Rhode Island Nursing Facilities Return

Nursing Facilities Return
HCP-2_new_Layout 1
State of Rhode Island and Providence Plantations

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

E-mail address

ZIP code

Calculation of Amount Due:
1 Gross patient revenue received.........................................................................................................

1

00

2 Provider assessment due. Multiply line 1 times 5.50% (0.0550) .....................................................

2

00

5 Total interest and penalty amount. Add lines 3 and 4.......................................................................

5

00

6 TOTAL AMOUNT DUE. Add lines 2 and 5........................................................................................

6

00

3 Interest calculated at 1.5% per month. See instructions.....................

3

00

4 Penalty calculated at 10%. See instructions ......................................

4

00

INSTRUCTIONS
Line 1: Gross Patient Revenue - Enter the gross amount received
on a cash basis by the provider from all patient care services provided on June 1, 1992 and thereafter. Charitable contributions,
donated goods and services, fund raising proceeds, endowment
support, income from meals on wheels, income from investments
and such other nonpatient revenues defined by the Tax Administrator upon the recommendation of the Department of Human
Services shall not be considered “gross patient revenue”.

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 Nursing Facility is 5.50%
for services provided 1/1/2008 and thereafter.

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

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

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

Paid preparer address

Print name

City, town or post office

Date

State

ZIP code

Telephone number

PTIN

May the Division of Taxation contact your preparer? YES
Mail to RI Division of Taxation - One Capitol Hill - Providence, RI 02908
Revised 04/2016