Form Hcp - Health Care Provider Tax Reconciliation Return Form

ADVERTISEMENT

HCP
Maine Revenue Services
031450000
Health Care Provider Tax
Reconciliation Return
Registration No.
Period
Due Date
1. Entity Information
Use this area only to report changes in your business
2.
OUT OF BUSINESS? Check here
, return permit to Bureau and
complete information at right. Date closed
3.
OWNERSHIP CHANGE?
If you have changed ownership, indicate the date
when this occurred here
and check off type of change below:
Incorporated
Partner added or dropped
Other (explain on reverse)
Sold to
ADDRESS CHANGE?: If your address above is incorrect, please
4.
NAME CHANGE?
Attach explanation to this return.
make the appropriate changes to the preprinted address.
1. Annual revenue for fiscal year identified above
1.
,
,
.
2. Health Care Provider Tax
(Line 1 multiplied by 6%)
2.
,
,
.
3. Less: Monthly estimated payments made
3.
,
,
.
4. Additional Amount Due
(Line 2 less line 3. Use Line 5 if this is a credit amount 4.
,
,
.
5. Credit due
If Line 2 minus line 3 is a credit amount, enter the amount to the right.
5.
If you wish a refund rather than a carry forward to the next period, check here
,
,
.
Instructions:
Line 1. For nursing homes, enter your annual net operating revenue for the fiscal year identified above. For residential treatment
facilities, enter your annual gross patient services revenue for the fiscal year identified above.
Line 3. Enter the total of all estimated payments made during the fiscal year period identified above.
Mail To:
Maine Revenue Service
P.O. Box 1064
Augusta, ME 04332-1064
Signature
Title
Date
Phone #
HCP-R Revised 07/03

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Hcp - Health Care Provider Tax Reconciliation Return Form Hcp - Health Care Provider Tax Reconciliation Return Financial
Form Hcp-r - Maine Revenue Sevices Health Care Provider Tax Reconciliation Return Form Hcp-r - Maine Revenue Sevices Health Care Provider Tax Reconciliation Return Financial
Form Hcp-1 - Health Care Provider Tax Return Form Hcp-1 - Health Care Provider Tax Return Financial
Form Hcp-2 - Health Care Provider Tax Return Form Hcp-2 - Health Care Provider Tax Return Financial
Form Hcp-1 - Health Care Provider Tax Return Form Hcp-1 - Health Care Provider Tax Return Financial
Form Hcp-2 - Rhode Island Health Care Provider Tax Return Form Hcp-2 - Rhode Island Health Care Provider Tax Return Financial
Form Hcp-est - Health Care Provider Tax Estimate Payment Voucher Form Form Hcp-est - Health Care Provider Tax Estimate Payment Voucher Form Financial
Form Hcp-1 - Health Care Provider Tax - Estimate Payment Voucher Form Hcp-1 - Health Care Provider Tax - Estimate Payment Voucher Financial
Form Wv/hcp-3a - West Virginia Annual Return Of Broad Based Health Care Related Taxes 2008 Form Wv/hcp-3a - West Virginia Annual Return Of Broad Based Health Care Related Taxes 2008 Financial
Form Wv/hcp-3a - Annual Return Of Broad Based Health Care Related Taxes Form Wv/hcp-3a - Annual Return Of Broad Based Health Care Related Taxes Financial

Related Categories

Parent category: Financial
Download
Go