Form Rct-113 - Gross Receipts Tax Other Report - 2011 Page 3

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RCT-113
(I)
1130011301
Page 3
Taxpayer Name:
Corp Tax Account ID:
Gross Receipts Tax
MANAGED CARE ORGANIZATIONS (MCO)
FOR TAX YEAR: 12/31/2011
1.
Gross Receipts from GRT MMCO Revenue Report issued by the Department of Public Welfare
$
2.
Tax at rate of 60.6 mills (59 mills tax + 1.6 mills PURTA Surcharge) (Line 1 x 0.0606; whole dollars only)
$
Carry the tax from Line 2 to Page 1, Gross Receipts - MCO line, Column A.
1130011301

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