All Self-Insured Employers in the State of Arizona on Tax Plan B are required to file the annual Self-Insured Employer - Annual Hospital Report Form on or before February 15. The “Hospital Report” is required of self-insurers that operate a hospital or direct medical care, pursuant to A.R.S. §23-1070.
The annual tax forms required for each tax plan are listed below for your convenience.
The Self-Insured Employer - Annual Hospital Report Instructions provide information on completing the Self-Insured Employer - Annual Hospital Report Form. See the Self-Insured Employer - Annual Tax Letter for a list of all the forms required for closing out the most recently completed tax year.
Annual Hospital Report Requirements are as follows:
- Lines 1 – 8 List the total cost of operations of the hospital for the calendar year
- Lines 9 – 13 List all revenue received by the hospital during the calendar year
- Lines 14 – 15 List the cash flow beginning of year and total cash available
- Lines 16 – 19 List the cash flow for the calendar year
Please direct questions regarding the Annual Hospital Report to [email protected] or call (602) 542-1836.
