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Minnesota Free Printable 2011 M11H, Insurance Premium Tax Return for HMOs for 2021 Minnesota Insurance Premium Tax Return for HMOs

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Insurance Premium Tax Return for HMOs
2011 M11H, Insurance Premium Tax Return for HMOs

M11H 2019 Insurance Premium Tax Return for HMOs Due March 1, 2020 Check if: Print or Type Name of Provider Mailing Address Check if New Address City State ZIP Code Email Address Website Address Amended Return No Activity Return FEIN Minnesota Tax ID (required) NAIC Number State/Country of Incorporation Contact Person Daytime Phone Fax Number 1 Total gross written premiums (total from NAIC, Schedule T; attach a copy) . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 a Federal employees health benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a Premiums b Nontaxable Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b c Other nontaxable premiums (attach separate itemized schedule) . . . . . 2c Total nontaxable premiums (add lines 2a, 2b and 2c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Other adjustments (attach separate itemized schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 Total taxable premiums (add line 3 and line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1% Premium Tax and Payments 6 Premium tax percentage rate (1%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Premium tax liability (multiply line 5 by line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Minnesota Guaranty Fund Association offset (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9 Tax liability (subtract line 8 from line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 Premium tax prepayments a Prior year‘s overpayment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10a b Estimated payment March 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10b c Estimated payment June 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10c d Estimated payment Sept. 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10d e Estimated payment Dec. 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10e Total payments (add lines 10a through 10e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Subtract line 10 from line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 a Additional charge for underpaying estimated tax (determine from worksheet in the instructions) . . . . . . . . . . . . . . . . . . . 12a b Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12b Amount Due/ Overpaid c Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12c Total (add lines 12a through 12c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 TOTAL AMOUNT DUE (or overpaid) (add lines 11 and 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 If you owe additional tax: Payment method: Electronic payment Check (payable to Minnesota Revenue; write MN tax ID number on check; attach voucher) Enter amount paid Date paid (If amount paid is different from amount due on line 13, attach an explanation.) If you overpaid: Amount on line 13 to be credited to next year‘s estimated tax . . . . . . . . . . . . . . Amount on line 13 to be refunded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sign Here I declare that this return is correct and complete to the best of my knowledge and belief. Authorized Signature Title Date Daytime Phone Signature of Preparer Print Name of Preparer Date Daytime Phone Mail to: Minnesota Department of Revenue, Mail Station 1780, 600 N. Robert St., St. Paul, MN 55145-1780 I authorize the Minnesota Department of Revenue to discuss this tax return with the preparer. 2019 Insurance Premium Tax Return for HMOs Instructions For insurance tax laws, see Minnesota Statutes, Chapter 297I at www.leg.state.mn.us. What’s New Guaranty Fund Assessment If you were assessed and made a payment to the Guaranty Fund Assessment (GFA), you may be able to claim a credit on line 8. See line 8 instructions. Before You File You Need a Minnesota Tax ID Your Minnesota tax ID is the seven-digit number you are assigned when you register with the Department of Revenue. You must include your Minnesota tax ID on your return so that your filing and any payments you make are properly credited to your account. If you do not have a Minnesota tax ID, apply online at www.revenue.state.mn.us or call 651‑282-5225 or 1-800-657-3605. It is also important to enter your federal ID number and NAIC number on your return, but not in place of your Minnesota tax ID number. Filing Requirements Any health care provider organized as a nonprofit health plan corporation, health maintenance organization, accountable provider networks (APN) or community integrated service network that writes premiums in Minnesota must file Form M11H, Insurance Premium Tax Return for HMOs. (M.S. 297I.05) Due Date File Form M11H with all required attachments and pay any tax due by March 1. Payment extensions are not allowed. The U.S. postmark date, or date recorded or marked by a designated delivery service, is considered the filing date (private postage meter marks are not valid). When the due date falls on a Saturday, Sunday or legal holiday, returns and payments electronically made or postmarked the next business day are considered timely. When a return or payment is late, the date it is received at the Department of Revenue is treated as the date filed or paid. Extension for Filing Return. If good cause exists, you may request a filing extension. Check Boxes At the top of the form, check if the return is: an Amended Return: Check only if you’re amending a previously filed return for the same period. Include all original and corrected premiums on the amended return. a No Activity Return: Check only if you did not have any tax activity during the year. Note: If no amount is due or if you pay electronically, do not send in a voucher. Line Instructions Round amounts to the nearest dollar. Decrease any amount less than 50 cents and increase any amount that is 50 cents or more to the next higher dollar. If the reported premiums are different from the premiums on the state page or Schedule T, attach a schedule reconciling the difference. Line 1 Total Premiums Enter total gross written premiums from NAIC, Schedule T. Line 2 None Taxable Premiums 2a. Enter all premiums from Federal employees health benefits. 2b. Enter all nontaxable Medicare premiums. 2c. Enter all other nontaxable premiums. Attach a separate itemized schedule. Line 4 Other Additions Enter other adjustments to the premiums include risk adjustment payments, broker fees, finance and service charges. Attach a separate itemized schedule. 1 Continued 2019 Form M11H Instructions (Continued) Line 8 Guaranty Fund Assessment Twenty percent of assessments (less any refunds) made and paid to the Minnesota Life and Health Guaranty Association or the Minnesota Insurance Guaranty Association are allowable offsets against the tax liability for the five years following the payment of the assessment. Contact our office if you have questions about carrying forward credits. Estimated Tax Payments If your estimated premium tax is more than $500, you must make estimated payments based on the entire estimated amount. To avoid an additional charge for underpaying the tax, your payments must be made on time and be at least one-fourth of the prior year’s total annual tax liability, or one-fourth of 80% of the current year’s total annual tax liability. Estimated payments are due quarterly on March 15, June 15, Sept. 15 and Dec. 15. When the due date falls on a weekend or legal holiday, payments made electronically or postmarked on the next business day are considered timely. Make a Payment Electronic Payments If your total insurance taxes and surcharges for the last 12-month period ending June 30 is $10,000 or more, you’re required to pay your tax electronically in all subsequent years. You must also pay electronically if you’re required to pay any Minnesota business tax electronically, such as sales or withholding tax. To pay electronically, go to the department’s website at www.revenue.state.mn.us and log in to e-Services. If you don’t have Internet access, call 1‑800-570-3329 to pay by phone. You’ll need your user name, password and bank routing and account numbers. When paying electronically, you must use an account not associated with any foreign banks. If you use other electronic payment methods, such as ACH credit method or Fed Wire, instructions are available on our website or by calling Business Registration Office at 651-282-5225 or 1-800-657-3605. Submit separate payments for each return. Check Payments If you’re not required to pay electronically and are paying by check, visit our website at www.revenue.state.mn.us and click on “Make a Payment” and then “By check” to create a voucher. Print and mail the voucher with a check made payable to Minnesota Revenue. When you pay by check, your check authorizes us to make a one-time electronic fund transfer from your account, and you may not receive your cancelled check. Note: If no amount is due or if you pay electronically, do not send in a voucher. Penalties and Interest Late Payment. If you do not pay all the tax due by the due date, a late payment penalty is due. The penalty is 5% of the unpaid tax for any part of the first 30 days the payment is late, and 5% for each additional 30-day period, up to a maximum of 15%. Late Filing. Add a late filing penalty to the late payment penalty if your return is not filed by the due date. The penalty is 5% of the unpaid tax. When added to the late payment penalty, the maximum combined penalty is 20%. Payment Method. If you’re required to pay electronically and do not, an additional 5% penalty applies to payments not made electronically, even if a paper check is sent on time. Interest. You must pay interest on the unpaid tax plus penalty from the due date until the total is paid. The interest rate for calendar year 2020 is 5%. The rate may change for future years. To figure how much interest you owe, use the following formula with the appropriate interest rate: Interest = (tax + penalty) × # of days late × interest rate ÷ 365 Mailing Your Return Mail your return and all required attachments to: Minnesota Department of Revenue Mail Station 1780 600 N. Robert St. St. Paul, MN 55145-1780 For express deliveries, use our street address: Minnesota Department of Revenue 600 N. Robert St. St. Paul, MN 55101 Continued 2 2019 Form M11H Instructions (Continued) Business Information Changes Be sure to let us know within 30 days if you change mailing addresses, phone numbers, or any other business information. To do so, to go our website, log in to e-Services and update your profile information. By notifying us, we will be able to let you know of any changes in Minnesota tax laws and filing requirements. Information and Assistance Website: www.revenue.state.mn.us Email: [email protected] Phone: 651-556‑3024 This material is available in other formats. For questions about licensing and regulations, contact the Minnesota Department of Health: Website: www.health.state.mn.us/facilities/insurance/managedcare/index.html Email: [email protected] Phone: 651-201-5100 or 1-800-657-3916 Fax: 651-201-5186 Worksheet Instructions Step 5 Payments of estimated tax are applied against any underpayments of required estimated payments in the order that the estimated payments were due. For example, if your first estimated payment is underpaid by $100 and you deposit $200 for your second estimated payment, $100 of your second payment is applied to the first estimated payment. The additional charge for the first estimated payment is computed from the first estimated payment’s due date to the date the second payment is made. Also, the second estimated payment will then be underpaid by $100 (assuming that the second payment is $200) until sufficient repayments are received to eliminate the underpayment. If more than one payment has been made for a required estimated payment, attach a separate computation for each payment. Credit the excess of any overpayment for a period on step 5 of the next payment period. Step 10 If there is no underpayment on step 7, enter “none” on step 10 for that period. Worksheet: Additional Charge for Underpaying Estimated Tax 1 Enter 80% of the total annual tax liability from line 7 of your 2019 Form M11H. If your tax liability was $500 or less, you do not owe an additional charge. . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Enter the amount from line 7 of your 2018 Form M11H. If you were not required to file a 2018 return, you do not owe an additional charge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 March 15 Due Dates June 15 Sept. 15 Dec. 15 3 Enter one-fourth of step 1 or step 2 (whichever is less) in each column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Amounts paid on or before the due date for each period. Include credits applied, such as prior year’s overpayment . . . . . . . . . . . . . . . . . . 4 5 Overpayment of previous installment (see worksheet instructions) . . . . 5 6 Add steps 4 and 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Underpayment (or overpayment). Subtract step 6 from step 3 . . . . . . . . 7 8 Date underpayment is paid or March 1, 2020, whichever is earlier . . . . . . 8 9 Number of days from the due date to the date on step 8 . . . . . . . . . . . . 9 10 Additional charge (step 9 ÷ 365 × interest (see below) × step 7) . . . . . 10 11 TOTAL. Add amounts in each column on step 10. Enter the result here and on Form M11H, line 10a . . . . . . . . . . . . . . . 11 If step 11 is zero, keep this worksheet for your records. Do not send it with your return. If it is more than zero, attach a copy of the worksheet to your Form M11H. Interest: 2019 = .05; 2020 = .05 3
Extracted from PDF file 2019-minnesota-form-m11h.pdf, last modified October 2012

More about the Minnesota Form M11H Individual Income Tax

We last updated the Insurance Premium Tax Return for HMOs in March 2020, and the latest form we have available is for tax year 2019. This means that we don't yet have the updated form for the current tax year. Please check this page regularly, as we will post the updated form as soon as it is released by the Minnesota Department of Revenue. You can print other Minnesota tax forms here.


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Other Minnesota Individual Income Tax Forms:

TaxFormFinder has an additional 95 Minnesota income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form M1 Instructions Minnesota Individual Income Tax Instructions (Form M1)
Form M1PR Instructions Homestead Credit Refund and Renter’s Property Tax Refund Instruction Booklet
Form M1 Individual Income Tax Return
Form M1NR Nonresidents/Part-Year Residents
Form M1M Income Additions and Subtractions (onscreen version)

Download all MN tax forms View all 96 Minnesota Income Tax Forms


Form Sources:

Minnesota usually releases forms for the current tax year between January and April. We last updated Minnesota Form M11H from the Department of Revenue in March 2020.

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About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Minnesota Form M11H

We have a total of eight past-year versions of Form M11H in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2019 Form M11H

2011 M11H, Insurance Premium Tax Return for HMOs

2018 Form M11H

2011 M11H, Insurance Premium Tax Return for HMOs

2017 Form M11H

2011 M11H, Insurance Premium Tax Return for HMOs

2016 Form M11H

2011 M11H, Insurance Premium Tax Return for HMOs

2015 Form M11H

2011 M11H, Insurance Premium Tax Return for HMOs

Insurance Premium Tax Return for HMOs 2014 Form M11H

2011 M11H, Insurance Premium Tax Return for HMOs

2013 Insurance Premium Tax Return and Instructions for HMOs 2013 Form M11H

2011 M11H, Insurance Premium Tax Return for HMOs

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