General Information For Rct-121b Page 6
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6RCT-121B – Line-by-Line Instruction
RCT-121B-I (11-13)
Page 6 of 6
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-121B Page 1, Line 1a or 1c (This is based on the company’s original registration with the
PA Insurance Department).
Page 3- Retaliatory Worksheet
Line 1 - Fire Casualty & Title Premiums Tax
1a. Enter the Pennsylvania tax (PA taxable premiums times PA tax rate).
1b. Enter the domicile state tax (PA taxable premiums times domicile state tax rate).
Line 2 - Ocean Marine Gross Profit Tax
2a. Enter the Pennsylvania ocean marine tax per the RCT-124 tax report.
2b. Enter the domicile state ocean marine tax, if applicable.
Line 3 - Life Premiums Tax
3a. Enter the Pennsylvania tax (PA taxable premiums times PA tax rate).
3b. Enter the domicile state tax (PA taxable premiums times domicile state tax rate).
Line 4 - Annuities Tax
Note: Annuities are not taxed nor are they a retaliatory item.
Line 5 - Accident and Health Premiums Tax
5a. Enter the Pennsylvania tax (PA taxable premiums times PA tax rate).
5b. Enter the domicile state tax (PA taxable premiums times domicile state tax rate).
Line 6 - Reinsurance Assumed from Unauthorized Companies
6a. Enter the Pennsylvania figure.
6b. Enter the domicile state figure.
Line 7 - Other Taxes (Include schedule of itemized taxes by type and amount for PA and domicile state.)
7a. Enter the total of other Pennsylvania taxes.
7b. Enter the total of other domicile state taxes.
Line 8 - Worker’s Compensation Assessments (Include schedule of itemized assessments by type and amount for domicile state.)
8a. Note: Pennsylvania worker’s compensation assessments are not a retaliatory item.
8b. Enter the domicile state assessments.
Line 9 - Other Assessments (Include schedule of itemized assessments by type and amount for PA and domicile state.)
9a. Enter the total of other Pennsylvania assessments.
9b. Enter the total of other domicile state assessments.
Line 10 - Licenses and Fees on an Annual Basis (Include schedule of itemized licenses and fees by type and amount for PA and domi-
cile state.)
10a. Enter the Pennsylvania licenses and fees.
10b. Enter the domicile state licenses and fees.
Line 11 - Totals
11a. Enter the sum of Lines 1a through 10a.
11b. Enter the sum of Lines 1b through 10b.
Line 12 - Retaliatory Payable to the Pennsylvania Department of Revenue
Enter the difference of Line 11b minus Line 11a. If it is a negative number enter zero. Carry the figure to Page 2, Line 16 and to RCT-
121B Page 1, Line 1b or 1d (This is based on the company’s original registration with the PA Insurance Department).
Line 13 - Enter the number of agents that are licensed to represent your company in Pennsylvania during the tax year.
Line 14 - Enter the state fees for licensing agents of similar Pennsylvania insurers.
Line 15 - Fees Imposed
Enter A if the fees are imposed on the company.
Enter B if the fees are imposed on the agent.
Page 2 - Retaliatory Fee and Other Information:
Line 16 - Retaliatory
Enter the figure from Page 3, Line 12.
Line 17 - Enter the company’s state of domicile.
Line 18 - Enter the company’s NAIC number.
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