INSURERS AND OTHERS

IMPORTANT! Visit our Annual Statement Forms And Quarterly Filing Requirements page for other requirements.

NEWS: (1) The Arizona Retaliation Guide was last updated 4/1/2013 to include completed information for the State of Washington; (2) Tamika Walton was promoted to a position at the Arizona Department of Revenue. Until further notice, Chief Operating Officer Scott Greenberg shall address matters formerly addressed by Tamika Walton.

USE THE FOLLOWING STEPS TO PAY ANNUAL TAXES AND FEES:

1. IMPORTANT FIRST STEP: Open the attached Annual Taxes and Fees Data Sheet and print the one Data Sheet page (do not print the whole document) that contains information about the insurer/entity. Your Data Sheet page will tell you what you need to submit.
2. FEE ONLY: If you only need to pay a fee, either:
   1. Use OPTins to pay the fee electronically; OR,
   2. Enclose a copy of your Data Sheet page with your mailed payment, and print your NAIC number in the memo section of your payment.
3. TAX REPORT:
• If the Data Sheet instructs you to submit Form E-TAX, read the instructions in E-TAX-I (PDF), and download, save, complete and submit Form E–TAX (PDF) and all other required schedules and documents. Failure to pay an installment when due may result in the imposition of a civil penalty equal to the greater of $25 or 5% of the amount due, plus interest at a rate of 1% per month from the due date. ARS § 20–225.
• If the Data Sheet instructs you to submit a form other than Form E-TAX, complete, sign and submit that form with your payment.
  
  
ADDITIONAL REQUIREMENTS: If the information in the left column applies, follow the instructions in the right column:



If you are...	Then you must...
Amending a previously submitted filing	Select the "Amended Report" box on each form. This will allow you to enter in the "Amended Report" column and will calculate information in the "Difference" column. You must complete the "Original Report" column with information as you entered it on your previously submitted tax report and the "Amended Report" column with the correct information. If you are submitting a second or subsequent tax report amendment, the "Original Report" column must contain information from the "Amended Report" column of the last-submitted tax report. CRITICAL! Because information cascades within and among forms, you must complete and submit all parts of all forms when filing an amended report, even if no information on a form changed.
An insurer needing to report Arizona orphan premiums	Review E-TAX-I instructions, complete Form E–TAX (PDF) and provide relevant attachments as if you were an Arizona-authorized insurer EXCEPT include "(ORPHAN)" immediately before the insurer name on each page that requests "Name of Insurer." Download, save to your computer, and complete Form E–RT (PDF), AND Use the information in the Arizona Retaliation Guide (PDF) (updated 2/27/2013) that pertains to your domicile (or, for an alien insurer, port-of-entry state) when completing Form E–RT.
An accountable health plan reporting tax-exempt small-employer group health insurance premium	Download, save to your computer, complete and submit on CD–ROM or DVD with your E–TAX filing, or as an OPTins attachment as part of your E–TAX filing, the E–SGHI (XLS) workbook. If submitting a CD–ROM or DVD, write the following on the media: E–SGHI The entity's name The entity's NAIC number
A foreign/alien title insurer	Download, save to your computer, complete and submit Form E-TITLE (PDF) (instead of Form E-TAX).
A foreign/alien fraternal benefit society (domiciled outside Arizona)	Download, save to your computer, complete and submit Form E-FBS (PDF) (instead of Form E-TAX), AND Use the information in the Arizona Retaliation Guide (PDF) (updated 2/27/2013) that pertains to your domicile (or, for an alien society, port-of-entry state) when completing Form E–FBS. If your domicile charges an appointment fee, appointment renewal fee or appointment termination fee, you must download, save to your computer, complete and submit on CD-ROM or DVD, or as an OPTins attachment, the E–TAX–AGENTS (XLS) spreadsheet, and post the total from the spreadsheet on Form E–FBS. If submitting a CD-ROM or DVD, write the following on the media: E–TAX–AGENTS The entity's name The entity's NAIC number
A foreign/alien insurer (domiciled outside Arizona) including risk retention group	Download, save to your computer, complete and submit with your E-TAX filing Form E–RT (PDF), AND Use the information in the Arizona Retaliation Guide (PDF) (updated 2/27/2013) that pertains to your domicile (or, for an alien insurer, port-of-entry state) when completing Form E–RT, AND Include your domicile's addition to the rate of tax on Form E-RT: 2012 Additions to the Rate of Tax 2011 Additions to the Rate of Tax 2010 Additions to the Rate of Tax (updated 5/17/2013) If your domicile charges an appointment fee, appointment renewal fee or appointment termination fee, you must download, save to your computer, complete and submit on CD-ROM or DVD, or as an OPTins attachment, the E–TAX–AGENTS (XLS) spreadsheet, and post the total from the spreadsheet on Form E–RT. If submitting a CD-ROM or DVD, write the following on the media: E–TAX–AGENTS The entity's name The entity's NAIC number
A domestic insurer, captive insurer or risk retention group (domiciled in Arizona)	Download, save to your computer, complete and submit with your E-TAX filing the E–LRTF (XLS) workbook, AND Submit the completed E–LRTF workbook with required documentation on a CD–ROM or DVD, or as an OPTins attachment, by or before your tax report due date. If submitting a CD–ROM or DVD, write the following on the media: E–LRTF The entity's name The entity's NAIC number
Claiming one or more tax credits	Download, save to your computer, complete and submit with your E-TAX filing Form E–TC (PDF)
Claiming the Enterprise Zone Credit	Download and review the E-ZONE-I (PDF) instructions document. Submit the Enterprise Zone Credit Form A and Form A–2 (PDF) to the Arizona Commerce Authority by or before the date you file your tax report with the Department of Insurance and before the tax report due date (ARS § 41–1525(C)), AND Include with your E-TAX filing the documents you submit to the Arizona Commerce Authority, AND Download, save to your computer, complete and submit with your E-TAX filing on a CD–ROM or DVD, or as an OPTins attachment, the E-ZONE (XLS) workbook. If submitting a CD–ROM or DVD, write the following on the media: E–ZONE The entity's name The entity's NAIC number
An unaffiliated credit life and disablity reinsurer	If your fiscal year ends December 31, submit Form E–UCLDR (PDF) between July 1 and August 1; Otherwise, submit Form E–UCLDR (PDF) between July 1 and September 1.
A life care provider	See the "LIFE CARE PROVIDER" section of our Annual Statement Forms and Quarterly Filing Requirements web page.

• INSTALLMENTS: Each insurer that has a prior-year tax liability of $2,000 or more must file installment payments by the 15th of each month, March through August, of the current year. ARS § 20–224(E).
  Example: An insurer with a 2012 tax liability of $10,000 would be required to make $1,500 payments (15% X $10,000) by the 15th of March, April, May, June, July and August of 2013.
  • To pay installments, either:
    • Use the NAIC OPTins system, OR
    • Submit Form E–INSTALL (XLS) with a check or money order that shows your NAIC number in the memo section.
  • An insurer may pay more than one installment in a single payment.
  • Failure to pay an installment when due may result in the imposition of a civil penalty equal to the greater of $25 or 5% of the amount due, plus interest at a rate of 1% per month from the due date. ARS § 20–225.