General Information For Rct-121a (Page 4 of 4) in pdf

RCT-121A – Line-by-Line Instruction

RCT-121A-I (11-12)

Page 4 of 4

RCT-121A should be completed in the following order:

Step 1 - Complete the taxpayer information and any applicable questions at the top of Page 1.

Step 2 - Indicate the type of insurance company on Page 1 - Domestic Casualty, Domestic Fire or Domestic Life. This is based on the com-

pany’s original registration with the Pennsylvania Insurance Department. This information is required.

Step 3 - Enter the Revenue ID number and other taxpayer information in the designated fields at the top of each page.

Step 4 - Complete Page 2.

Step 5 - Complete Page 1, Tax Liability, Payment and Overpayment sections.

Step 6 - Complete the corporate officer information section, sign and date at the bottom of Page 1.

Step 7 - Complete the preparer information section, sign and date at the bottom of Page 2, if applicable.

Step 8 - Mail the completed report and any supporting schedules to the PA Department of Revenue.

Page 2

Calculation of taxable premiums as follows:

Domestic casualty and domestic fire insurers will use Lines 1 through 5 and Lines 10 through 13.

Domestic life insurers will use Lines 6 through 13.

Casualty and Fire Insurance

Line 1

Direct Premiums: Enter the difference of total direct premiums written reported on the Pennsylvania business page less ocean marine

premiums less accident and health premiums. Ocean marine premiums are reported on the RCT-124 and accident and health premi-

ums are reported below on Line 10. The direct premiums written as reported on the Pennsylvania business page already includes the

adjustment for returned and cancelled policies.

Cash Basis: Enter the direct premiums received; provide a schedule of taxable premiums. Show the beginning and ending receivables

and any other deductions or additions.

Line 2 - Enter the extraordinary medical benefit premiums.

Line 3 - Enter the dividends to policy holders from the Pennsylvania business page.

Line 4 - Enter any other deductions. A schedule detailing all other deductions must be provided.

Line 5 - Taxable Fire and Casualty Premiums

Enter the difference of Line 1 minus Lines 2, 3 and 4.

Life Insurance

Line 6 - Gross Life Premiums (Direct Written Basis)

Enter the total life premiums from the Pennsylvania business page.

Line 7 - Enter the dividends to policy holders from the Pennsylvania business page.

Line 8 - Enter any other deductions. A schedule detailing all other deductions must be provided.

Line 9 - Taxable Life Premiums

Enter the difference of Line 6 minus Lines 7 and 8.

Accident and Health Insurance

Line 10 - Gross Direct Accident and Health Premiums

Enter the total accident and health premiums from the Pennsylvania business page.

Line 11 - Enter the dividends to policy holders from the Pennsylvania business page.

Line 12 - Enter any other deductions. A schedule detailing all other deductions must be provided.

Line 13 - Taxable Accident and Health Premiums

Enter the difference of Line 10 minus Lines 11 and 12.

Line 14 - Total Taxable Premiums

Enter the sum of Lines 5, 9 and 13.

Line 15 - Tax

Multiply Line 14 by 0.02. Carry the tax to RCT-121A Page 1, Line 1a, 1b or 1c (This is based on the company’s original registration with

the Pennsylvania Insurance Department).

Line 16 - Enter the company’s state of domicile.

Line 17 - Enter the company’s NAIC number.

General Information For Rct-121a Page 4

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