Form RCT-113B Gross Receipts Tax (Grt) Report - Managed Care Organization - Pennsylvania

Form RCT-113B is a Pennsylvania Department of Revenue form also known as the "Gross Receipts Tax (grt) Report - Managed Care Organization". The latest edition of the form was released in March 1, 2016 and is available for digital filing.

Download an up-to-date Form RCT-113B in PDF-format down below or look it up on the Pennsylvania Department of Revenue Forms website.

Step-by-step Form 113B instructions can be downloaded by clicking this link.

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1132016101
rct-113B
Date Received (Official Use Only)
PagE 1 of 2
(03-16)
groSS rEcEIPtS taX (grt) rEPort
c
ManagED carE organIZatIonS
Tax Year Begin:
Revenue ID
Federal ID (FEIN)
Parent Corporation (FEIN)
Tax Year End:
_ _
12 31 20
Due Date: March 15
Taxpayer Name
Check to Indicate a Change of Address
Send All Correspondence to the Preparer
First Line of Address
Amended Report (Include REV-1175.)
First Report
Second Line of Address
Payment Made Electronically
City
State
ZIP
Final Report (See Instructions.)
Phone
Out of Existence Date:
Email
USE wholE DollarS only
1.
Gross Receipts Tax Managed Care Organizations (Page 2, Line 2)
1.
2.
Total Estimated Payments
2.
3.
Total Payments Carried Forward From Prior Year Return
3.
4.
Total “Restricted” Tax Credits
4.
5.
Total Credit: (Line 2 plus Line 3 plus Line 4)
5.
6.
Tax Due: (If Line 1 is more than Line 5, enter the difference here.)
6.
7.
Remittance
7.
8.
Overpayment: (If Line 5 is more than Line 1, enter the difference here.)
8.
9.
Refund: (Amount of Line 8 to be refunded after offsetting all unpaid liabilities)
9.
10. Transfer: (Amount of Line 8 to be credited to the next tax year after offsetting
10.
all unpaid liabilities)
1132016101
corporate officer Information:
Social Security
Officer Last Name
Number of Officer
Officer First Name
Phone
Title of Officer
Email
I affirm under penalties prescribed by law, this report, including any accompanying schedules and statements, has been examined by me and to the best of my
knowledge and belief is a true, correct and complete report. If this report is an amended report, the taxpayer hereby consents to the extension of the assessment
period for this tax year to one year from the date of filing of this amended report or three years from the filing of the original report, whichever period last expires,
and agrees to retain all required records pertaining to that tax and tax period until the end of the extended assessment period, regardless of any statutory
provision providing for a shorter period of retention. For purposes of this extension, an original report filed before the due date is deemed filed on the due date.
I am authorized to execute this consent to the extension of the assessment period.
Signature of officer
Date
1132016101
rct-113B
Date Received (Official Use Only)
PagE 1 of 2
(03-16)
groSS rEcEIPtS taX (grt) rEPort
c
ManagED carE organIZatIonS
Tax Year Begin:
Revenue ID
Federal ID (FEIN)
Parent Corporation (FEIN)
Tax Year End:
_ _
12 31 20
Due Date: March 15
Taxpayer Name
Check to Indicate a Change of Address
Send All Correspondence to the Preparer
First Line of Address
Amended Report (Include REV-1175.)
First Report
Second Line of Address
Payment Made Electronically
City
State
ZIP
Final Report (See Instructions.)
Phone
Out of Existence Date:
Email
USE wholE DollarS only
1.
Gross Receipts Tax Managed Care Organizations (Page 2, Line 2)
1.
2.
Total Estimated Payments
2.
3.
Total Payments Carried Forward From Prior Year Return
3.
4.
Total “Restricted” Tax Credits
4.
5.
Total Credit: (Line 2 plus Line 3 plus Line 4)
5.
6.
Tax Due: (If Line 1 is more than Line 5, enter the difference here.)
6.
7.
Remittance
7.
8.
Overpayment: (If Line 5 is more than Line 1, enter the difference here.)
8.
9.
Refund: (Amount of Line 8 to be refunded after offsetting all unpaid liabilities)
9.
10. Transfer: (Amount of Line 8 to be credited to the next tax year after offsetting
10.
all unpaid liabilities)
1132016101
corporate officer Information:
Social Security
Officer Last Name
Number of Officer
Officer First Name
Phone
Title of Officer
Email
I affirm under penalties prescribed by law, this report, including any accompanying schedules and statements, has been examined by me and to the best of my
knowledge and belief is a true, correct and complete report. If this report is an amended report, the taxpayer hereby consents to the extension of the assessment
period for this tax year to one year from the date of filing of this amended report or three years from the filing of the original report, whichever period last expires,
and agrees to retain all required records pertaining to that tax and tax period until the end of the extended assessment period, regardless of any statutory
provision providing for a shorter period of retention. For purposes of this extension, an original report filed before the due date is deemed filed on the due date.
I am authorized to execute this consent to the extension of the assessment period.
Signature of officer
Date
1132016201
Revenue ID
rct-113B
PagE 2 of 2
(03-16)
SoUrcE of groSS rEcEIPtS
c
USE wholE DollarS only
1.
Gross Receipts from GRT MMCO Revenue Report issued by the
1.
Department of Public Welfare
2.
Managed Care Organizations GRT (Line 1 times tax rate - See Instructions.)
2.
Preparer’s Information:
1132016201
Firm Name
Individual Preparer Name
Firm FEIN
Phone
Address
Email
City
Social Security Number
or PTIN
State
ZIP
I affirm under penalties prescribed by law, this report, including any accompanying schedules and statements, has been prepared by me and to the best of
my knowledge and belief is a true, correct and complete report.
Signature of Preparer
Date

Download Form RCT-113B Gross Receipts Tax (Grt) Report - Managed Care Organization - Pennsylvania

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