Form Ld-T - Annual Report Of Premiums,taxes And Fees Of Foreign Life And Accident And Health Insurance Companies - 2011 Page 8

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NAIC__________ COMPANY NAME________________________________
2011 FORM AID AC LD-T
SCHEDULE IC-PT
LIFE AND /OR ACCIDENT AND HEALTH INSURERS AND HEALTH MAINTENANCE
ORGANIZATION SALARY ANNUAL OFFSET
Each authorized life or accident and health insurer, including an HMO, may take an annual credit for non-
commissioned salaries and wages of the insurer’s Arkansas employees as an offset against the 2.5% direct
written tax on life and or accident and health insurance. The offset may not reduce tax due on accident &
health premiums by more than 80%: or due on life premiums by more than 70%. The employee must have
been employed 6 months in Arkansas for the wages to qualify.
MUST
The Company
report as follows:
1. Number of non-commissioned Arkansas employees employed for a minimum of six (6) months as of
0
the last day of the calendar year to which this report applies: _________________.
2. Amount of non-commissioned salaries and wages paid to individuals listed in item 1 above:
$0.00
___________________________________________________________.
3. Complete addresses of Company’s Arkansas offices, which are staffed with individuals listed in Item 1.
a.
b.
c.
Attach additional sheets if necessary.
ARKANSAS INSURANCE DEPARMENT
Page 3 of 4
REVISED 2011

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