Arkansas Insurance Department - Product Compliance Division

Form PEO-P: PEO Application

$1,000

• A list by jurisdiction of each name under which the PEO(s) has operated in the preceding five (5) years, including any fictitious names, alternative names, names of predecessors and, if known, successor business entities
• Controlling Person Exhibit for each controlling person
• A financial statement setting forth the financial condition of the PEO, as of a date not earlier than 180 days before the date the financial statement is submitted to the commissioner. The financial shall be prepared in accordance with generally accepted accounting principles, and unless the PEO provides financial assurance as set forth in Ark. Code Ann. §23-92-408(a)(2), the financial statement shall be audited by an independent certified public accountant licensed to practice in Arkansas or the state of domicile of the PEO.
• The states in which the applicant is currently doing business as a PEO
• A list of all licenses held by the applicant or its controlling persons
• If the applicant is organized under Arkansas law as a corporation, limited partnership or limited liability company, attach a copy the relevant certificate issued by the Secretary of State of Arkansas. If a partnership or sole proprietor doing business under an assumed name, please furnish a copy of any assumed name filing and indicate the county or counties in which it is filed.
• If the applicant is organized under the laws of another state as a corporation, limited partnership or limited liability company, attach a copy of the relevant certificate issued by the Secretary of State of Arkansas, evidencing the applicant’s authority to conduct business in the State of Arkansas
• Copies of all notices, pleadings, answers, complaints, orders that set out the allegations, the applicant’s defenses, the basis upon which the action was concluded (if applicable)
• A list of litigation pending against the applicant (if applicable)
• A specimen copy of the proposed contract between the applicant and its clients
• An explanation of any health benefits available to your employees
• An explanation of any other benefits that may be provided to the employee

Form PEO-PR: PEO Renewal Application

$1,000

Biennially by the date of issuance.

• A list by jurisdiction of each name under which the PEO(s) has operated in the preceding five (5) years, including any fictitious names, alternative names, names of predecessors and, if known, successor business entities
• Controlling Person Exhibit for each controlling person
• A financial statement setting forth the financial condition of the PEO, as of a date not earlier than 180 days before the date the financial statement is submitted to the commissioner. The financial shall be prepared in accordance with generally accepted accounting principles, and unless the PEO provides financial assurance as set forth in Ark. Code Ann. §23-92-408(a)(2), the financial statement shall be audited by an independent certified public accountant licensed to practice in Arkansas or the state of domicile of the PEO.
• The states in which the applicant is currently doing business as a PEO
• A list of all licenses held by the applicant or its controlling persons
• If the applicant is organized under Arkansas law as a corporation, limited partnership or limited liability company, attach a copy the relevant certificate issued by the Secretary of State of Arkansas. If a partnership or sole proprietor doing business under an assumed name, please furnish a copy of any assumed name filing and indicate the county or counties in which it is filed.
• If the applicant is organized under the laws of another state as a corporation, limited partnership or limited liability company, attach a copy of the relevant certificate issued by the Secretary of State of Arkansas, evidencing the applicant’s authority to conduct business in the State of Arkansas
• Copies of all notices, pleadings, answers, complaints, orders that set out the allegations, the applicant’s defenses, the basis upon which the action was concluded (if applicable)
• A list of litigation pending against the applicant (if applicable)
• A specimen copy of the proposed contract between the applicant and its clients
• An explanation of any health benefits available to your employees
• An explanation of any other benefits that may be provided to the employee

$0

Annually by the registration anniversary date.

Licensees must submit a financial statement setting forth the financial condition of the PEO, as of a date not earlier than 180 days before the date the financial statement is submitted to the commissioner. The financial shall be prepared in accordance with generally accepted accounting principles, and unless the PEO provides financial assurance as set forth in Ark. Code Ann. §23-92-408(a)(2), the financial statement shall be audited by an independent certified public accountant licensed to practice in Arkansas or the state of domicile of the PEO.

Form PC EL - Quarterly Report

$0

Within 45 days after the end of each calendar quarter.

Form PEO-E: Initial and Renewal PEO Exempt Application

$100

• A list by jurisdiction of each name under which the PEO(s) has operated in the preceding five (5) years, including any fictitious names, alternative names, names of predecessors and, if known, successor business entities
• The states in which the applicant is currently doing business as a PEO

Form PEO-E: Initial and Renewal PEO Exempt Application

$100

Biennially by the date of issuance.

• A list by jurisdiction of each name under which the PEO(s) has operated in the preceding five (5) years, including any fictitious names, alternative names, names of predecessors and, if known, successor business entities
• The states in which the applicant is currently doing business as a PEO

Form PEO-G: Group PEO Application

$1,000 per individual PEO affiliate applicant.

• A list by jurisdiction of each name under which the group or its related PEOs have operated in the preceding five (5) years, including any fictitious names, alternative names, names of predecessors and, if known, successor business entities
• Cross Guarantee Form
• Controlling Person Exhibit for each controlling person
• A financial statement setting forth the financial condition of the group, as of a date not earlier than one hundred eighty (180) days before the date the financial statement is submitted to the commissioner. The financial shall be prepared in accordance with generally accepted accounting principles, and unless the group provides financial assurance as set forth in Ark. Code Ann. §23-92-408(a)(2), the financial statement shall be audited by an independent certified public accountant licensed to practice in Arkansas or the state of domicile of the group. A group may submit combined or consolidated financial statements to meet this requirement but should indicate that the statements are combined or consolidated.
• The states in which the applicant or one or more of its affiliates is currently doing business as a PEO or group
• A list of all licenses held by the applicant or its controlling persons
• If the applicant is organized under Arkansas law as a corporation, limited partnership or limited liability company, attach a copy the relevant certificate issued by the Secretary of State of Arkansas. If a partnership or sole proprietor doing business under an assumed name, please furnish a copy of any assumed name filing and indicate the county or counties in which it is filed.
• If the applicant is organized under the laws of another state as a corporation, limited partnership or limited liability company, attach a copy of the relevant certificate issued by the Secretary of State of Arkansas, evidencing the applicant’s authority to conduct business in the State of Arkansas
• Copies of all notices, pleadings, answers, complaints, orders that set out the allegations, the applicant’s defenses, the basis upon which the action was concluded (if applicable)
• A list of litigation pending against the applicant (if applicable)
• A specimen copy of the proposed contract between the applicant and its clients
• If the group holding company also offers professional employer organization services directly to clients in addition to any provided by its members, attach a list of all clients
• An explanation of any health benefits available to your employees
• An explanation of any other benefits that may be provided to the employee

Form PEO-GR: Group PEO Renewal Application

$1,000 per individual PEO affiliate applicant.

Biennially by the date of issuance.

• A list by jurisdiction of each name under which the group or its related PEOs have operated in the preceding five (5) years, including any fictitious names, alternative names, names of predecessors and, if known, successor business entities
• Cross Guarantee Form
• Controlling Person Exhibit for each controlling person
• A financial statement setting forth the financial condition of the group, as of a date not earlier than one hundred eighty (180) days before the date the financial statement is submitted to the commissioner. The financial shall be prepared in accordance with generally accepted accounting principles, and unless the group provides financial assurance as set forth in Ark. Code Ann. §23-92-408(a)(2), the financial statement shall be audited by an independent certified public accountant licensed to practice in Arkansas or the state of domicile of the group. A group may submit combined or consolidated financial statements to meet this requirement but should indicate that the statements are combined or consolidated.
• The states in which the applicant or one or more of its affiliates is currently doing business as a PEO or group
• A list of all licenses held by the applicant or its controlling persons
• If the applicant is organized under Arkansas law as a corporation, limited partnership or limited liability company, attach a copy the relevant certificate issued by the Secretary of State of Arkansas. If a partnership or sole proprietor doing business under an assumed name, please furnish a copy of any assumed name filing and indicate the county or counties in which it is filed.
• If the applicant is organized under the laws of another state as a corporation, limited partnership or limited liability company, attach a copy of the relevant certificate issued by the Secretary of State of Arkansas, evidencing the applicant’s authority to conduct business in the State of Arkansas
• Copies of all notices, pleadings, answers, complaints, orders that set out the allegations, the applicant’s defenses, the basis upon which the action was concluded (if applicable)
• A list of litigation pending against the applicant (if applicable)
• A specimen copy of the proposed contract between the applicant and its clients
• If the group holding company also offers professional employer organization services directly to clients in addition to any provided by its members, attach a list of all clients
• An explanation of any health benefits available to your employees
• An explanation of any other benefits that may be provided to the employee

$0

Annually by the registration anniversary date.

Licensees must submit a financial statement setting forth the financial condition of the PEO, as of a date not earlier than 180 days before the date the financial statement is submitted to the commissioner. The financial shall be prepared in accordance with generally accepted accounting principles, and unless the PEO provides financial assurance as set forth in Ark. Code Ann. §23-92-408(a)(2), the financial statement shall be audited by an independent certified public accountant licensed to practice in Arkansas or the state of domicile of the PEO.

Form PC EL - Quarterly Report

$0

Within 45 days after the end of each calendar quarter.