Form In-1362 - Quarterly Filing Statement Of Premiums And Fees For Taxation

STATE OF TENNESSEE

DEPARTMENT OF COMMERCE AND INSURANCE

FINANCIAL AFFAIRS SECTION / ANALYTICAL UNIT 0576

500 JAMES ROBERTSON PARKWAY

NASHVILLE, TENNESSEE 37243

(615) 741-1670

TO:

HEALTH MAINTENANCE ORGANIZATIONS AND TENNCARE PROVIDERS TRANSACTING BUSINESS IN THE

STATE OF TENNESSEE

RE:

QUARTERLY FILING STATEMENT OF PREMIUMS AND FEES FOR TAXATION

Following you will find the tax form for filing “Statement of Premiums and Fees for Taxation” for June 1, August 20,

and December 1.

PLEASE NOTE: All such taxes shall not be considered as paid on or before each quarterly due date unless the tax return

and payment are actually received in the department on or before the appropriate quarterly due date as prescribed by Tenn.

Code Ann. § 56-32-224(b). A tax return with payment will be considered “timely filed” provided such premium tax return and

payment bears a United States Post Office Cancellation Mark stamped on the envelope of no later than the appropriate

quarterly due date. A company meter date or postage stamp will not be acceptable as competent evidence that the tax

return was timely filed if the tax return is received in the department after the due date, unless it is cancelled over by the U.S.

Postal Service. It is advised, if your company feels the tax return may be received in the department after the appropriate

quarterly due date, that certified mail with a U.S. Postal Cancellation Stamp on the receipt be obtained, a certificate of

mailing, or request that the U.S. Postal authorities cancel over the postage in your presence. Based upon past experience,

the U.S. Post Office does not always cancel over company metered mail. No grace period is allowed for late filing of the

premium tax return.

Premium tax returns and payments thereon must be mailed to a separate post office box number. Any materials which do not

pertain to premium tax should be sent under separate cover. The address for PREMIUM TAX RETURNS is as follows:

TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE

Division of Insurance

P.O. Box 198983

Nashville, TN 37219-8983

HOWEVER, PLEASE NOTE: If the tax return is mailed via overnight courier, the following address should be used:

TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE

FINANCIAL AFFAIRS SECTION / ANALYTICAL UNIT 0576

ATTENTION: PREMIUM TAX SECTION

500 James Robertson Parkway, 4th Floor

Nashville, TN 37243

Effective July 1, 2009 Tenn. Code Ann. §56-32-124(a) was amended to change the premium tax rate from two percent (2%)

to five and one-half percent (5.5%). The five and one-half percent (5.5%) is to be used with the third quarter tax return due

on or before December 1, 2009.

Premium Tax Forms Website:

Should you have any questions, please contact the Premium Tax Section at (615) 741-1670.

FORM IN-1362 HMO Quarterly Rev 9/2011

Form In-1362 - Quarterly Filing Statement Of Premiums And Fees For Taxation - 2011