Rhode Island Group Homes Return

Group Homes Return
HCP-1.qxp
HCP-1

State of Rhode Island and Providence Plantations
Department of Revenue - Division of Taxation

GROUP
HOMES
RETURN

HEALTH CARE PROVIDER TAX RETURN
Due on or before the 25th day of the following month

NAME
ADDRESS
CITY

STATE

ZIP CODE

PHONE NUMBER
FEDERAL IDENTIFICATION NUMBER
RETURN FOR THE PERIOD OF:
MONTH

NAME

OF

YEAR

FACILITY

LICENSE NUMBER

TOTALS

OF

FACILITY

LINE 1: RESIDENT CARE
SERVICE INCOME
FROM PROVIDING 24
HOUR A DAY SERVICE
LINE 2: RATE:

5.5%

5.5%

5.5%

5.5%

5.5%

5.5%

LINE 3: TAX DUE
(LINE 1 TIMES LINE 2)
LINE 4: INTEREST
LINE 5: PENALTY
LINE 6: TOTAL DUE
(ADD LINES 3, 4 AND 5)
INSTRUCTIONS
Line 1: Resident Care Service Income from Providing 24
Hour a Day Service - Enter the amount of cash receipts
for Resident Care Service from the State of Rhode
Island provided on a twenty-four hour basis for individuals with developmental disabilities.

Line 4: Interest - Interest is calculated from the due date of the
return to the date of remittance at a rate of 18% per
annum. If remitting after the due date, multiply Line 3
times 1.5% (0.015) times the number of months late.

Line 2: Rate - The applicable rate for a Residential Care Facility
or Residential Provider is 5.5%.

Line 5: Penalty - If remitting after the due date, multiply Line 3
times 10% (0.10). Penalty is calculated at 10% of the
tax due.

Line 3: Tax Due - Multiple Line 1 times Line 2.

Line 6: Total Amount Due - Add lines 3, 4 and 5.

PROVIDERS WITH MORE THAN SIX (6) RESIDENTIAL CARE FACILITIES SHOULD
COMPLETE MORE THAN ONE RETURN, BUT ONLY ONE TOTAL COLUMN.
Under penalties of perjury, I hereby certify that I have personal knowledge of the statements and other information constituting this return, that the same are true,
correct and complete to the best of my knowledge and belief.

Date

Signature of authorized officer

Title

Date

Signature of preparer

Address of preparer

MAY THE DIVISION CONTACT YOUR PREPARER ABOUT THIS RETURN? YES

NO

Phone number

MAILING ADDRESS: RHODE ISLAND DIVISION OF TAXATION, ONE CAPITOL HILL, PROVIDENCE, RI 02908-5811
revised 2/6/2009

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