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ARKANSAS DIRECT WRITTEN PREMIUMS AND COPAY- MENTS OF INSURERS, HMO’S, FMAA’S, AND OTHERS (total for preceding calendar year) $0 01-499,999 500,000-2,499,999 2,500,000-4,999,999 5,000,000-7,499,999 7,500,000-9,999,999 10,000,000-19,999,999 20,000,000-29,999,999 30,000,000-49,999,999 50,000,000-74,999,999 75,000,000-99,999,999 100,000,000 AND UP ANNUAL ADMINISTRATIVE AND FINANCIAL REGULA- TION FEE DUE STATE OF ARKANSAS $ 500 750 1,000 2,500 5,000 7,500 10,000 12,000 15,000 17,500 20,000 25,000

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