Fillable Form M27 - Hmo Insurance Estimated Tax Payment printable pdf download

HMO Insurance Estimated Tax Payment

M27

IMPORTANT:

Type in the required information while this form is on the screen and print a copy. A personalized scan

line will be printed on the voucher using the information you entered. To help ensure your payment is properly credited

to your account, verify that the period end date and Minnesota tax ID number are included in the scan line.

When you print this voucher, be sure to set the Page Scaling to “None” in your Print options. DO NOT check the “Auto-

rotate and center pages” or “Shrink to fit” boxes. If they are already checked, click on the box to uncheck them.

Due Dates

Pay Electronically

Pay by Credit or Debit Card

• Go to , log in

• Go to payMNtax.com; or

Your quarterly estimated tax payments are

to e-Services and follow the prompts for

due March 15, June 15, September 15 and

• Call 1‑855‑9‑IPAY‑MN.

a business to make an HMO insurance

December 15.

You will be charged a fee to use this service,

estimated tax payment; or

When the due date falls on a Saturday,

which goes directly to Value Payment

• Call 1‑800‑570‑3329 to pay by phone.

Sunday or legal holiday, payments elec-

Systems (a national company that partners

tronically made or postmarked on the next

with federal, state and local governments to

For both methods, you’ll need your Minne-

provide credit/debit card payment services).

business day are considered timely.

sota tax ID number, password and banking

information. When paying electronically,

The Department of Revenue does not have

Before a Payment Can Be

you must use an account not associated

any financial agreement with Value Payment

with any foreign banks.

Made

Systems and does not receive any of its fees.

To ensure your payment is processed cor-

Note: If you’re using e-Services for the first

Pay by Check

rectly, you must have a Minnesota tax ID

time and you need a temporary password,

If you are not required to pay electroni-

number. To register for a Minnesota tax ID

call our Business Registration Office at 651‑

cally, you may pay by check. Complete the

number:

282‑5225 or 1‑800‑657‑3605.

voucher below and mail it with your check.

• Go to and

After you authorize the payment, you’ll re-

All information is required to process your

click “Register for a Minnesota tax ID

payment, including your Minnesota tax ID

ceive a confirmation number. You can can-

number.

number” on the e-Services menu; or

cel a payment up to one business day before

the scheduled payment date, if needed.

• Register by phone at 651‑282‑5225 or

When you pay by check, your check autho-

1‑800‑657‑3605.

rizes us to make a one-time electronic fund

Do not send in the voucher below unless

transfer from your account, and you may

you are paying by check.

not receive your canceled check.

Cut carefully along this line to detach.

(Rev. 10/12)

M27

504

HMO Insurance Estimated Tax Payment

Minnesota Tax ID

(required)

Name of insurance company

Mailing address

NAIC Number

City

State

ZIP code

Enter the last day of the period. Use

mmddyy format.

Period End Date

(mmddyy)

Example: If making a 2013 estimated

Name of contact person

Phone

tax payment, enter 123113 for all four

quarters.

Make check payable to Minnesota Revenue and mail to:

AMOUNT

Minnesota Revenue, Mail Station 1785, St. Paul, MN 55145-1785

OF CHECK

To help ensure your payment is properly credited to your account, be sure to verify that the scan line below includes the correct period end date and your Minnesota tax ID.

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Form M27 - Hmo Insurance Estimated Tax Payment

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