Form RCT-121A-I General Information and Instructions for RCT-121A (RCT-121A-I)

PA Life and Health Insurance Guaranty Association Credit (P L 1125 No 399) A corporate officer must sign and date the tax report The signature must be original; photocopies or faxes will not be accepted Print the first and last name title Social Security number telephone number and email address of the corporate officer Accident and Health Insurance Line 10 Gross Direct Accident and Health Premiums Address Change All accounts are expected to remit estimated prepayments toward the final liability a corporation estimates is due for the taxable year Prepayment for gross premiums tax is due March 15 of the reported year Tax remaining due at the close of the taxable year must be paid on or before April 15 of the following year All tax calculations must be shown in whole dollar amounts An amount less than 50 cents Amended Report Amounts returned on policies cancelled or not taken An amended report must be filed within three years of the filed date of the original report The department may adjust the tax originally reported based on information from the amended report The taxpayer must consent to extend the assessment period If the amended report is timely filed and the taxpayer consented to extend the assessment period the time period in which to assess tax will be the greater of three years from the filed date of the original report or one year from the filed date of the amended report Annual Report Checklist: Make sure you include the following to file your annual report properly and completely: As the department transitions to an integrated tax system a 10 digit Revenue ID number will be assigned and communicated to each taxpayer A corporation s PA Tax Account ID will continue to be accepted by the department on tax forms and schedules but upon assignment of a 10 digit Revenue ID to a taxpayer the department will begin using the 10 digit Revenue ID on outbound cor respondence in lieu of referencing the Tax Account ID Calculation of taxable premiums as follows: Domestic casualty and domestic fire insurers will use Lines 1 through 5 and Lines 10 through 13 Cash Basis: Enter the direct premiums received; provide a schedule of taxable premiums Show the beginning and ending receivables and any other deductions or additions Casualty and Fire Insurance Line 1 Companies exempt from the tax include title insurance companies subject to the title insurance and trust companies shares tax; purely mutual beneficial associations whose funds for the benefit of members and families or heirs are made up entirely of the contributions from their members and the accumulated interest on those contributions; corporations organized under the Nonprofit Hospital Plan Act of 1937 (Act of June 21 1937 (P L 1948 No 378); and corporations organized under the Nonprofit Medical Osteopathic Dental and Podiatry Service Corporation Act of 1939 (Act of June 27 1939 (P L 1125 No 399) Act of 1937 (Act of June 21 1937 (P L 1948 No 378)); and corporations organized under the Nonprofit Medical Osteopathic Dental and Podiatry Service Corporation Act of 1939 (Act of June 27 1939 Complete RCT 121A Gross Premiums Tax Report for Domestic Casualty Life or Life Insurance Companies Associations or Exchanges CONTACT INFORMATION Copy of Schedule T from the annual report Copy of the Pennsylvania Business Page Corporate Officer Information Corporate officer s signature on Page 1 and preparer s signature and PTIN on Page 2 (if applicable) Correspondence to Preparer Current Period Overpayment Direct Premiums: Enter the difference of total direct premiums written reported on the Pennsylvania business page less ocean marine premiums less accident and health premiums Ocean marine premiums are reported on the RCT 124 and accident and health premi ums are reported below on Line 10 The direct premiums written as reported on the Pennsylvania business page already includes the adjustment for returned and cancelled policies Domestic life insurers will use Lines 6 through 13 Educational Improvement Tax Credit Electronic Payment Employment Incentive Payment Credit Employment incentive payment credits are not posted to the account prior to assessment therefore the account review state ment will reflect a debit balance until the credit is approved Schedule W must be attached to claim this credit Check the appro priate box if the corporate taxpayer is claiming the employment incentive payment credit Enter month day and year (MM DD YYYY) for the tax year beginning and enter year (YY) for the tax year end Enter the sum of Lines 5 9 and 13 Enter the total accident and health premiums from the Pennsylvania business page Enter the total life premiums from the Pennsylvania business page Enter Y in the block on Page 1 if all correspondence (notices and requests for additional information) is to be sent to the preparer s address If Y is entered the address recorded on Page 2 will be used Enter Y in the block on Page 1 if the address of the corporation has changed from prior tax periods The current mailing address should be reflected on the report Enter Y in the block on Page 1 if the corporate taxpayer is claiming the Keystone Opportunity Zone Credit the Keystone Opportunity Expansion Zone Credit or the Employment Incentive Payment Credit For these and all other restricted credits complete Line 4 on Page 1 Enter Y in the block on Page 1 if the taxpayer has made any electronic payments using e TIDES Enter Y in the block on Page 1 if this is the taxpayer s first PA gross premiums tax filing Enter Y in the block on Page 1 if this report will be the last report filed with the department Indicate the effective date of the event as MM DD YYYY Enter Y in the block on Page 1 if you are filing an amended report to add delete or adjust information Provide documentation to support all changes being made An amended report should only be filed if an original report was filed previously for the same period Estimated Payment Instructions Extension Request Due Date Extraordinary medical benefit premiums for coverage under 75 Pa C S 1715(a)(1 1) are not subject to the tax (See 75 Pa C S 1798 1(c)) First Report Gross premiums tax is imposed on insurance companies at a rate of 2 percent of gross premiums received from business conducted in Pennsylvania For more information see the Act of March 4 1971 (P L 6 No 2) HARRISBURG PA 17128 0407 HARRISBURG PA 17128 0701 If an overpayment exists on Page 1 of RCT 121A the taxpayer must instruct the department to refund or transfer overpayment as indicat ed below If you have general business tax questions call 717 787 1064 If you have questions regarding estimated payments call the Accounting Division at 717 705 6225 (Option 5 then Option 1 or 3) If you have questions regarding extensions call the Extension Unit at 717 787 2632 Requests can be faxed to 717 346 1958 If you have questions regarding payments or refunds call the Accounting Division at 717 705 6225 (Option 5 then Option 1 or 3) If you have questions regarding tax settlements assessments tax determinations or filing requirements call the Specialty Tax Unit at 717 783 6031 (Option 7 then Option 2) Imposition Base and Rate Include a copy of the regulatory authority s approval of the merger dissolution plan of reorganization and/or articles of merger Include information from the Pennsylvania Insurance Department verifying the taxpayer s insurance license expired was cancelled or not renewed KOZ/EIP Credit Last Report Life Insurance Line 11 Enter the dividends to policy holders from the Pennsylvania business page Line 12 Enter any other deductions A schedule detailing all other deductions must be provided Line 13 Taxable Accident and Health Premiums Enter the difference of Line 10 minus Lines 11 and 12 Line 14 Total Taxable Premiums Line 15 Tax Line 16 Enter the company s state of domicile Line 17 Enter the company s NAIC number Line 2 Enter the extraordinary medical benefit premiums Line 3 Enter the dividends to policy holders from the Pennsylvania business page Line 4 Enter any other deductions A schedule detailing all other deductions must be provided Line 5 Taxable Fire and Casualty Premiums Enter the difference of Line 1 minus Lines 2 3 and 4 Line 6 Gross Life Premiums (Direct Written Basis) Line 7 Enter the dividends to policy holders from the Pennsylvania business page Line 8 Enter any other deductions A schedule detailing all other deductions must be provided Line 9 Taxable Life Premiums Enter the difference of Line 6 minus Lines 7 and 8 Line by line instructions for RCT 121A are now available Mail payments extension requests and Tax Report RCT 121A to the following address: Multiply Line 14 by 0 02 Carry the tax to RCT 121A Page 1 Line 1a 1b or 1c (This is based on the company s original registration with the Pennsylvania Insurance Department) Neighborhood Assistance Program Tax Credit NEW FOR 2012 NOTE: If no option is selected the department will automatically transfer any overpayment to the next tax year for estimated tax pur poses after offsetting current period liabilities and other unpaid liabilities or commonwealth obligations within the account Notes and other obligations received by mutual insurance companies to secure contingent premium liabilities to the extent that no assessment has been made and collected against the notes or obligations One estimated payment coupon (REV 423) and one extension coupon (REV 426) will be used for all specialty taxes The coupons and the tax report (RCT 121A) will no longer be mailed They are available as fill in documents on the department s website at www revenue state pa us The coupons can be filed electronically through e TIDES at www etides state pa us However elec tronic filing of the tax report is not available The report should be completed using the computer based fill in form printed and sub mitted by mail to the department The form can be saved electronically for your records PA DEPARTMENT OF REVENUE PA Property and Casualty Insurance Guaranty Association (PIGA) Credit Page 2 Paid preparers must sign and date the tax report If the preparer works for a firm provide the name FEIN and address of the firm along with the name telephone number email address and PTIN/SSN of the individual preparing the report If the preparer is an individual without any association to a firm provide the name address telephone number email address and PTIN/SSN of the individual prepar ing the report Payment and Mailing Information Please do not duplicate requests for refund and/or transfer by submitting both RCT 121A and written correspondence PO BOX 280407 PO BOX 280701 Premiums received for reinsurance Preparer s Information Provide the Revenue ID number and FEIN of the surviving entity if applicable RCT 121A has been redesigned and is no longer year specific RCT 121A I (11 12) RCT 121A Line by Line Instruction Page 4 of 4 RCT 121A is available as a fill in form on the department s website at www revenue state pa us RCT 121A should be completed in the following order: Refund: Identify the amount to refund from the current tax period overpayment Prior to any refund the department will offset current period liabilities and other unpaid liabilities or commonwealth obligations within the account REMINDER Remittance should include tax plus interest and penalty if applicable Penalty and interest calculators can be found at www revenue state pa us Payments of $10 000 or more must be remitted electronically For more information on electronic filing options visit www etides state pa us Payments under $10 000 may be remitted by mail made payable to the PA Department of Revenue Report Due Date Requests can also be submitted in writing to the following address: Requests for Refund or Transfer of Available Credit Requests for refund or transfer of available credit from prior periods can be faxed on company letterhead signed by an authorized repre sentative to 717 705 6227 Requests for transfer of credit may be faxed to the Accounting Division at 717 705 6227 Research Enhancement and Protection Tax Credit REV 1175 Schedule AR (explanation for amending) must be included when filing an amended report Revenue ID Federal Employer Identification Number (FEIN) Parent Corporation FEIN Name and Address Revenue ID: For the 2012 tax year a corporation s Revenue ID is its seven digit PA Tax Account ID OR a new unique 10 digit number assigned by the department to a taxpayer separate from any federally issued identification number(s) or Pennsylvania license number(s) Should a corporation realize estimated tax is underpaid additional payments should be submitted to minimize underpayment penalty Underpayment is measured against 90 percent of the tax reported due for the taxable year However if the final total tax increases the self reported tax by 10 percent or more the underpayment will be measured against 90 percent of the final total tax The period of underpayment is measured from the due date of the installment to the date the underpayment is paid or the date the safe harbor is sat isfied A corporation may avoid interest charges by timely paying estimated tax equal to the liability in the second prior taxable year (safe harbor) This amount must be adjusted to reflect the tax rate and law for the estimated tax year and must reflect the total liabil ity if it exceeds the self reported liability by 10 percent or more Where the second prior year is a short period the safe harbor is annu alized Second year corporations may use the immediate prior year (annualized if necessary) as the base year for the safe harbor Mail the estimated payment coupon (REV 423) separately from all other forms Step 1 Complete the taxpayer information and any applicable questions at the top of Page 1 Step 2 Indicate the type of insurance company on Page 1 Domestic Casualty Domestic Fire or Domestic Life This is based on the com pany s original registration with the Pennsylvania Insurance Department This information is required Step 3 Enter the Revenue ID number and other taxpayer information in the designated fields at the top of each page Step 4 Complete Page 2 Step 5 Complete Page 1 Tax Liability Payment and Overpayment sections Step 6 Complete the corporate officer information section sign and date at the bottom of Page 1 Step 7 Complete the preparer information section sign and date at the bottom of Page 2 if applicable Step 8 Mail the completed report and any supporting schedules to the PA Department of Revenue Tax Year The following credits are available against gross premiums tax: The following may be deducted from taxable premiums: The portion of advanced premiums premium deposits or assessments returned in cash or credited to members or policyholders upon the expiration or termination of their contracts (in the case of mutual insurance companies associations exchanges and stock com panies with participating features) The Revenue ID number FEIN name and complete mailing address must be provided If the taxpayer is a subsidiary of a corporation the parent corporation s FEIN must be provided Also provide the telephone number and email address of the taxpayer This report is due April 15 for the preceding year ended Dec 31 If April 15 falls on a Saturday Sunday or holiday the report is due the next business day A penalty for late filing will be imposed as follows and assessed at the time of filing: 10 percent of the first $1 000 of tax liability 5 percent of the next $4 000 of tax liability and 1 percent on any tax liability in excess of $5 000 To claim a credit for a PA Life and Health Insurance Guaranty Association assessment submit a copy of the assessment invoice certificate of contribution for the first year the credit is claimed Submit all pages Include a copy of the Pennsylvania Business Page Schedule T for the year immediately preceding the year of the assessment and a schedule of all credits claimed for each type of assessment (i e life insurance accident and health insurance annuity) Note this credit is only allowed for policies that guarantee premium rates without increase To confirm account payments call 1 888 PATAXES (1 888 728 2937) To make payments and file extensions electronically visit e TIDES at www etides state pa us For additional information and assistance with electronic payments and extensions call 717 705 6225 (Option 5 then Option 2) To request a due date extension of up to 60 days to file the annual report you must file an extension request (REV 426) by the original report due date However an extension of time to file does not extend the deadline for payment of tax and an extension request must be accompanied by payment of taxes owed for the taxable year for which the extension is requested Mail the extension coupon separately from all other forms A taxpayer using an electronic method to make a payment with an extension request should not submit the extension coupon Do not use the extension coupon to remit other unpaid liabilities or commonwealth obligations within the account Transfer: Identify the amount to transfer from the current tax period overpayment to the next tax period for estimated tax purposes Prior to any transfer the department will offset current period liabilities and other unpaid liabilities or commonwealth obligations within the account When filing an amended report record the amended tax liability on Page 1 Line 1a 1b or 1c REV 1175 Schedule AR must be included when filing an amended report will be eliminated and an amount of 50 cents or more will be rounded to the next dollar