Enlarge image | State of Rhode Island Division of Taxation 2024 Form T-71 Insurance Companies Tax Return of Gross Premiums 24111699990101 Insurance Name Federal employer identification number Company Nonprofit Hos- Address State or country of incorporation or organization pital Service Corp, Non- profit Dental Corp, Non- Address 2 Company type: stock, mutual or participating profit Medical Service Corp and HMO City, town or post office State ZIP code E-mail address Amended ATTACH LEGIBLE COPY OF SCHEDULE T AND SCHEDULE OF DIRECT BUSINESS IN THIS Schedule A - Computation of Tax STATE FROM THE ANNUAL STATEMENT SUBMITTED TO THE INSURANCE COMMISSIONER 1 a Direct premiums (Gross premiums less return premiums from Sch. T, Part 1 of Annual Statement to Insurance Commissioner).. 1a b Reinsurance assumed from companies not authorized to do 1b business in Rhode Island (covering property and risks in RI)........ 2 TOTAL PREMIUMS. Add lines 1a and 1b ..................................................................................................... 2 3 a Dividends paid or credited to policyholders - Direct (Mutual & 3a Mutual Plan Companies Only)........................................................... b Federally exempt premiums. See instructions. (Gross premiums 3b less return premiums).................................................................... c Capital investments deduction....................................................... 3c Deductions d Tax Incentives for Employers deduction - R.I. Gen. Laws §44-55. 3d Attach Form RI-107........................................................................ 4 TOTAL DEDUCTIONS. Add lines 3a, 3b, 3c and 3d..................................................................................... 4 5 Net taxable premium. Subtract line 4 from line 2........................................................................................... 5 6a Rhode Island tax. Multiply line 5 by the tax rate of 2% (0.02)...... 6a DRAFT b Tax that would be imposed by taxpayer’s state or country............. 6b 7 TOTAL TAX DUE. Line 6a or 6b, whichever is greater.................................................................................. 7 8 a RI Credits from Schedule B-CR, Business Entity Credit Schedule, line 19................................................................................................ 8a Tax and Fee Amount b Life and Health Guaranty Fee........................................................ 8b 9 TOTAL CREDITS. Add lines 8a and 8b......................................................................................................... 9 10aTAX AFTER CREDITS. Subtract line 9 from line 7.10/01/2024If zero or less, enter zero...............................................10a Page 1 Revised 08/2024 |
Enlarge image | State of Rhode Island Division of Taxation 2024 Form T-71 Insurance Companies Tax Return of Gross Premiums 24111699990102 Name Federal employer identification number 10b TAX AFTER CREDITS from line 10a.............................................................................................................. 10b 11a Payments made on 2024 BUS-EST, Business Tax Estimated Payment........................................................................ 11a b Other payments.............................................................................. 11b Payments 12 TOTAL PAYMENTS. Add lines 11a and 11b.................................................................................................. 12 13 Previously issued overpayments (if filing an amended return)....................................................................... 13 14 Net Payments. Subtract line 13 from line 12................................................................................................... 14 15 Net tax due. Subtract line 14 from line 10b.................................................................................................... 15 16 Interest due: (a) Late payment interest ___________ (b) Underestimating interest ___________ Total (a) + (b) .... 16 Balance Due 17 TOTAL DUE WITH RETURN. Add lines 15 and 16....................................................................................... 17 18 Overpayment. Subtract lines 10b and 16 from line 14................................................................................... 18 19 Amount of overpayment to be applied to 2025 estimated tax......................................................................... 19 Refund 20 Amount to be refunded. Subtract line 19 from line 18.................................................................................... 20 IMPORTANT INFORMATION See Form Instructions for requirements on how to file your return and remit payments. DRAFT Form T-71 is due on or before April 15, 2025. 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 of10/01/2024preparer (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 Page 2 |