2009/cl2009_13.htm. State Authority: New York State Insurance Department. Link to Filing Website: http://www.ins.state.ny.us/nyins.htm. Contact Email: billing@ins.state.ny.us. Friday, October 15, 2010.

Quarterly Expenditure Report

State Required Filings StateAbbrv: MT. Insurance Type: Workers Compensation. Filing Period: Qtr 1. Link to State Form: http://erd.dli.mt.gov/wcregs/wcrdocs/qer2005.pdf. Link to Supporting Information: http://erd.dli.mt.gov/wcregs/wcrdocs/qerinst2005.pdf. State Authority: Department of Labor & Industry, Workers’ Compensation Regulation Bureau. Link to Filing Website: http://erd.dli.mt.gov. Contact Email: WCRegBureauQER@mt.gov. Contact Phone: 406-444-0051. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Hard Copy. Friday, October 15, 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). StateAbbrv: MD. Insurance Type: Health. LAH. Filing Period: Qtr 3. Link to State Form: http://www.mdinsurance.state.md.us/sa/documents/ReportingForm15-10A-06-rev06.pdf. 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. Link to Filing Website: www.mdinsurance.state.md.us. Contact Email: lbutler@mdinsurance.state.md.us. Contact Phone: 410-468-2271. Due by Postmark or Receive Date: Postmark. Friday, October 15, 2010.

State Filing Fees

State Required Filings StateAbbrv: FL. Insurance Type: PC. Filing Period: Qtr 3. Link to Supporting Information: http://www.myflorida.com/dor/forms/. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: www.floir.com. Contact Email: Steve.Szypula@floir.com. Contact Phone: 850-413-3825. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): 1. Friday, October 15, 2010.

Insurance Premium Tax Return - First Second Third or Fourth Period (Form 66-066)

Premium Tax See supporting information link. State Form ID: 66-066-03-1. StateAbbrv: MS. Insurance Type: LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.mstc.state.ms.us/taxareas/misc/iptforms/6606607.pdf. Link to Supporting Information: Instructions: http://www.mstc.state.ms.us/taxareas/misc/iptforms/InsurancePremiumInstructions.pdf. State Authority: Mississippi State Tax Commission. Link to Filing Website: http://www.mstc.state.ms.us. Contact Email: kgaston@mstc.state.ms.us. Contact Phone: 601-923-7183. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Wednesday, October 20, 2010.

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

Premium Tax The monthly return shall be filed and any tax then due shall be paid no later than the twentieth day of the following month. You may file your GRT form by mail at the following address: Department of Revenue and Taxation Taxpayer Services Division P.O. Box 23607 GMF, Guam 96921. StateAbbrv: GU. Filing Period: Monthly. Link to State Form: https://www.guamtax.com/forms/GRT1.pdf. Link to Supporting Information: https://www.guamtax.com/forms/GRTi.pdf. State Authority: Department of Revenue and Taxation. Link to Filing Website: http://www.govguamdocs.com/revtax/index_revtax.htm. Contact Email: grt@revtax.gov.gu. Contact Phone: 671-635-1835/6. Wednesday, October 20, 2010.

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

Premium Tax Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address:Kentucky Department of Revenue 501 High Street Frankfort, KY 40601. State Form ID: 74A117. StateAbbrv: KY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://revenue.ky.gov/NR/rdonlyres/DD594E1A-9FE8-47D8-9E71-14B86DCAD15D/0/74A117.pdf. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://revenue.ky.gov/forms/curyrfrms.htm. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Wednesday, October 20, 2010.

Monthly Insurance Surcharge Report (Form 74A118)

Premium Tax Make check payable to Kentucky State Treasurer and mail return with payment to: Kentucky Department of Revenue P.O. Box 1303 Frankfort, KY 40602-1303 Overnight Address:Kentucky Department of Revenue 501 High Street Frankfort, KY 40601. State Form ID: 74A118. StateAbbrv: KY. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://revenue.ky.gov/NR/rdonlyres/9A1D4D5E-A11C-42D5-872B-C260AC77891F/0/74A118.pdf. State Authority: Commonwealth of Kentucky, Department of Revenue. Link to Filing Website: http://revenue.ky.gov/forms/curyrfrms.htm. Contact Phone: 502-564-4810. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Wednesday, October 20, 2010.

Quarterly Tax Payment Form

Premium Tax Mail the Tax Payment Form (Form LEB 4), printed as a full page and not reduced, and check made payable to WV Offices of the Insurance Commissioner to: West Virginia Insurance Commissioner STO/RPD P. O. Box 1913 Charleston, WV 25327 Online Payment (OPTins): https://eapps.naic.org/optins-static/implementation.html ACH Payment: https://epay.wvsto.com/inscommtax/broker.aspx. State Form ID: LEB 4. StateAbbrv: WV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.wvinsurance.gov/LinkClick.aspx?fileticket=pnVf7EKrD3Q%3d&tabid=320&mid=867. Link to Supporting Information: http://www.wvinsurance.gov/LinkClick.aspx?fileticket=SpKFAx1h7to%3d&tabid=320&mid=867. State Authority: West Virginia Insurance Commissioner. Link to Filing Website: http://www.wvinsurance.gov/. Contact Email: wvtaxsection@wvinsurance.gov. Contact Phone: 304-558-2100. Filing Method: Hard Copy. Electronic. Payment Method: Check, OPTins or ACH payment through the West Virginia State Treasurer’s Office. Domestic/Foreign: Domestic. Foreign. Monday, October 25, 2010.

Tax Payment Form

Premium Tax WV has municipal tax/fees. State Form ID: On-line. StateAbbrv: WV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: https://epay.wvsto.com/inscommtax/Login.aspx. State Authority: West Virginia Offices of the Insurance Commissioner. Link to Filing Website: http://www.wvinsurance.gov. Contact Email: financial.conditions@wvinsurance.gov. Contact Phone: 304-558-2100. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Monday, October 25, 2010.

State Filing Fees

State Required Filings $100 Fee. StateAbbrv: WV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. State Authority: West Virginia Insurance Commissioner. Link to Filing Website: http://www.wvinsurance.gov/. Contact: Darlene Parsons. Contact Email: darlene.parsons@wvinsurance.gov. Contact Phone: 304-558-2100. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Monday, October 25, 2010.

KWCFC Quarterly Premiums Report - WC

Premium Tax Make check payable to and mail report and check to: Kentucky Workers’ Compensation Funding Commission #42 Millcreek Park P.O. Box 1128 Frankfort, Kentucky 40602-1128. StateAbbrv: KY. Insurance Type: PC. Workers Compensation. Filing Period: Qtr 3. Link to State Form: http://www.kwcfc.ky.gov/NR/rdonlyres/831CEEE4-4C4A-4E6A-8558-4FB94D502C64/0/Ins_Co_QPR.pdf. State Authority: Kentucky Workers’ Compensation Funding Commission. Link to Filing Website: www.kwcfc.ky.gov. Contact Email: renee.campbell@ky.gov. Contact Phone: 502-573-3505 ext. 235. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Saturday, October 30, 2010.

KWCFC Quarterly Premiums Report - WC

Premium Tax Insurance Type: PC. Filing Period: Qtr 3. StateAbbrv: KY. Domestic/Foreign: Domestic. State Form ID: KWCFC – A009. Link to Filing Website: http://www.kwcfc.ky.gov. State Authority: Renee Campbell. Contact Email: Renee.Campbell@ky.gov. Contact Phone: (502) 573-3505 ext. 235. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Payment Method: Check. Saturday, October 30, 2010.

Administrative Fund Quarterly Tax Report (Form 201 B)

Premium Tax Arizona Department of Insurance ATTN: Tax Unit Financial Affairs Division 2910 North 44th Street, Suite 210 Phoenix, Arizona 85018-7269 You may electronically file and pay taxes and fees via the NAIC OPTins System. StateAbbrv: AZ. Insurance Type: PC. Workers Compensation. Filing Period: Qtr 3. Link to State Form: http://www.ica.state.az.us/Administrative%20Support/Tax_Form_Files/InsCarrierQuarterly/forms/2010_InsCarrier_AF_Qtly_Form.pdf. State Authority: Arizona Department of Insurance, Tax Unit. Link to Filing Website: http://www.id.state.az.us/index.html. Contact Email: TWalton@azinsurance.gov. Contact Phone: 602-364-2713. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Electronic. Sunday, October 31, 2010.

Assessment Tax Credit

Premium Tax Pursuant to Indiana Code 27-8-10-2.3(a) effective July 1, 2004, a member shall, not later than October 31 of each year, certify an independently audited report to the (a) Association (b) Legislative Council, and (c) Department of Insurance of the amount of tax credits taken against assessments by the member under section 2.4. Pursuant to section 2.3(b), the member must also certify an independently audited report to the association the amount of assessments paid by the member against which a tax credit has not been taken under section 2.4 of this chapter as of the date of the report. This information should be submitted to the Indiana Comprehensive Health Insurance Association (ICHIA) for compilation of the report to the Legislative Council and the Department of Insurance. StateAbbrv: IN. Insurance Type: Health. HMO. PC. Reinsurance. Filing Period: Qtr 3. Link to State Form: www.in.gov/idoi. State Authority: Indiana Department of Insurance. Link to Filing Website: http://www.in.gov/idoi/files/TaxCreditFormAssessment10-25-07.pdf. Contact Phone: 317-232-1993. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

CoverColorado Premium Tax Credit

Premium Tax Insurers shall make the contribution to CoverColorado prior to October 31st and may take the credit with the quarterly tax returns beginning with the one due each October 31st and subsequent quarterly or annual returns. Insurers are permitted to carry over any excess credit to other tax returns. See Notice of Intent to Contribute to CoverColorado due July 31st. StateAbbrv: CO. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to Supporting Information: http://www.dora.state.co.us/insurance/regs/B-2.6.pdf. State Authority: Colorado Division of Insurance, Corporate Affairs. Link to Filing Website: http://www.dora.state.co.us/insurance/index.htm. Sunday, October 31, 2010.

Insurance Premium Tax Quarterly Prepayment (Form TC-670)

Premium Tax State Form ID: TC-670. StateAbbrv: UT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.tax.utah.gov/forms/current/tc-670.pdf. State Authority: Utah State Tax Commission. Link to Filing Website: http://www.tax.utah.gov/forms/current.html. Contact Email: taxmaster@utah.gov. Contact Phone: 801-297-3525. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

Premium Tax Statement - Quarterly (Form 323)

Premium Tax All authorized insurers must file four quarterly Premium Tax Statements and payments if applicable regardless of tax liability. The statement and payment shall be due on or before the last day of the calendar month following the end of the quarter. StateAbbrv: HI. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://hawaii.gov/dcca/ins/insurers/annual-filing-instructions-and-tax-forms/Form_323-2010.pdf. State Authority: Department of Commerce and Consumer Affairs. Link to Filing Website: http://hawaii.gov/dcca/areas/ins. Contact Email: shansen@dcca.hawaii.gov. Contact Phone: 808-586-7381. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

Premium Taxes Homepage

Premium Tax StateAbbrv: CO. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.dora.state.co.us/insurance/annual/prem.htm. Link to Supporting Information: http://www.dora.state.co.us/insurance/annual/premc2.pdf. State Authority: Colorado Division of Insurance. Link to Filing Website: http://www.dora.state.co.us/insurance/index.htm. Contact Email: copremiumtax@dora.state.co.us. Due by Postmark or Receive Date: Receive Date. Filing Method: Electronic. Sunday, October 31, 2010.

Quarterly Industrial Insurance Return

Premium Tax State Form ID: IIP. StateAbbrv: NV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.tax.state.nv.us/documents/Qtr%20Industrial%20Ins%20Return.pdf. Link to Supporting Information: FAQs: http://www.doi.state.nv.us/checklist/FAQ's_Annual_09.pdf. State Authority: Nevada Department of Taxation. Link to Filing Website: http://www.tax.state.nv.us/forms.htm. Contact Email: alonnegren@tax.state.nv.us. Contact Phone: 775-684-2128. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

Quarterly Insurance Return

Premium Tax State Form ID: IPT. StateAbbrv: NV. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.tax.state.nv.us/documents/Qtr%20Ins%20Return%20with%20risk%20retention%20%20(fill-in).pdf. Link to Supporting Information: FAQs: http://www.doi.state.nv.us/checklist/FAQ's_Annual_09.pdf. State Authority: Nevada Department of Taxation. Link to Filing Website: http://www.tax.state.nv.us/forms.htm. Contact Email: alonnegren@tax.state.nv.us. Contact Phone: 775-684-2128. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

Quarterly Premium Tax Return

Premium Tax Qtrly form must be filed if zero. Filing all 3 quarters with the April 20th return is permitted. If filing all 3 quarters please fill out EACH quarter with the correct amount. StateAbbrv: WY. Insurance Type: LAH. PC. Filing Period: Qtr 3. Link to State Form: http://insurance.state.wy.us/COMPANY/Word60/Ptq10.doc. State Authority: Wyoming Insurance Department. Link to Filing Website: http://insurance.state.wy.us/company5.html. Contact Email: mearns@state.wy.us. Contact Phone: 307-777-6884. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

Quarterly Premium Tax Voucher

Premium Tax Mail checks, payable to SD Division of Insurance, along with the below voucher for quarterly tax payments to: South Dakota Remittance Center PO Box 5055 Sioux Falls, SD 57117-5055 South Dakota Remittance Center 300 S. Sycamore Ave STE #102 Sioux Falls, SD 57110. StateAbbrv: SD. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.state.sd.us/drr2/reg/insurance/companies/documents/quarterlytaxvoucher10_000.doc. State Authority: South Dakota Division of Insurance. Link to Filing Website: http://www.state.sd.us/. Contact Email: luann.johnson@state.sd.us. Contact Phone: 605-773-3563. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Payment Method: Check. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

Quarterly Report of Premiums and Tax - RRG

Premium Tax State Form ID: RRG-03. StateAbbrv: NC. Insurance Type: Risk Retention Group. Filing Period: Qtr 3. Link to State Form: http://www.ncdoi.com/FED/SE/Documents/RRG/RRG03_2010QtrlyPremiumTaxReturn.pdf. State Authority: North Carolina Department of Revenue. Link to Filing Website: http://www.dor.state.nc.us. Contact Email: chris.long@dornc.com. Contact Phone: 877-308-9103. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

Self Insurance Premium Tax Quarterly Prepayment (Form TC-420B)

Premium Tax See instructions attached to TC-420. State Form ID: TC-420B. StateAbbrv: UT. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to Supporting Information: Instructions: http://www.tax.utah.gov/forms/current/tc-420.pdf. State Authority: Utah State Tax Commission. Link to Filing Website: http://www.tax.utah.gov/forms/current.html. Contact Email: taxmaster@utah.gov. Contact Phone: 801-297-3525. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Sunday, October 31, 2010.

Special Fund Quarterly Tax Report (Form 201 A)

Premium Tax Industrial Commission of Arizona Attention: Tax Accountant 800 West Washington Street, Suite 301 Phoenix, Arizona 85007. StateAbbrv: AZ. Insurance Type: PC. Workers Compensation. Filing Period: Qtr 3. Link to State Form: http://www.ica.state.az.us/Administrative%20Support/Tax_Form_Files/InsCarrierQuarterly/forms/2010_InsCarrier_SF_Qtly_Form.pdf. Link to Supporting Information: http://www.ica.state.az.us/Administrative%20Support/Tax_Form_Files/InsCarrierQuarterly/forms/2010_InsCarrier_AF_Qtly_Information.pdf. State Authority: Industrial Commission of Arizona. Link to Filing Website: http://www.id.state.az.us/index.html. Contact Email: taxes@ica.state.az.us. Contact Phone: 602-542-1836. Sunday, October 31, 2010.

Premium Growth Report (Form OIR-A1-1229)

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

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

Premium Tax State Form ID: INS-2. StateAbbrv: ME. Insurance Type: PC. Filing Period: Monthly. Link to State Form: http://www.maine.gov/revenue/forms/insurance/2010/10_INS-2.pdf. State Authority: Maine Department of Administrative and Financial Services. Link to Filing Website: http://www.maine.gov/revenue/forms/insurance/2009.htm. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Monday, November 1, 2010.

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

Premium Tax State Form ID: INS-1. StateAbbrv: ME. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.maine.gov/revenue/forms/insurance/2010/10_INS-1.pdf. State Authority: Maine Department of Administrative and Financial Services. Link to Filing Website: http://www.maine.gov/revenue/forms/insurance/2009.htm. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Monday, November 1, 2010.

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

Premium Tax State Form ID: INS-6. StateAbbrv: ME. Insurance Type: PC. Surplus Lines. Filing Period: Qtr 3. Link to State Form: http://www.maine.gov/revenue/forms/insurance/2010/10_INS-6.pdf. State Authority: Maine Department of Administrative and Financial Services. Link to Filing Website: http://www.maine.gov/revenue/forms/insurance/2009.htm. Contact Phone: 207-624-9753. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Monday, November 1, 2010.

Unaffiliated Credit Life and Disability Reinsurer Annual Statement Worksheet (Form E-UCLDR.AS)

State Required Filings Your annual statement is due August 1 if your fiscal year end is December 31st, or November 1 if your fiscal year ends on any other date. State Form ID: E-UCLDR.AS. StateAbbrv: AZ. Insurance Type: Reinsurance. Filing Period: Qtr 3. Link to State Form: http://www.id.state.az.us/forms/corp_forms/E-UCLDR.AS.pdf. Link to Supporting Information: http://www.id.state.az.us/forms/corp_forms/E-UCLDR.I.pdf. State Authority: Arizona Department of Insurance, Financial Affairs Division - Compliance Section. Link to Filing Website: http://www.id.state.az.us. Contact: Compliance Section. Contact Email: AMccormack@azinsurance.gov. Contact Phone: 602-364-3245. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Monday, November 1, 2010.

Unaffiliated Credit Life and Disability Reinsurer Certification (Form E-UCLDRCERT)

State Required Filings Your annual statement is due August 1 if your fiscal year end is December 31st, or November 1 if your fiscal year ends on any other date. You must complete form E-UCLDR.CERT including the affidavit on page 2 and file it with your Annual Statement. Your President and Secretary must sign the affidavit. If they cannot sign, you must attach a certified Corporate Resolution of Authorization for signers other than your President and Secretary. Attach completed E-UCLDR.CERT to Form E-UCLDR.AS. State Form ID: E-UCLDR.CERT. StateAbbrv: AZ. Insurance Type: Reinsurance. Filing Period: Qtr 3. Link to State Form: http://www.id.state.az.us/forms/corp_forms/E-UCLDRCert.pdf. Link to Supporting Information: http://www.id.state.az.us/forms/corp_forms/E-UCLDR.I.pdf. State Authority: Arizona Department of Insurance, Financial Affairs Division - Compliance Section. Link to Filing Website: http://www.id.state.az.us. Contact: Compliance Section. Contact Phone: 602-364-3245. Monday, November 1, 2010.

Quarterly Net Solvency Report

State Required Filings StateAbbrv: HI. Insurance Type: Health. Filing Period: Qtr 3. State Authority: Hawaii Department of Commerce and Consumer Affairs - Insurance Division. Link to Filing Website: www.hawaii.gov. Contact Email: dcheung@dcca.hawaii.gov. Contact Phone: 808-587-6735. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): N/A. Sunday, November 14, 2010.

Medicare Part D Coverage Supplement

NAIC Filings Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. 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 Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Monday, November 15, 2010.

Qtrly Statement Filing as of September 30th

NAIC Filings Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Due by Postmark or Receive Date: Receive Date. Filing Type: Statement. Filing Method: Electronic. NAIC Contacts: https://www.naic.org/index_contact.htm. Link to Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Monday, November 15, 2010.

Supplement A to Schedule T (Medical Malpractice Supplement) Qtr Ending September 30th

NAIC Filings If applicable. Insurance Type: PC. Filing Period: Qtr 3. 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 Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Monday, November 15, 2010.

Trusteed Surplus Statement Qtr Ending September 30th

NAIC Filings If applicable. Insurance Type: LAH. PC. Filing Period: Qtr 3. 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 Filing Website: http://www.naic.org/industry_filing_participation_deadlines.htm. Monday, November 15, 2010.

Domestic HMO 3rd Qtr

Premium Tax See supporting information link. State Form ID: PA-G. StateAbbrv: AL. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.aldoi.gov/PDF/Companies/DomesticHMO3rdQtr.pdf. Link to Supporting Information: Instructions: http://www.aldoi.gov/PDF/Companies/DomesticHMOInstruct.pdf. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.aldoi.gov/. Contact Email: ann.strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Monday, November 15, 2010.

Domestic LAH 3rd Qtr

Premium Tax Notary required. Alabama has Municipal tax/fees. See supporting information link. State Form ID: PA-B. StateAbbrv: AL. Insurance Type: LAH. Filing Period: Qtr 3. Link to State Form: http://www.aldoi.gov/PDF/Companies/DomesticLife3rdQtr.pdf. Link to Supporting Information: Instructions: http://www.aldoi.gov/PDF/Companies/domesticLifeInstruct.pdf. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.aldoi.gov/. Contact Email: ann.strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Monday, November 15, 2010.

Domestic PC 3rd Qtr

Premium Tax Notary required. Alabama has Municipal tax/fees. See supporting information link. State Form ID: PB-Y. StateAbbrv: AL. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.aldoi.gov/PDF/Companies/DomesticPC3rdQtr.pdf. Link to Supporting Information: Instructions: http://www.aldoi.gov/PDF/Companies/DomesticPCInstruct.pdf. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.aldoi.gov/. Contact Email: ann.strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Monday, November 15, 2010.

Estimated Insurance Premium Tax (Form AID AC EST-Q)

Premium Tax State Form ID: AID AC-EST-Q. StateAbbrv: AR. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.arkansas.gov/Accounting/2009PremiumTaxforms/EST-Q.pdf. Link to Supporting Information: EFT Login Menu: http://www.insurance.arkansas.gov/is/EFT_PT/login_qtrly.asp. State Authority: Arkansas Insurance Department, Accounting Division. Link to Filing Website: http://www.insurance.arkansas.gov/Accounting/divpage.htm. Contact Email: insurance.accounting@arkansas.gov. Contact Phone: 501-371-2605. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Electronic. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Estimated Premium Tax - FPRF (Form AID AC FPRF-Q)

Premium Tax State Form ID: AID-AC-FPRF-Q. StateAbbrv: AR. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.arkansas.gov/Accounting/2009PremiumTaxforms/FPRF-Q.pdf. Link to Supporting Information: EFT Login Menu: http://www.insurance.arkansas.gov/is/EFT_PT/login_qtrly.asp. State Authority: Arkansas Insurance Department, Accounting Division. Link to Filing Website: http://www.insurance.arkansas.gov/Accounting/divpage.htm. Contact Email: insurance.accounting@arkansas.gov. Contact Phone: 501-371-2605. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Electronic. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Fire Safety Surcharge (Form IG261)

Premium Tax Required to pay electronically this year if your total taxes and surcharges due for the last calendar year exceeded $120,000 OR if you’re required to pay any Minnesota business tax electronically, such as sales or withholding tax. Use eFile Minnesota Pay by phone at 1‑800-570-3329 Mail to: Minnesota Revenue Mail Station 1780 St. Paul, MN 55145-1780. State Form ID: IG261. StateAbbrv: MN. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.taxes.state.mn.us/taxes/special/insurance/forms/ig261.pdf. Link to Supporting Information: eFile Minnesota: www.taxes.state.mn.us. State Authority: Minnesota Department of Revenue. Link to Filing Website: http://www.taxes.state.mn.us/. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-297-1772. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Fire Safety Surcharge for Mutual Insurance Companies (Form IG262)

Premium Tax Instructions attached to form. State Form ID: IG262. StateAbbrv: MN. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.taxes.state.mn.us/taxes/special/insurance/forms/ig262.pdf. State Authority: Minnesota Department of Revenue. Link to Filing Website: http://www.taxes.state.mn.us/taxes/. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-297-1772. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

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

Premium Tax State Form ID: PV55. StateAbbrv: MN. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.taxes.state.mn.us/taxes/special/insurance/forms/pv55_web.pdf. State Authority: Minnesota Department of Revenue. Link to Filing Website: http://www.taxes.state.mn.us/. Contact Email: insurance.taxes@state.mn.us. Contact Phone: 651-297-1772. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Electronic. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Foreign Casualty 3rd Qtr

Premium Tax Notary required. Alabama has Municipal tax/fees. See supporting information link. State Form ID: PF-Y. StateAbbrv: AL. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.aldoi.gov/PDF/Companies/ForeignCasualty3rdQtr.pdf. Link to Supporting Information: Instructions: http://www.aldoi.gov/PDF/Companies/ForeignPCInstruct.pdf. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.aldoi.gov/. Contact Email: ann.strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Foreign. Monday, November 15, 2010.

Foreign HMO 3rd Qtr

Premium Tax See supporting information link. State Form ID: PD-G. StateAbbrv: AL. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.aldoi.gov/PDF/Companies/ForeignHMO3rdQtr.pdf. Link to Supporting Information: Instructions: http://www.aldoi.gov/PDF/Companies/ForeignHMOInstruct.pdf. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.aldoi.gov/. Contact Email: ann.strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Foreign. Monday, November 15, 2010.

Foreign LAH 3rd Qtr

Premium Tax Notary required. Alabama has Municipal tax/fees. See supporting information link. State Form ID: PD-B. StateAbbrv: AL. Insurance Type: LAH. Filing Period: Qtr 3. Link to State Form: http://www.aldoi.gov/PDF/Companies/ForeignLife3rdQtr.pdf. Link to Supporting Information: Instructions: http://www.aldoi.gov/PDF/Companies/ForeignLifeInstruct.pdf. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.aldoi.gov/. Contact Email: ann.strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Foreign. Monday, November 15, 2010.

Foreign Property 3rd Qtr

Premium Tax Notary required. Alabama has Municipal tax/fees. See supporting information link. State Form ID: PE-Y. StateAbbrv: AL. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: http://www.aldoi.gov/PDF/Companies/ForeignProperty3rdQtr.pdf. Link to Supporting Information: Instructions: http://www.aldoi.gov/PDF/Companies/ForeignPCInstruct.pdf. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.aldoi.gov/. Contact Email: ann.strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Foreign. Monday, November 15, 2010.

Risk Retention Companies 3rd Qtr

Premium Tax See supporting information link. State Form ID: RR-W. StateAbbrv: AL. Insurance Type: Risk Retention Group. Filing Period: Qtr 3. Link to State Form: http://www.aldoi.gov/PDF/Companies/RiskRetention3rdQtr.pdf. Link to Supporting Information: Instructions: http://www.aldoi.gov/PDF/Companies/RiskRetentionInstruct.pdf. State Authority: Alabama Department of Insurance. Link to Filing Website: http://www.aldoi.gov/. Contact Email: ann.strickland@insurance.alabama.gov. Contact Phone: 334-241-4154. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Surplus Lines Licensee Affidavit for Purchasing Groups

Premium Tax Surplus lines producers may file and pay their premium tax with SLAOR. There is a fee for filing with SLAOR. Please call SLAOR, 503-718-6700, if you have any questions. State Form ID: 440-3928. StateAbbrv: OR. Insurance Type: PC. Surplus Lines. Filing Period: Qtr 3. Link to State Form: http://www.insurance.oregon.gov/forms/insurer/3928.pdf. Link to Supporting Information: SLAOR: www.SLAOR.org. State Authority: Oregon Insurance Division. Link to Filing Website: http://www.insurance.oregon.gov. Contact Email: lynette.m.hadley@state.or.us. Contact Phone: 503-947-7046. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Accredited Reinsurers Checklist

State Required Filings with Column 1 completed. StateAbbrv: LA. Insurance Type: Reinsurance. Filing Period: Qtr 3. Link to State Form: http://www.ldi.la.gov/Insurers/2009Filing/2009AccreditedReinsurers.pdf. State Authority: Louisiana Department of Insurance. Link to Filing Website: http://www.ldi.la.gov/. Contact Email: sguerin@ldi.state.la.us. Contact Phone: 225-219-3929. Due by Postmark or Receive Date: Postmark. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Agents Balances Certification

State Required Filings StateAbbrv: FL. Insurance Type: PC. Filing Period: Qtr 3. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Contact Email: Helen.Westberry@floir.com. Contact Phone: 850-413-5212. # of Copies to State (Domestic Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): REFS. Monday, November 15, 2010.

Amounts Due From Parent, Subsidiaries and Affiliates / Annual Exhibit 5

State Required Filings If your company is requested to submit quarterly financial statements pursuant to Note N, complete Annual Statement Exhibit 5 on a quarterly basis and mail it to the Department in a separate envelope. StateAbbrv: PA. Insurance Type: Health. Filing Period: Qtr 3. State Authority: Pennsylvania Insurance Department - Financial Analysis Division. Link to Filing Website: www.ins.state.pa.us. Contact Email: ra-in-analysis@state.pa.us. Contact Phone: 717-787-5890. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): N/A. Monday, November 15, 2010.

Analysis of Excess Capital and Surplus Investments Report (Form R01)

State Required Filings StateAbbrv: VA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.scc.virginia.gov/division/boi/webpages/inspagedocs/frr01.pdf. State Authority: Virginia Bureau of Insurance, Financial Regulation Division. Link to Filing Website: http://www.scc.virginia.gov/. Contact Email: karen.traylor@scc.virginia.gov. Contact Phone: 804-371-9908. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): N/A. Monday, November 15, 2010.

Analysis of Operations by Line of Business

State Required Filings On a quarterly basis. All foreign HMOs and LSHMOs must file like an Indiana Domestic HMO or LSHMO, as indicated on the health checklist, under the domestic column. All foreign companies filing on the Health blank, other than HMOs or LSHMOs, must file as indicated on the health checklist, under the foreign column. StateAbbrv: IN. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://www.in.gov/idoi/files/HMO_Qtrly_LOB.pdf. State Authority: Indiana Department of Insurance (IDOI), Financial Services. Link to Filing Website: www.in.gov. Contact Email: dbullman@idoi.in.gov. Contact Phone: Deanne Bullman at 317-232-5692. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. # of Copies to State (Domestic Insurer): 2. # of Copies to NAIC (Domestic Insurer): #BLANK#. # of Copies to State (Foreign Insurer): #BLANK#. Monday, November 15, 2010.

Annual Statement Exhibit 2 Accident & Health Premiums Due & Unpaid

State Required Filings StateAbbrv: FL. Insurance Type: Health. HMO. Filing Period: Qtr 3. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. # of Copies to State (Domestic Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/R. Monday, November 15, 2010.

Annual Statement Exhibit 3 Health Care Receivables

State Required Filings StateAbbrv: FL. Insurance Type: Health. HMO. Filing Period: Qtr 3. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. # of Copies to State (Domestic Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/R. Monday, November 15, 2010.

Annual Statement Exhibit 7 Summary of Transactions with Providers & Intermediaries

State Required Filings StateAbbrv: FL. Insurance Type: Health. HMO. Filing Period: Qtr 3. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. # of Copies to State (Domestic Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/R. Monday, November 15, 2010.

Annual Statement Filing Requirements - Trusteed Reinsurer

State Required Filings StateAbbrv: MS. Insurance Type: Reinsurance. Filing Period: Qtr 3. Link to State Form: http://www.mid.state.ms.us/financial_examination/trustreinsrequire.pdf. State Authority: Mississippi Insurance Division. Link to Filing Website: http://www.mid.state.ms.us. Contact Phone: 601-359-3569. Due by Postmark or Receive Date: Received. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Annual Statement Schedule E Part 3

State Required Filings StateAbbrv: FL. Insurance Type: Health. HMO. Filing Period: Qtr 3. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. # of Copies to State (Domestic Insurer): REFS. # of Copies to NAIC (Domestic Insurer): N/R. Monday, November 15, 2010.

AR Domestic Insurers Affiliated Transaction Form (Form AID FI STDR)

State Required Filings All domestic companies (except FMAAs) which are not subject to the Holding Company Act should file the form quarterly with the filing of the quarterly statutory financial statements. This form may be filed electronically as a PDF by emailing insurance.finance@arkansas.gov. If filed electronically, the original form evidencing the original signatures should be kept on file at the Company for 5 years. The original and one copy of the form should be mailed to: Arkansas Insurance Department Finance Division 1200 West Third Street Little Rock, AR 72201-1904. State Form ID: AID-FI-STDR. StateAbbrv: AR. Insurance Type: Health. LAH. PC. Surplus Lines. Filing Period: Qtr 3. Link to State Form: http://www.insurance.arkansas.gov/finance/financialstmthomepagefiles/FormAIDFISTDR.doc. State Authority: Arkansas Insurance Department. Link to Filing Website: http://insurance.arkansas.gov/. Contact: Kimberly Johnson, Examiner. Contact Email: Kimberly.johnson@arkansas.gov. Contact Phone: 501-371-2680. Due by Postmark or Receive Date: Receive Date. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 2. Monday, November 15, 2010.

Call for Third Quarter WC Experience Bulletin Form

State Required Filings Hardcopy filings no longer accepted. See supporting document links for instructions and bulletin. StateAbbrv: TX. Insurance Type: PC. Reinsurance. Workers Compensation. Filing Period: Qtr 3. Link to State Form: http://www.tdi.state.tx.us/bulletins/2009/documents/attach2.doc. Link to Supporting Information: Bulletin: http://www.tdi.state.tx.us/bulletins/2009/cc41.html. State Authority: Texas Department of Insurance. Link to Filing Website: http://www.tdi.state.tx.us/bulletins/. Contact Email: ChiefClerk@tdi.state.tx.us. Contact Phone: 512-475-3030. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Compulsory and Security Surplus Calculation - Health (Form OCI 22-310)

State Required Filings All domestic insurers are required to file two hard copies of the quarterly financial statements and quarterly electronic compulsory and security surplus calculation. Mailing address for US Mail: Office of Commissioner of Insurance P O Box 7873 Madison WI 53707 Street Address (for hand delivery): Office of Commissioner of Insurance 125 South Webster Street Madison WI 53703-3474. State Form ID: OCI 22-310. StateAbbrv: WI. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: https://ociaccess.oci.wi.gov/FillableForms/jsp/22_310_intro.oci. State Authority: Wisconsin Office of Commissioner of Insurance. Link to Filing Website: http://oci.wi.gov/oci_home.htm. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive Date. Filing Method: Electronic. Domestic/Foreign: Domestic. Monday, November 15, 2010.

Compulsory and Security Surplus Calculation - HMO (Form OCI 22-061)

State Required Filings All domestic insurers are required to file two hard copies of the quarterly financial statements and quarterly electronic compulsory and security surplus calculation. It will no longer be necessary to file a hard copy of the compulsory surplus calculation, however, it is recommended that the company retain a hard copy for its records. State Form ID: OCI 22-061. StateAbbrv: WI. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: https://ociaccess.oci.wi.gov/FillableForms/jsp/22_061_intro.oci. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://oci.wi.gov/oci_home.htm. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): xxx. Monday, November 15, 2010.

Compulsory and Security Surplus Calculation - LAH (Form OCI 22-009)

State Required Filings All domestic insurers are required to file two hard copies of the quarterly financial statements and quarterly electronic compulsory and security surplus calculation. One copy must have original signatures. All licensed nondomestic insurers are required quarterly to file one signed jurat with this office and the electronic filing of the quarterly compulsory and security surplus calculation form. Other than the jurat, quarterly hard copies are not required, including supplemental filings. State Form ID: OCI 22-009. StateAbbrv: WI. Insurance Type: Health. LAH. Filing Period: Qtr 3. Link to State Form: https://ociaccess.oci.wi.gov/FillableForms/jsp/22_009_intro.oci. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: https://oci.wi.gov. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): n/a. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Compulsory and Security Surplus Calculation - PC (Form OCI 22-008)

State Required Filings All domestic insurers are required to file two hard copies of the quarterly financial statements and quarterly electronic compulsory and security surplus calculation. One copy must have original signatures. All licensed nondomestic insurers are required quarterly to file one signed jurat with this office and the electronic filing of the quarterly compulsory and security surplus calculation form. Other than the jurat, quarterly hard copies are not required. State Form ID: OCI 22-008. StateAbbrv: WI. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: https://ociaccess.oci.wi.gov/FillableForms/jsp/22_008_intro.oci. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: oci.wi.gov. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): n/a. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Costs of HMOs Indemnification and Nonparticipating Referral Provider Arrangements(Form R06)

State Required Filings StateAbbrv: VA. Insurance Type: Health. Filing Period: Qtr 3. Link to Supporting Information: http://www.scc.virginia.gov/division/boi/webpages/inspagedocs/frr06.pdf. State Authority: Virginia Bureau of Insurance, Financial Regulation Division. Link to Filing Website: http://www.scc.virginia.gov/. Contact Email: karen.traylor@scc.virginia.gov. Contact Phone: 804-371-9908. Due by Postmark or Receive Date: Postmark. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Data Collection for 3515(3) Report (Form FIS 0323)

State Required Filings Domestic Insurers Only: Combined or Consolidated Annual Statements are required from each group of affiliated property and casualty insurers. Instructions are included in the supplemental section of the NAIC Annual Statement Instructions. State Form ID: FIS-0323. StateAbbrv: MI. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.michigan.gov/documents/cis/FIS_0323_180773_7.pdf. State Authority: Michigan Department of Labor & Economic Growth. Link to Filing Website: www.michigan.gov. Contact Email: finleym@michigan.gov. Contact Phone: 517-241-4490. Due by Postmark or Receive Date: Receive. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): xxx. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Detail Listing of Securities Held Under Safekeeping (Form 143)

State Required Filings State Form ID: 143. StateAbbrv: KY. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://insurance.ky.gov/Documents/form143updated1207.xls. State Authority: Kentucky Department of Insurance, Financial Standards and Examination Division. Link to Filing Website: http://doi.ppr.ky.gov/kentucky/docs.asp?Divid=6. Contact Email: KOIFinancialStandardsMail@ky.gov. Contact Phone: 502-564-6082. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 2. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 0. Monday, November 15, 2010.

Disclosure of Material Transactions (Form FAD26) - Excel

State Required Filings Every 15th of the month, when applicable. All required documents must be submitted online with (OASIS) Online Assistance System for Insurer Submittal. In addition, please submit a paper copy of pages containing original signatures by the reporting deadline to: California Department of Insurance Financial Analysis Division-Financial Records 300 South Spring Street, 13th Floor, South Tower Los Angeles, CA 90013. State Form ID: FAD26. StateAbbrv: CA. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/forms/upload/FAD026-ABC_Disclosure_Material_Tranactions.xls. Link to Supporting Information: http://www.insurance.ca.gov/0250-insurers/0300-insurers/0100-applications/financial-filing-notices-forms/annualnotices/disclosure.cfm. State Authority: California Department of Insurance, Financial Analysis Division - Financial Records Unit. Link to Filing Website: http://www.insurance.ca.gov/. Contact: 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. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 0. # of Copies to NAIC (Foreign Insurer): 0. Paper Size: Letter size; Orientation: Portrait. Monday, November 15, 2010.

DPO NJ Supplement and/or Schedules

State Required Filings StateAbbrv: NJ. Insurance Type: Health. Filing Period: Qtr 3. State Authority: Department of Banking & Insurance, Office of Solvency Regulation. Link to Filing Website: http://www.state.nj.us/dobi/index.html. Contact Email: admissions&selfinsurance@dobi.state.nj.us. Contact Phone: 609-292-5350 ext 50085. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 4. # of Copies to State (Foreign Insurer): 4. Monday, November 15, 2010.

Electronic Filing Authenticity Affidavit (Form INS7240)

State Required Filings State Form ID: IN S7240. StateAbbrv: OH. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: https://secured.insurance.ohio.gov/Forms/INS7240.pdf. State Authority: Ohio Department of Insurance, Office of Financial Regulation Services. Link to Filing Website: http://www.ohioinsurance.gov. Contact Email: taxes@ins.state.oh.us. Contact Phone: 614-644-2658. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 0. Monday, November 15, 2010.

Exhibit of Premiums Enrollment and Utilization (Form INS7226)

State Required Filings State Form ID: INS7226. StateAbbrv: OH. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: https://secured.insurance.ohio.gov/Forms/INS7226.pdf. State Authority: Ohio Department of Insurance, Office of Financial Regulation Services. Link to Filing Website: www.ohioinsurance.gov. Contact Email: taxes@ins.state.oh.us. Contact Phone: 614-644-2566. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Financial Filing Requirements - All Eligible Surplus Lines Insurers

State Required Filings All companies are required to include a completed Connecticut Form SL-10 as a part of their annual and quarterly filings. All mail, including certified and registered mail, should be sent to the Financial Regulation Division, at the following address: P.O. Box 816 Hartford, CT 06142-0816. State Form ID: Form SL-10. StateAbbrv: CT. Insurance Type: Surplus Lines. Filing Period: Qtr 3. Link to State Form: http://www.ct.gov/cid/lib/cid/BullFS-4SL-09.pdf. State Authority: Connecticut Insurance Department. Link to Filing Website: http://www.ct.gov/cid/site/default.asp. Contact: Financial Analysis & Compliance Division. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-3814. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Health - HMDI Checklist

State Required Filings Column 1 completed with each filing on due date. State Form ID: OCI 22-050. StateAbbrv: WI. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://oci.wi.gov/ociforms/22-050.pdf. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://oci.wi.gov/. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. # of Copies to State (Domestic Insurer): 2. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): xxx. Monday, November 15, 2010.

Health - HMO Checklist

State Required Filings Column 1 completed with each filing on due date. All domestic insurers are required to file two hard copies of the quarterly financial statements and quarterly electronic compulsory and security surplus calculation. State Form ID: OCI 22-060. StateAbbrv: WI. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://oci.wi.gov/ociforms/22-060.pdf. State Authority: Wisconsin Office of the Commissioner of Insurance. Link to Filing Website: http://oci.wi.gov/. Contact Email: yvonne.sherry@wisconsin.gov. Contact Phone: 608-266-0091. Due by Postmark or Receive Date: Receive. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): N/A. # of Copies to State (Foreign Insurer): xxx. Monday, November 15, 2010.

Health Checklist

State Required Filings A checklist with column 1 completed is required to be submitted with all required hard copy filings. StateAbbrv: CT. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://www.ct.gov/cid/lib/cid/FS409_hlthchklist.pdf. State Authority: Connecticut Insurance Department. Link to Filing Website: http://www.ct.gov/cid/site/default.asp. Contact: Financial Analysis & Compliance Division. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-3814. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 2. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Health Checklist

State Required Filings Mailing Address: P.O. Box 94214 Baton Rouge, LA 70804-9214 Attn: Administrative Services Physical Address: 1702 North Third Street Baton Rouge, LA 70802 All items must be delivered through the US Postal Service in accordance with LDOI Rule No. 12. If the due date falls on a weekend or holiday, the deadline is extended to the next business day. StateAbbrv: LA. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://www.ct.gov/cid/lib/cid/FS409_hlthchklist.pdf. State Authority: Louisiana Department of Insurance. Link to Filing Website: http://www.ldi.la.gov/Insurers/index.htm. Contact Email: sguerin@ldi.state.la.us. Contact Phone: 225-219-3929. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Health Enrollment Report Form

State Required Filings This report is to be filed on a quarterly basis. Direct all inquiries to: Carla Wagner Department of Consumer & Business Services Market Surveillance-7 PO Box 14480 Salem, OR 97309-0405. StateAbbrv: OR. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to State Form: https://www4.cbs.state.or.us/exs/ins/multifile/. State Authority: Department of Consumer & Business Services, Market Surveillance-7. Link to Filing Website: http://www.cbs.state.or.us/external/ins/index.html. Contact Phone: 503-947-7268. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Monday, November 15, 2010.

Health Insurance Claims Payable - Quarterly Report

State Required Filings StateAbbrv: NY. Insurance Type: LAH. Filing Period: Qtr 3. Link to State Form: http://www.ins.state.ny.us/annual/kits/asprop08.exe. State Authority: New York Insurance Department. Link to Filing Website: http://www.ins.state.ny.us/. Due by Postmark or Receive Date: Receive Date. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Health Insurance Claims Payable Quarterly Report - Accident and Health

State Required Filings StateAbbrv: NY. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://www.ins.state.ny.us/acrobat/a&hq.xls. Link to Supporting Information: Instructions: http://www.ins.state.ny.us/hinstah.htm. State Authority: New York Insurance Department. Link to Filing Website: www.ins.state.ny.us. Contact Email: ashealth@ins.state.ny.us. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Health Premium Assessment Report

State Required Filings The Health Premium Assessment Report must be filed on-line with the Oregon Insurance Division within 45 days after the end of every calendar quarter. This is a new assessment that became effective 10/1/2009 and applies to all insurers authorized in Oregon for health insurance. StateAbbrv: OR. Insurance Type: Health. LAH. PC. Filing Period: Qtr 3. Link to Supporting Information: http://www.cbs.state.or.us/external/ins/bulletins/bulletin2009-09.html. State Authority: Department of Consumer & Business Services, Insurance Division-4. Link to Filing Website: http://www.cbs.state.or.us/external/ins/index.html. Contact Email: OrInstax@state.or.us. Contact Phone: 503-947-7046. Due by Postmark or Receive Date: Postmark. Filing Method: Electronic. Monday, November 15, 2010.

HMO Checklist

State Required Filings Attach a Required Filings Checklist to each filing submitted to the Office. Fill in the company name, federal employer identification number and NAIC company code. In column (1) check off the items being submitted and attach the checklist as the cover page. StateAbbrv: FL. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.floir.com/mc/Documents/HMOFilingReq.doc. State Authority: Florida Office of Insurance Regulation. Link to Filing Website: http://www.floir.com/OIR_Required_Filing_Reporting.aspx. Contact: Marie Bachman. Contact Email: Marie.Bachman@floir.com. Contact Phone: 850-413-3800. Due by Postmark or Receive Date: Receive Date. Filing Method: Electronic. # of Copies to NAIC (Domestic Insurer): 1. Monday, November 15, 2010.

HMO Inpatient Discharges and Benefit Payouts Report (Form FIS 0320)

State Required Filings Domestic Insurers Only: Combined or Consolidated Annual Statements are required from each group of affiliated property and casualty insurers. Instructions are included in the supplemental section of the NAIC Annual Statement Instructions. State Form ID: FIS-0320. StateAbbrv: MI. Insurance Type: Health. HMO. Filing Period: Qtr 3. Link to State Form: http://www.michigan.gov/documents/cis_ofis_fis_0320_24273_7.pdf. State Authority: Michigan Department of Labor & Economic Growth. Link to Filing Website: www.michigan.gov. Contact Email: mlfinle@michigan.gov. Contact Phone: 517-241-4490. Due by Postmark or Receive Date: Receive. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): xxx. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

HMO NJ Supplement and/or Schedules

State Required Filings StateAbbrv: NJ. Insurance Type: Health. HMO. Filing Period: Qtr 3. State Authority: Department of Banking & Insurance, Office of Solvency Regulation. Link to Filing Website: http://www.state.nj.us/dobi/index.html. Contact Email: admissions&selfinsurance@dobi.state.nj.us. Contact Phone: 609-292-5350 ext 50085. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 4. # of Copies to State (Foreign Insurer): 4. Monday, November 15, 2010.

HMO Product Mix Report

State Required Filings Only HMOs are subject to this requirement. Foreign licensed HMOs are required to make the same type and number of filings as a domestic HMO. StateAbbrv: WV. Insurance Type: Health. Filing Period: Qtr 3. State Authority: West Virginia Insurance Commissioner. Link to Filing Website: http://www.wvinsurance.gov/. Contact: Darlene Parsons. Contact Email: darlene.parsons@wvinsurance.gov. Contact Phone: 304-558-2100. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

HMO Quarterly Supplement (Form FIN252)

State Required Filings To be filed hard copy and electronically with the Department. Filed with Texas only. StateAbbrv: TX. Insurance Type: HMO. Filing Period: Qtr 3. Link to State Form: http://www.tdi.state.tx.us/forms/finanalysis/fin252hmoqtrsupp.pdf. State Authority: Texas Department of Insurance, Financial Analysis and Examinations. Link to Filing Website: www.tdi.state.tx.us. Contact Email: kristine.ehrlich@tdi.state.tx.us. Contact Phone: 512-322-5030. Due by Postmark or Receive Date: Postmark. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Illinois Mine Subsidence Insurance Fund

State Required Filings Mail to: Illinois Mine Subsidence Insurance Fund P.O. Box 71915 Chicago, IL 60694-1915. State Form ID: IMSIF 08-1, 08-2, 08-2L, 08-2C, 08-R. StateAbbrv: IL. Insurance Type: PC. Filing Period: Qtr 3. Link to State Form: https://www.imsif.com/home/. State Authority: Illinois Mine Subsidence Insurance Fund. Link to Filing Website: https://www.imsif.com/. Contact Email: hmweber@imsif.com. Contact Phone: 312-819-0060 Ext. 252. Due by Postmark or Receive Date: Receive. Filing Method: Electronic. Hard Copy. Domestic/Foreign: Domestic. Foreign. Monday, November 15, 2010.

Jurat Page

State Required Filings Captive insurers file. The Jurat Page must be notarized, have the Company Seal affixed, and have original (wet) signatures. StateAbbrv: OK. Insurance Type: Health. Filing Period: Qtr 3. State Authority: Oklahoma Insurance Department. Link to Filing Website: http://www.ok.gov/oid/. Contact: Finance Division - Premium Tax Division. Contact Phone: 405-521-3966. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 1. Monday, November 15, 2010.

Kentucky Supplemental Schedule (Form 495)

State Required Filings FOREIGN ONLY: The Kentucky Supplemental Schedule (Form #495) is no longer required. State Form ID: 495. StateAbbrv: KY. Insurance Type: Health. Filing Period: Qtr 3. Link to State Form: http://insurance.ky.gov/Documents/form495rev071708.xls. State Authority: Kentucky Department of Insurance, Financial Standards and Examination Division. Link to Filing Website: https://doi.ppr.ky.gov/kentucky/secured/Eservices/default.aspx. Contact Email: KOIFinancialStandardsMail@ky.gov. Contact Phone: 502-564-6082. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. # of Copies to State (Domestic Insurer): 2. # of Copies to NAIC (Domestic Insurer): 0. Monday, November 15, 2010.

LAH Checklist

State Required Filings A checklist with column 1 completed is required to be submitted with all required hard copy filings. StateAbbrv: CT. Insurance Type: LAH. Filing Period: Qtr 3. Link to State Form: http://www.ct.gov/cid/lib/cid/FS409_lifechklist.pdf. State Authority: Connecticut Insurance Department. Link to Filing Website: http://www.ct.gov/cid/site/default.asp. Contact: Financial Analysis & Compliance Division. Contact Email: ctinsdept.financial@ct.gov. Contact Phone: 860-297-3814. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 2. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

LAH Checklist

State Required Filings StateAbbrv: LA. Insurance Type: LAH. Filing Period: Qtr 3. Link to State Form: http://www.ct.gov/cid/lib/cid/FS409_lifechklist.pdf. State Authority: Louisiana Department of Insurance. Link to Filing Website: http://www.ldi.la.gov. Contact Email: sguerin@ldi.state.la.us. Contact Phone: 225-219-3929. Due by Postmark or Receive Date: 1. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to State (Foreign Insurer): 0. Monday, November 15, 2010.

LAH Checklist

State Required Filings StateAbbrv: NH. Insurance Type: LAH. Filing Period: Qtr 3. Link to State Form: http://www.nh.gov/insurance/companies/documents/lifecklist_2010.pdf. Link to Supporting Information: Domestic: http://www.commerce.state.ak.us/insurance/pub/ACC_Domestic.pdf Foreign: http://www.commerce.state.ak.us/insurance/pub/ACC_Foreign.pdf. State Authority: New Hampshire Insurance Department. Link to Filing Website: www.nh.gov. Contact: Rebecca Nesheim, Tax Auditor. Contact Email: Mary.Verville@ins.nh.gov. Contact Phone: 603-271-7973. Due by Postmark or Receive Date: Postmark. Filing Method: Hard Copy. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): xxx. Monday, November 15, 2010.

Membership by County in SC

State Required Filings StateAbbrv: SC. Insurance Type: Health. HMO. Filing Period: Qtr 3. State Authority: South Carolina Department of Insurance. Link to Filing Website: http://www.doi.sc.gov/. Contact Email: tcampbell@doi.sc.gov. Contact Phone: 803-737-6109. Due by Postmark or Receive Date: Receive. Domestic/Foreign: Domestic. Foreign. # of Copies to State (Domestic Insurer): 1. # of Copies to NAIC (Domestic Insurer): 0. # of Copies to State (Foreign Insurer): 1. Monday, November 15, 2010.

Mortgage Guaranty Insurers Report of Policyholders Position

State Required Filings Only for companies that write mortgage guaranty business. Other companies need not file. Effective 10/01/07 the calculation for minimum policyholder position was changed to comply with legislative changes contained in House Bill 737. Please refer to NCGS 58-10-125. In