Pennsylvania Gross Premiums Tax Report

Gross Premiums Tax Report
Gross Premiums Tax - Foreign Casualty or Foreign Fire Insurance Companies (RCT-121C)
IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
FILL IN FORM USING ALL CAPS. DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.

1213022105

OFFICIAL USE ONLY

rct-121c

03-23 (FI)

Date Received (Official Use Only)

Page 1 of 4

gross Premiums taX - foreigN casuaLtY
or foreigN fire iNsuraNce comPaNies
START

c

Tax Year Begin:
Revenue ID

Federal ID (FEIN)

➜

Parent Corporation (FEIN)
Tax Year End:

12/31/20_ _
Due Date: april 15
Please select correct letter in drop down
Taxpayer Name

Check to Indicate a Change of Address
Amended Report (Include REV-1175.)
First Report
New PLHIGA Credit
As Originally Registered with PA Dept. of
Insurance: Foreign Casualty = A Foreign Fire = B

First Line of Address
Second Line of Address
City

State

ZIP
Final Report (See Instructions.)

Phone
Out of Existence Date:
Email

use whoLe DoLLars oNLY
1a.
1b.
1c.
1d.

Foreign
Foreign
Foreign
Foreign

Casualty Gross Premiums Tax (Page 2, Line 11)
Casualty Retaliatory (Page 2, Line 12)
Fire Gross Premiums Tax (Page 2, Line 11)
Fire Retaliatory (Page 2, Line 12)

1e.
2.
3.
4.
5.
6.
7.
8.
9.

Total Insurance Premiums Tax Liability (Line 1a plus Line 1b plus Line 1c plus Line 1d)
Total Estimated Payments
Total Payments Carried Forward From Prior Year Return
Total “Restricted” Tax Credits
Total Credit: (Line 2 plus Line 3 plus Line 4)
Tax Due: (If Line 1e is more than Line 5, enter the difference here.)
Remittance
Overpayment: (If Line 5 is more than Line 1e, enter the difference here.)
Refund: (Amount of Line 8 to be refunded after offsetting all unpaid liabilities)

10. Transfer: (Amount of Line 8 to be credited to the next tax year after offsetting
all unpaid liabilities)

1a.
1b.
1c.
1d.
1e.
2.
3.
4.
5.
6.
7.
8.
9.
10.

1213022105

corporate officer information:

Officer Last Name

Social Security
Number of Officer

Officer First Name
Title of Officer

Phone
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.vI
am authorized to execute this consent to the extension of the assessment period.

signature of officer

Date
Signature of Officer – Please sign after printing

Reset Entire Form

RETURN TO TOP

NEXT PAGE

PRINT FORM

FILL IN FORM USING ALL CAPS.DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.

1213022205

rct-121c

03-23 (FI)

Revenue ID

Page 2 of 4

attach a coPY of the PeNNsYLVaNia BusiNess Page aND scheDuLe t of
the aNNuaL rePort fiLeD with the PeNNsYLVaNia iNsuraNce DePartmeNt

use whoLe DoLLars oNLY

c

casualty and fire insurance
1.
2.
3.
4.
5.

Gross Direct Premiums Received less Cancellations and Premiums Returned
Extraordinary Medical Benefit Premiums (Include footnote, see instructions.)
Dividends to Policy Holders
Other Deductions (Attach Schedule.)
Taxable Fire and Casualty Premiums (Line 1 minus Lines 2, 3 and 4)

1.
2.
3.
4.
5.

accident and health insurance
6.
7.
8.
9.
10.
11.
12.

Gross Direct Accident and Health Premiums
Dividends to Policy Holders
Other Deductions (Attach Schedule.)
Taxable Accident and Health Insurance Premiums (Line 6 minus Lines 7 and 8)
Total Taxable Premiums (Add Lines 5 and 9)
Tax (Line 10 times tax rate - See Instructions.)
Retaliatory (From Page 3, Line 12)

6.
7.
8.
9.
10.
11.
12.

if registered with the Pa Department of insurance as a foreign casualty insurance company, enter Line 11 on Page 1, Line 1a and enter
Line 12 on Page 1, Line 1b. if registered with the Pa Department of insurance as a foreign fire insurance company, enter Line 11 on Page
1, Line 1c, and enter Line 12 on Page 1, Line 1d.

13.
14.

13. State of Domicile
14. NAIC Number

1213022205

Preparer’s information:
Individual Preparer Name
Phone
Email
Social Security Number
or PTIN

Firm Name
Firm FEIN
Address
City
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
Signature of Preparer – Please sign after printing

Reset Entire Form

RETURN TO PAGE 1

NEXT PAGE

PRINT FORM

FILL IN FORM USING ALL CAPS.DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.

1213022305

rct-121c

03-23 (FI)

Revenue ID

Page 3 of 4

retaLiatorY worKsheet - scheDuLe of taXes, assessmeNts,
LiceNses aND fees

c

use whoLe DoLLars oNLY

PeNNsYLVaNia

state of DomiciLe

Premiums taxes
1.
2.
3.
4.
5.
6.

Casualty and Fire Premiums Tax
Ocean Marine Gross Profit Tax
Life Premiums Tax
Annuities Tax
Accident and Health Premiums Tax
Reinsurance Assumed from
Unauthorized Companies
7. Other Taxes (Add schedule itemizing
by type.)
8. Worker’s Compensation Assessments
(Add schedule itemizing by type.)
9. Other Assessments (Include copies of
assessments.)
10. Licenses and Fees (Annual basis, add
schedule itemizing by type.)
11. Totals (Add Line 1 through Line 10)

1a.
2a.
3a.
4a.
5a.

1b.
2b.
3b.
4b.
5b.

6a.

6b.

7a.

7b.

8a.

8b.

9a.

9b.

10a.
11a.

10b.
11b.

12. Retaliatory payable to the PA Department of Revenue (11b minus 11a)
13. How many agents are licensed to represent your company in Pennsylvania during
the tax year?
14. What are your total state fees for licensing agents of similar Pennsylvania insurers?
Provide schedule with a detailed breakdown.
15. Are the fees in Line 14 imposed on the company (Enter “C”) or the agent
(Enter “A”)? If “C” is entered, include Line 14 on Line 10b above. Include total agent
licensing fees paid to PA during the tax year on Line 10a above.

12.

13.
14.
15.

1213022305

1213022305

1213022305
Reset Entire Form

RETURN TO PAGE 1

PREVIOUS PAGE

NEXT PAGE

PRINT FORM

FILL IN FORM USING ALL CAPS.DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.

1213022405

rct-121c

03-23 (FI)

Revenue ID

Page 4 of 4

rct-121c PLhiga caLcuLatioN worKsheet

schedule of guaranteed Premiums
Accident & Health

Life

Annuity

Guaranteed
Non-Guaranteed
Total
guaranteed Premiums are those premiums in which the premium rates are guaranteed during the continuance of the respective policies without a
right exercisable by the company to increase said premium rates. 40 P.S. § 991.1711(b)
Use the PA Business Page for the year immediately preceeding the year of the assessment to complete the Schedule of Guaranteed Premiums.

PLhiga credit calculation
Accident & Health Amount

Prior Year Class B Assmnt. Date

Life Amount

Annuity Amount

Total of Assessments
Guaranteed Premiums
Total Premiums
Proportion of Qualified Premiums =
(carry to six decimal places)
Total of Assessment

Total Credits Allowed

X

Proportion of Qualified Premiums

=

Accident & Health

X

=

Life

X

=

Annuity
Prior Year class-a
administrative assessment

X

1.000000

=

X

1.000000

=

Total Credit Allowed

totaL
total credit allowed Per Year
Total Credit Allowed

X

20%

=

X

20%

=

Total Credit Per Year (Limited to 2% Tax) Carry to Current Year Total Below

in order to claim a credit, you must complete the above calculations aND include a copy of the assessment summary, assessment detail,
proof of payment paying the assessment and Pa Business Page and schedule t for the year immediately preceding the year of the assessment. failure to complete the worksheet and provide the required documentation will result in the denial of the credit.

history of Prior credits already approved
Amount Previously Approved

Assessment Year

Current Year Total
Total credits. Enter on Page 1, Line 4

1213022405
Reset Entire Form

RETURN TO PAGE 1

PREVIOUS PAGE

1213022405
NEXT PAGE

PRINT FORM

instructions for rct-121c

Gross Premiums Tax - Foreign Casualty or Foreign Fire Insurance Companies

RCT-121C IN 10-23

HIGHLIGHTS
● The RCT-121C can now be filed electronically at
mypath.pa.gov.
● All RCT-121C gross premiums taxpayers are required
to make an annual estimated prepayment of tax.
Failure to do so will result in an assessment of
Underpayment Interest and could result in the taxpayer
losing operating authority in the state of Pennsylvania.
For further guidance, refer to the “Estimated Payment
Instructions” on Page 3.
● Worksheet for PLHIGA calculation (Page 4 of RCT121C). In order to claim a credit for a PA Life and
Health Insurance Guaranty Association Assessment,
the PLHIGA calculation worksheet (Schedule of
Guaranteed Premiums and PLHIGA Credit Calculation)
must be completed.
● History of Prior Credits Already Approved Section
added to PLHGIA Calculation Worksheet. Complete
this section with credits claimed for the current year
plus prior 4 years to arrive at your total PLHIGA credit
claimed on Page 1 of this report.

GENERAL INFORMATION
REMINDER
● Reports should NOT be mailed to the PA Department
of Insurance – this will delay the processing of your
report and does not satisfy the filing requirements.
Please see the payment and mailing information section to find the correct mailing address for the PA
Department of Revenue.
● All payments of $1,000 or more must be made electronically or by certified or cashier’s check remitted in
person or by express mail courier.
● Use only whole dollars when preparing tax reports.
● The REV-423, estimated payment coupon, and REV426, extension coupon, can be filed electronically
through myPATH at mypath.pa.gov. These coupons
are also available on the department's website at
revenue.pa.gov.
NOTE: The automatic PA extension provided by
Act 52 of 2013 to those with valid federal extensions DOES NOT apply to this tax.
● The penalty imposed for failure to file timely reports is
now a minimum of $500, regardless of the determined
tax liability, plus an additional 1 percent of any determined tax liability over $25,000.

● Use ONLY the most current, non-year-specific tax form
and instructions for filing ALL years. If an amended
report must be filed, taxpayers must use the most
current, non-year-specific tax form, completing all
sections of the form. REV-1175, Schedule AR
(explanation for amending), must be included when
an filing an amended report.
ANNUAL REPORT CHECKLIST
Make sure you include the following to file your annual
report properly and completely:
● Negative amounts must be written using a minus sign
preceding the number. Do not use parentheses.
● Complete RCT-121C, Gross Premiums Tax Report for
Foreign Casualty or Foreign Fire Insurance Companies,
Associations or Exchanges
● Copy of the Pennsylvania Business Page
● Copy of Schedule T from the Annual Report
● Provide a copy of the domicile state’s tax report substituting Pennsylvania values for domicile state’s values.
Please indicate the report as a “Pro-Forma Report with
PA Values.”
● Corporate officer’s signature on Page 1 and preparer’s
signature and PTIN on Page 2 (if applicable)
IMPOSITION, BASE, AND RATE
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).
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)).
To claim the deduction for extraordinary medical benefit
premiums, you must include the policy numbers and premium
amounts for any deduction taken. Schedule T should also
include a footnote to report the premiums.
The following may be deducted from taxable premiums:
● Amounts returned on policies cancelled or not taken
● Premiums received for reinsurance
● 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 companies
with participating features)

www.revenue.pa.gov
PREVIOUS PAGE

RCT-121C
NEXT PAGE

1

● 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.
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 Non-profit 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, (P.L. 1125, No.399).
REVENUE ID, FEDERAL EMPLOYER IDENTIFICATION
NUMBER (FEIN), PARENT CORPORATION FEIN, NAME,
AND ADDRESS
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
of the taxpayer.

all sections of the report. This includes those sections
originally filed and those sections being amended. All tax
liabilities should be recorded on Page 1. Taxpayers must
check the Amended Report check box on Page 1 and include
Schedule AR, REV-1175, with the report.
FIRST REPORT
Enter “Y” in the block on Page 1 if this is the taxpayer’s first
PA gross premiums tax filing.
PLHIGA CREDIT
Enter “Y” in the block on Page 1 if the corporate taxpayer is
claiming a new PA Life and Health Insurance Guaranty
Association Credit. Complete the PLHIGA Calculation
Worksheet on Page 4.
The following credits are available against gross premiums
tax:
● PA Life and Health Insurance Guaranty Association
(PLHIGA) Credit

°

TAX YEAR
Enter month, day, and year (MMDDYYYY) for the tax year
beginning and enter year (YY) for the tax year end.
REPORT DUE DATE
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. The penalty imposed
for failure to file timely reports is now a minimum of $500,
regardless of the determined tax liability, plus an additional
1 percent of any determined tax liability over $25,000.
ADDRESS CHANGE
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.
AMENDED REPORT
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.
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.
Regardless of the tax year being amended, taxpayers must
use the most current non-year-specific tax form, completing
2

RCT-121C

CAUTION: In order to claim a credit for a PA
Life and Health Insurance Guaranty
Association Assessment, the PLHIGA calculation
worksheet (Schedule of Guaranteed Premiums
and PLHIGA Credit Calculation) must be completed.
Submit a copy of the assessment summary and
assessment detail. Provide a proof of payment indicating the assessment was paid. Include a copy of
the Pennsylvania Business Page and Schedule T
for the year immediately preceding the year of the
assessment. Also include a schedule with a
detailed breakdown of all PLHIGA credits claimed
on RCT-121C, Page 1, Line 4.

● Neighborhood Assistance Credit
● Educational Improvement Tax Credit
● PA Property and Casualty Insurance Guaranty
Association (PIGA) Credit

°

PIGA credits are not available until there have been
sufficient billings to create a credit. Billings must
exceed 1 percent of the base year. For additional
information, please contact the PA Property and
Casualty Insurance Guaranty Association at
215-568-1007.

● Research Enhancement and Protection Tax Credit
RETALIATORY INFORMATION SCHEDULE
Retaliatory fees are imposed on foreign insurance companies under Section 212 of the Insurance Company Law
of 1921 (P.L. 682, No. 284). Such fees are reported and
remitted to the Department of Revenue.
Foreign insurance companies must complete the
Retaliatory Information Schedule on Page 3 of RCT-121C,
furnishing sufficient detail to enable the Department of
Revenue to calculate the retaliatory fee. For each premiums-based tax, show the tax rate and all items used in
determining the taxable amount, including gross premiums,
return premiums, and dividends to policyholders. Include
reinsurance assumed from unlicensed insurers if your state
of domicile imposes a base tax on net direct premiums plus
reinsurance assumed from unlicensed insurers.
www.revenue.pa.gov

PREVIOUS PAGE

NEXT PAGE

Any retaliatory fee in excess of the amount submitted and
due with the filing of the report is due when the debtor
receives a copy of the assessment. If your state of
incorporation imposes a franchise or income tax, submit a
copy of the tax report as filed in your state, along with a copy
of the tax report on which Pennsylvania totals are substituted
for your state totals. Please submit this information to
Pennsylvania within 30 days of filing in your state.
Payment for renewal of certificate of authority and filing fees
should be made using a separate check only after a bill is
received from the Pennsylvania Insurance Department.
Include with the Retaliatory Information Schedule, a copy of
the Pennsylvania Business Page, Schedule T filed with the
Pennsylvania Insurance Department and all supporting
documentation.

harbor” tax year liability. The “safe harbor” tax year is the
second preceding year to the current tax year. For example,
the “safe harbor” year for purposes of making the 2019 estimated prepayment is tax year 2017.
EXTENSION REQUEST DUE DATE
To request a due date extension of up to 60 days to file the
annual report, you must file an extension request by the
original report due date. You can request an extension on
mypath.pa.gov or by sending the REV-426. 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.

FINAL REPORT
● Enter “Y” in the block on Page 1 if this report will be the
final report filed with the department. Indicate the effective date of the event as MMDDYYYY.

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 within the account.

● Include information from the Pennsylvania Insurance
Department verifying the taxpayer’s insurance license
expired, was cancelled, or not renewed.

PAYMENT AND MAILING INFORMATION
All payments of $1,000 or more must be made electronically
or by certified or cashier’s check mailed to:

● Include a copy of the regulatory authority’s approval of
the merger, dissolution, plan of reorganization, and/or
articles of merger.
● Provide the Revenue ID and FEIN of the surviving entity,
if applicable.
CORPORATE OFFICER INFORMATION
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 of the corporate
officer.
PREPARER’S INFORMATION
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, 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,
and PTIN/SSN of the individual preparing the report.
ESTIMATED PAYMENT INSTRUCTIONS
The full amount of the required prepayment for gross
premiums tax is due on or before 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.
Mail the estimated payment coupon, REV-423, separately
from all other forms.
If you have questions regarding estimated payments, email
the department at [email protected].
ESTIMATED PAYMENT SAFE HARBOR
The gross premiums tax prepayment MUST be equal to
90 percent of the current tax year liability. However, taxpayers are eligible to use the “safe harbor” option in the event
they cannot accurately estimate their current year liability.
The prepayment requirement will be satisfied if the taxpayer prepays an amount equal to 100 percent of their “safe

PA DEPARTMENT OF REVENUE
PO BOX 280404
HARRISBURG PA 17128-0404
Tax returns and certified or cashier’s check may be remitted
in person or by express mail courier. Mail payments and
returns to the following address:
PA DEPARTMENT OF REVENUE
1854 BROOKWOOD ST
HARRISBURG PA 17104
Payments under $1,000 may be remitted by mail, made
payable to the PA Department of Revenue. Mail payments,
extension requests and returns to the following address:
PA DEPARTMENT OF REVENUE
PO BOX 280427
HARRISBURG PA 17128-0427
Failure to make a payment by an approved method will result
in the imposition of a 3 percent penalty of the tax due, up to
$500. For more information on electronic filing options, visit
mypath.pa.gov.
NOTE: Reports should NOT be mailed to the PA
Department of Insurance – this will delay the processing of your report and does not satisfy the filing requirements.
CURRENT PERIOD OVERPAYMENT
If an overpayment exists on Page 1 of RCT-121C, the taxpayer must instruct the department to refund or transfer
overpayment as indicated below.
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 within
the account.

www.revenue.pa.gov
PREVIOUS PAGE

RCT-121C
NEXT PAGE

3

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 within
the account.

STEP 7
Complete Page 1, Lines 1 through 10.

NOTE: If no option is selected, the department will
automatically transfer any overpayment to the next
tax year for estimated tax purposes after offsetting current
period liabilities and other unpaid liabilities within the
account.

STEP 9
Complete the preparer information section, sign, and date
at the bottom of Page 2, if applicable.

REQUESTS FOR REFUND OR TRANSFER
OF AVAILABLE CREDIT
Requests for refund or transfer of available credit from prior
periods can be requested on company letterhead, signed
by an authorized representative, and emailed to
[email protected].
Please do not duplicate requests for refund and/or transfer
by submitting both RCT-121C and written correspondence.

CONTACT INFORMATION
● For additional information regarding electronic payments
visit the departments Online Customer Service Center
at revenue.pa.gov.
● Questions regarding payments or refunds, email
[email protected].
● General business tax questions, visit the department's
Online Customer Service Center at revenue.pa.gov.
● Business taxpayers and tax practitioners have the ability
to receive and view department issued electronic
statement of accounts and correspondence
electronically by visiting mypath.pa.gov.

LINE INSTRUCTIONS
RCT-121C should be completed in the following order:
(Page instructions start with Page 2 below.)
STEP 1
Complete the taxpayer information and any applicable
questions at the top of Page 1. If claiming a PLHIGA credit, you must check the box on Page 1.
STEP 2
Indicate the type of insurance company on Page 1, Foreign
Casualty or Foreign Fire. This is based on the company’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, Lines 1 through 11.
STEP 5
Complete Page 3, Retaliatory Worksheet.
STEP 6
Complete Page 2, Lines 12 through 14.
4

RCT-121C

STEP 8
Complete the corporate officer information section, sign, and
date at the bottom of Page 1.

STEP 10
Mail the completed report and any supporting schedules to
the PA Department of Revenue.

PAGE 2
CASUALTY AND FIRE INSURANCE

LINE 1
DIRECT PREMIUMS
Enter the gross direct premiums received, less cancellations,
and returned premiums from the Pennsylvania business page.
Total direct premiums written from the Pennsylvania business
page less ocean marine premiums, less accident and health
premiums (accident and health premiums apply to Line 6.)
OR
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.

LINE 2
Enter the extraordinary medical benefit premiums. To claim
the deduction for extraordinary medical benefit premiums,
you must include the policy numbers and premium amounts
for any deduction taken. PA Business Page must also
include a footnote to report the 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.
ACCIDENT AND HEALTH INSURANCE

LINE 6
GROSS DIRECT ACCIDENT AND HEALTH PREMIUMS
Enter the total accident and health premiums from the
Pennsylvania business page.
www.revenue.pa.gov

PREVIOUS PAGE

NEXT PAGE

LINE 7
Enter the dividends to policy holders from the Pennsylvania
business page.

LINE 5
ACCIDENT AND HEALTH PREMIUMS TAX
5a.

Enter the Pennsylvania tax (PA taxable premiums times
PA tax rate).

5b.

Enter the domicile state tax (PA taxable premiums times
domicile state tax rate).

LINE 8
Enter any other deductions. A schedule detailing all other
deductions must be provided.

LINE 6

LINE 9
TAXABLE ACCIDENT AND HEALTH PREMIUMS
Enter the difference of Line 6 minus Lines 7 and 8.

LINE 10
TOTAL TAXABLE PREMIUMS
Enter the sum of Lines 5 and 9.

LINE 11
TAX
Multiply Line 10 by 0.02. Carry the tax to RCT-121C Page
1, Line 1a or 1c (This is based on the company’s original
registration with the PA Insurance Department).

REINSURANCE ASSUMED FROM UNAUTHORIZED
COMPANIES
6a.

Enter the Pennsylvania figure.

6b.

Enter the domicile state figure.

LINE 7
OTHER TAXES
(Include schedule of itemized taxes by type and amount for
PA and domicile state.)
7a.

Enter the total of other Pennsylvania taxes.

7b.

Enter the total of other domicile state taxes.

PAGE 3
RETALIATORY WORKSHEET

LINE 1
CASUALTY & FIRE PREMIUMS TAX
1a. Enter the Pennsylvania tax (PA taxable premiums times
PA tax rate).
1b.

Enter the domicile state tax (PA taxable premiums times
domicile state tax rate).

LINE 2
OCEAN MARINE GROSS PROFIT TAX
2a. Enter the Pennsylvania ocean marine tax per the RCT124 tax report.
2b.

WORKER’S COMPENSATION ASSESSMENTS
(Include schedule of itemized assessments by type and
amount for domicile state.)
8a.

Enter the total of allowable PA Worker’s Compensation
Assessments.

8b.

Enter the domicile state assessments.

LINE 9
OTHER ASSESSMENTS
(Include copies of assessments for PA and domicile state.)
9a.

Enter the total of otherPennsylvania assessments.

9b.

Enter the total of other domicile state assessments.

Enter the domicile state ocean marine tax, if applicable.

LINE 3
LIFE PREMIUMS TAX
3a. Enter the Pennsylvania tax (PA taxable premiums times
PA tax rate).
3b.

LINE 8

Enter the domicile state tax (PA taxable premiums times
domicile state tax rate).

LINE 10
LICENSES AND FEES ON AN ANNUAL BASIS
(Include schedule of itemized licenses and fees by type and
amount for PA and domicile state.)
10a. Enter the Pennsylvania licenses and fees.
10b. Enter the domicile state licenses and fees.

LINE 11

LINE 4
ANNUITIES TAX
NOTE: Annuities are not taxed nor are they a retaliatory item.

TOTALS
11a. Enter the sum of Lines 1a through 10a.
11b. Enter the sum of Lines 1b through 10b.

www.revenue.pa.gov
PREVIOUS PAGE

RCT-121C
NEXT PAGE

5

LINE 12
RETALIATORY PAYABLE TO THE PENNSYLVANIA
DEPARTMENT OF REVENUE
Enter the difference of Line 11b minus Line 11a. If it is a
negative number, enter zero. Carry the figure to Page 2,
Line 16 and to RCT-121C Page 1, Line 1b or 1d (This is
based on the company’s original registration with the PA
Insurance Department).

LINE 13
Enter the number of agents that are licensed to represent
your company in Pennsylvania during the tax year.

LINE 14
Enter your total state fees for licensing agents of similar
Pennsylvania insurers. Provide schedule with a detailed
breakdown.

LINE 15

of premiums for each type of assessment. (Accident &
Health and Life).
NOTE: All Annuity premiums are treated as guaranteed premiums.
TOTAL
Enter the total of guaranteed and non-guaranteed premiums for each column.
PLHIGA CREDIT CALCULATION
ASSESSMENT DATE AND AMOUNT
Enter the date of the Class B assessment and the amount
of assessment for each type (Accident & Health, Life,
Annuity), paid during the previous year. Do not include
Class A Assessments in this section. Enter Class A
Assessments in the Total Credits Allowed section.
TOTAL OF ASSESSMENTS
Enter the total of each column.

FEES IMPOSED
If “C” is entered, include Line 14 on Line 10b and include
total agent licensing fees paid to PA during the tax year on
Line 10a.

GUARANTEED PREMIUMS
Enter amount of premiums from Schedule of Guaranteed
Premiums for each type.

Enter C if the fees are imposed on the company.

TOTAL PREMIUMS
Enter total premiums from Schedule of Guaranteed
Premiums for each type.

Enter A if the fees are imposed on the agent.

PAGE 2
RETALIATORY FEE AND OTHER INFORMATION

LINE 16
RETALIATORY
Enter the figure from Page 3, Line 12.

LINE 17
Enter the company’s state of domicile.

LINE 18
Enter the company’s NAIC number.

PAGE 4
PLHIGA CALCULATION WORKSHEET
SCHEDULE OF GUARANTEED PREMIUMS
Guaranteed Premiums are those premiums in which the
premium rates are guaranteed during the continuance of
the respective policies without a right exercisable by the
company to increase said premium rates.
GUARANTEED
Use the PA Business Page for the year immediately preceding the year of the assessment to determine the amount
of premiums for each type of assessment. (Accident &
Health, Life and Annuity).
NON-GUARANTEED
Use the PA Business Page for the year immediately preceding the year of the assessment to determine the amount
6

RCT-121C

PROPORTION OF QUALIFIED PREMIUMS
Divide Guaranteed Premiums by Total Premiums for each
type. Carry to six decimal places.
TOTAL CREDITS ALLOWED
Enter Total of Assessment and Proportion of Qualified
Premiums for each type. Multiply Total of Assessment by
Proportion of Qualified Premiums to calculate Total Credit
Allowed.
Enter the Class-A Administrative Assessment paid during
the previous year.
TOTAL
Add Total Credit Allowed column.
TOTAL CREDIT ALLOWED PER YEAR
Enter Total figure from Total Credit Allowed column and
multiply by 20 percent to calculate credit amount per year.
HISTORY OF PRIOR CREDITS ALREADY APPROVED
Enter each prior year and amount of credit for the previous
four years credits already approved by the Department of
Revenue, if applicable.
Enter the current year amount from Total Credit Per Year.
Include the Total Credit in the amount on Page 1, Line 4.
The total amount of PLHIGA credit cannot exceed the current year Gross Premiums tax liability. The credit cannot be
claimed against retaliatory amounts.
www.revenue.pa.gov

PREVIOUS PAGE

NEXT PAGE

Class A Assessments in this section. Enter Class A
Assessments in the Total Credits Allowed section.

Proportion of Qualified Premiums to calculate Total Credit
Allowed.

TOTAL OF ASSESSMENTS
Enter the total of each column.

Enter the Class-A Administrative Assessment paid during
the previous year.

GUARANTEED PREMIUMS
Enter amount of premiums from Schedule of Guaranteed
Premiums for each type.

TOTAL
Add Total Credit Allowed column.

TOTAL PREMIUMS
Enter total premiums from Schedule of Guaranteed
Premiums for each type.

TOTAL CREDIT ALLOWED PER YEAR
Enter Total figure from Total Credit Allowed column and
multiply by 20 percent to calculate credit amount per year.

PROPORTION OF QUALIFIED PREMIUMS
Divide Guaranteed Premiums by Total Premiums for each
type. Carry to six decimal places.

HISTORY OF PRIOR CREDITS ALREADY APPROVED
Enter each prior year and amount of credit for the previous
four years credits already approved by the Department of
Revenue, if applicable.

TOTAL CREDITS ALLOWED
Enter Total of Assessment and Proportion of Qualified
Premiums for each type. Multiply Total of Assessment by

Enter the current year amount from Total Credit Per Year.
Carry the Total credit to RCT-121C, Page 1, Line 4. Credit
is limited to 2 percent tax.

www.revenue.pa.gov
PREVIOUS PAGE

RCT-121C
RETURN TO PAGE 1

7