Form Rpd-41292 - Daily Bed Surcharge Return (Page 2 of 2) in pdf

State of New Mexico - Taxation and Revenue Department

RPD-41292

Rev. 11/2007

DAILY BED SURCHARGE RETURN

INSTRUCTIONS

How to calculate the number of occupied bed days. The surcharge is assessed for each day a bed is occupied. The sum

of the occupied beds per day is counted according to the daily bed occupancy as reported on the Daily Census Report for

each day during the reporting month. Add the daily occupied bed counts from all Daily Census Reports during the reporting

month. Do not include the beds counted for unoccupied Reserve Bed Days or beds unoccupied because of discharge.

Completing the Return: Complete all information on the return using the instructions below. Enter your company's federal

employer identification number (FEIN) and New Mexico combined report system (CRS) number. Enter the name and mailing

address of the health care business. Enter the first and last day of the reporting month (MM/DD/YY). The report period begins

with the first day of the calendar month and ends on the last day of the calendar month in which the surcharge is imposed.

Enter the number of facilities included on this report. Use the instruction for lines 1 through 6 below to complete the return.

Check the "amended" box if amending a previously filed return. Sign and date the return.

Line Instructions:

Line 1. No. occupied bed days. Enter the sum of all occupied bed days during the report period for each facility as described

above.

Line 2. Effective rate. Enter the effective rate of the daily bed surcharge for the reporting period of the return. See The Ef-

fective Daily Occupied Bed Rate below.

Line 3. Surcharge. Multiply line 1 by line 2. This is the daily surcharge for the reporting month.

Line 4: Penalty. Add penalty if the entity fails to file timely or to pay when due the amount on line 3. Calculate the penalty

by multiplying the amount on line 3 by 2%, then by the number of months or partial months for which the return or

payment is late, not to exceed 20% of the surcharge due. The penalty may not be less than $5.00.

Line 5: Interest. Interest accrues daily on the unpaid principal of tax due, and can change on a quarterly basis. The ef-

fective annual and daily interest rates are posted on the Department's web page at or can be

obtained by contacting the Department.

Line 6: Total due. Enter the total of lines 3, 4 and 5. Pay this amount.

The Effective Daily Occupied Bed Rate

The rate of the daily bed surcharge was determined annually by the Human Services Department. No later than June 1 of

each year, the Human Services Department determined the rate of the daily bed surcharge to be paid by each licensed

nursing home, licensed intermediate care facility for the mentally retarded, and licensed residential treatment center during

the subsequent fiscal year and notified the Taxation and Revenue Department and each nursing home, intermediate care

facility and treatment center of the applicable rate for the subsequent fiscal year. For the fiscal year beginning July 1, 2004,

and until February 28, 2006, the rate was $8.82 per day for licensed nursing homes and licensed intermediate care facilities

for the mentally retarded. The rate was zero for licensed residential treatment centers and no return was required to

be filed.

For licensed nursing homes and licensed intermediate care facilities for the mentally retarded:

If your report period falls between:

the effective rate is:

$8.82

July 1, 2004, through February 28, 2006

Form Rpd-41292 - Daily Bed Surcharge Return Page 2