State of Rhode Island Division of Taxation 
2023 Form T-71 
Insurance Companies Tax Return of Gross Premiums 23111699990101

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

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

10a TAX AFTER CREDITS. Subtract line 9 from line 7. If zero or less, enter zero............................................... 10a

Page 1   Revised 
08/2023

State of Rhode Island Division of Taxation 
2023 Form T-71 
Insurance Companies Tax Return of Gross Premiums 23111699990102

Name Federal employer identification number

10b TAX AFTER CREDITS from line 10a.............................................................................................................. 10b
11a Payments made on 2023 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 2024 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.

Form T-71 is due on or before April 15, 2024. 

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 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

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