Navigating the complexities of healthcare taxation can often feel overwhelming, but understanding the essentials of specific forms can make the process smoother. Among these, the HCP-65 form stands out in Rhode Island for its role in the financial operations of imaging services. Mandated by the State of Rhode Island and the Providence Plantations Department of Revenue - Division of Taxation, this form addresses the Imaging Services Surcharge Return, a requirement for entities offering imaging services. Due monthly, the form meticulously outlines the calculation of the surcharge owed, emphasizing net patient imaging revenue, applicable surcharges, along with interest and penalties for late submissions. The surcharge is calculated at 2% of the net patient imaging revenue, underscoring the direct relationship between the volume of services provided and the taxation imposed. In cases of delayed payment, the form guides on calculating interest at an annual rate of 18% and a penalty of 10% of the due surcharge, showcasing the financial implications of non-compliance. Moreover, the shift to mandatory Electronic Funds Transfer (EFT) payments since October 31, 2007, reflects the state's move towards modernizing tax collection processes. This form, therefore, not only serves as a financial reporting tool but also as a compliance mechanism, ensuring that imaging service providers contribute rightfully to state revenues. With the added assurance of certification under penalties of perjury, the HCP-65 form encapsulates a critical aspect of Rhode Island's taxation framework, directly linking healthcare services to fiscal responsibility.
| Question | Answer |
|---|---|
| Form Name | Form Hcp 65 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | HCP 65 form hcp 65 ri |
IMAGING
SERVICE
SURCHARGE
State of Rhode Island and Providence Plantations Department of Revenue - Division of Taxation
IMAGING SERVICES SURCHARGE RETURN
Due on or before the 25th day of the following month
NAME
ADDRESS
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ZIP CODE |
PHONENUMBER
FEDERALEMPLOYERIDENTIFICATION NUMBER
RETURNFORTHEPERIOD OF:
MONTHYEAR
Calculation of Amount Due:
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Net patient imaging revenuereceived |
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Imaging services surcharge - line 1 time 2% (0.02) |
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Interest - (1.5% per month) see instructions |
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Penalty - (10%) see instructions |
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Total Interest and penalty amount |
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TOTALAMOUNTDUE(Add lines 2 and 5) |
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INSTRUCTIONS
Line 1: Net Patient Imaging Revenue Received - Enter the amount of all monies and other consideration received for the provision of imaging services for the month being reported on this return.
Line 4: Penalty - If remitting after the due date, multiply Line 2 time 10% (0.10). Penalty is calculated at 10% of the surcharge due.
Line 2: Imaging Services Surcharge - Multiply Line 1 times 2.0% (0.02)
Line 3: Interest - If remitting after the due date, multiply Line 2 times 1.5% (0.015) times the number of months late. Interest is calculated from the due date of the return to the date of remittance at a rate of 18% per annum.
Line 5: Total Interest and Penalty Amount
Line 6: Total Amount Due
EFFECTIVE OCTOBER 31, 2007, PAYMENTS MUST BE MADE BYELECTRONIC FUNDS TRANSFER (EFT). QUESTIONS REGARDING EFT TRANSFERS MAYBE DIRECTED TO
Under penalties of perjury, I hereby certify that Ihave personal knowledge of the statements and other information constituting this return, that the same are true, correct and complete to the best of my knowledge and belief.
Date |
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Signature of authorized officer |
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Signature of preparer |
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MAYTHE DIVISION CONTACTYOUR PREPARERABOUTTHIS RETURN? YES |
NO |
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Title
Address of preparer
Phone number
MAILING ADDRESS:RHODE ISLAND DIVISION OF TAXATION, ONE CAPITOLHILL, PROVIDENCE,
Key #75
revised 9/28/2011