Form HCP-2 "Health Care Provider Tax Return - Nursing Facilities" - Rhode Island

What Is Form HCP-2?

This is a legal form that was released by the Rhode Island Department of Revenue - Division of Taxation - a government authority operating within Rhode Island. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2021;
  • The latest edition provided by the Rhode Island Department of Revenue - Division of Taxation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HCP-2 by clicking the link below or browse more documents and templates provided by the Rhode Island Department of Revenue - Division of Taxation.

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Download Form HCP-2 "Health Care Provider Tax Return - Nursing Facilities" - Rhode Island

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State of Rhode Island Division of Taxation
Form HCP-2
16113199990101
Health Care Provider Tax Return - Nursing Facilities
Name
Federal employer identification number
Address
For the month ending:
Address 2
License number
City, town or post office
State
ZIP code
E-mail address
Calculation of Amount Due:
1
Gross patient revenue received.........................................................................................................
1
2
Provider assessment due. Multiply line 1 times 5.50% (0.0550) .....................................................
2
Interest calculated at 1.5% per month. See instructions.....................
3
3
4
Penalty calculated at 10%. See instructions ......................................
4
5
Total interest and penalty amount. Add lines 3 and 4.......................................................................
5
6
TOTAL AMOUNT DUE. Add lines 2 and 5........................................................................................
6
INSTRUCTIONS
Line 1: Gross Patient Revenue - Enter the gross amount received
Line 4: Interest - Interest is calculated from the due date of the
on a cash basis by the provider from all patient care services pro-
return to the date of remittance at a rate of 18% per
vided on June 1, 1992 and thereafter. Charitable contributions,
annum. If remitting after the due date, multiply line 3
donated goods and services, fund raising proceeds, endowment
times 1.5% (0.015) times the number of months late.
support, income from meals on wheels, income from investments
and such other nonpatient revenues defined by the Tax Adminis-
Line 5: Penalty - If remitting after the due date, multiply line 3
trator upon the recommendation of the Department of Human
times 10% (0.10). Penalty is calculated at 10% of the
Services shall not be considered “gross patient revenue”.
provider assessment due.
Line 2: Rate - The applicable rate for a Nursing Facility is 5.50%
Line 6: Total Amount Due - Add lines 3, 4 and 5.
for services provided 1/1/2008 and thereafter.
Line 3: Provider Assessment Due - Multiply line 1 times line 2.
FORM HCP-2 is due on or before the 25th day of the month for the preceding month.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Authorized officer signature
Print name
Date
Telephone number
Paid preparer signature
Print name
Date
Telephone number
Paid preparer address
City, town or post office
State
ZIP code
PTIN
May the Division of Taxation contact your preparer? YES
Mail to RI Division of Taxation - One Capitol Hill - Providence, RI 02908
Revised 03/2021
State of Rhode Island Division of Taxation
Form HCP-2
16113199990101
Health Care Provider Tax Return - Nursing Facilities
Name
Federal employer identification number
Address
For the month ending:
Address 2
License number
City, town or post office
State
ZIP code
E-mail address
Calculation of Amount Due:
1
Gross patient revenue received.........................................................................................................
1
2
Provider assessment due. Multiply line 1 times 5.50% (0.0550) .....................................................
2
Interest calculated at 1.5% per month. See instructions.....................
3
3
4
Penalty calculated at 10%. See instructions ......................................
4
5
Total interest and penalty amount. Add lines 3 and 4.......................................................................
5
6
TOTAL AMOUNT DUE. Add lines 2 and 5........................................................................................
6
INSTRUCTIONS
Line 1: Gross Patient Revenue - Enter the gross amount received
Line 4: Interest - Interest is calculated from the due date of the
on a cash basis by the provider from all patient care services pro-
return to the date of remittance at a rate of 18% per
vided on June 1, 1992 and thereafter. Charitable contributions,
annum. If remitting after the due date, multiply line 3
donated goods and services, fund raising proceeds, endowment
times 1.5% (0.015) times the number of months late.
support, income from meals on wheels, income from investments
and such other nonpatient revenues defined by the Tax Adminis-
Line 5: Penalty - If remitting after the due date, multiply line 3
trator upon the recommendation of the Department of Human
times 10% (0.10). Penalty is calculated at 10% of the
Services shall not be considered “gross patient revenue”.
provider assessment due.
Line 2: Rate - The applicable rate for a Nursing Facility is 5.50%
Line 6: Total Amount Due - Add lines 3, 4 and 5.
for services provided 1/1/2008 and thereafter.
Line 3: Provider Assessment Due - Multiply line 1 times line 2.
FORM HCP-2 is due on or before the 25th day of the month for the preceding month.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Authorized officer signature
Print name
Date
Telephone number
Paid preparer signature
Print name
Date
Telephone number
Paid preparer address
City, town or post office
State
ZIP code
PTIN
May the Division of Taxation contact your preparer? YES
Mail to RI Division of Taxation - One Capitol Hill - Providence, RI 02908
Revised 03/2021