Form Ipt-A - Annual Insurance Premium Tax Return 2010 (Page 4 of 5) in pdf

Line 14

Enter the total policy dividends, savings, or unabsorbed premium deposits returned to policyholders in cash or credited to policyholders’ accounts

during the calendar year which were not used to provide paid-up additions or to reduce endowment or premium-paying periods here.

Life Companies: This number should coincide with the amounts shown on Line 6.1 Column 5 and Line 7.1 Column 5 of the Nevada State Page of the NAIC Annual

Statement.

Accident/Health Companies: If your company paid/credited dividends to policyholders in the reporting year enter the amount paid/credited on this line and attach

documentation supporting the amount of dividends paid/credited to accident and health insurance contracts covering property or risks located, resident, or to be

performed in Nevada.

Property/Casualty Companies: This number should coincide with Line 35 Column 3 less the sum of Column 3 Lines 15.6, 16, and 17.3 on the Nevada State Page of the

NAIC Annual Statement.

Line 15

Enter the total policy dividends, savings, or unabsorbed premium deposits applied to pay renewal premiums during the calendar year.

Life Companies: This number should coincide with Line 6.2 Column 5 of the Nevada State Page of your NAIC Annual Statement.

Accident/Health Companies: Enter zero (0) on this line.

Property/Casualty Companies: Enter zero (0) on this line.

Line 16

Add Lines 14 and 15 and enter the total here.

Line 17

Subtract Line 16 from Line 13 and enter the total here.

Retaliatory Worksheet

Line 18

Enter the Premium Tax Due on the Nevada basis in Column A. This number can be found on Line 9 of the Annual Reconciliation Return. Enter

the Premium Tax Due in the insurers’ state of domicile in Column B. This amount should not include any Guaranty Association offsets/credits or offsets/credits earned

through overpayment in the current or prior periods. ATTACH A COPY OF THE TAX RETURN FILED WITH STATE OF DOMICILE OR A SEPARATE

SCHEDULE ILLUSTRATING HOW THE TAX IN COLUMN B WAS CALCULATED.

Lines 19-23

Include any additional taxes or assessments (including Fire Marshall, Ocean Marine, or other state or municipal tax) that are levied

within the state of domicile that are not levied within Nevada.

Line 24

Add Lines 18-23 and enter the total here.

Lines 25-34

Enter the fees levied by Nevada and the insurers’ state of domicile in the appropriate Line and Column.

Lines 35-37

Enter any additional fees that are levied on a company doing business in the state of domicile not enumerated here.

Line 38

Add Lines 25-37 and enter the total here.

Annual Reconciliation Return

Line 1 Enter the gross premiums.

Line 2 Multiply line one by 3.5% (2% for qualified RRGs)

Line 3a Home Office Credit .50% or .5 of Line 7. NRS 680B.050 provides that insurers who maintain a “home” or “regional” office may be entitled to a credit against

tax to be paid. It provides for a 50 percent credit for tax due. Each insurer claiming a home or regional home office credit must have a certified copy of the deed to the

property in the name of the insurer on file with the Department.

Line 3b Ad Valorem Taxes Enter the amount of Ad Valorem Taxes paid during the year. NRS 680B.050(1) provides for credit for ad valorem taxes actually paid upon

the home office or regional home office together with the land, as reasonably required for the convenient use of the office, upon which the home office or regional home

office is situated. Further, the insurer must provide certified copies of the billing by local authorities for the ad valorem taxes in addition to a receipt for proof of

payment.

Line 3c Enter max credit allowed. Multiply Line 7 by 80% or .80. NRS 680B.050(1) imposes a limit on the total amount of the credit that may be obtained. The

credits may not reduce the total amount of taxes payable to less than 20 percent of the amount of the gross premium taxes payable.

Line 3d Enter the available Home Office and Ad Valorem taxes credit. Add Lines 8a and 8b. Compare to line 8c. Enter the lesser of the two.

Line 4 Subtotal of Premium Tax Due Enter the net premium tax Line 7 minus Line 8d.

Line 5 Life/Health Guaranty Enter amount of Life/Health Guaranty Association Offset.

Line 6 Enter amount of Property/Casualty Guaranty Association credit.

Line A Enter the amount due to you for overpayments made in prior reporting periods for which you have received a Department of Taxation Credit Notice. Monthly

notices received from the Department are not cumulative. Do not take the credit if you have applied for a refund. NOTE: Only credits established by the Department

may be used.

Line B Enter the amount of Overpayments refunded by Nevada during the calendar year.

Line 7 Net Premium Tax Due. Enter the amount of Net Premium Tax due. Line 9 minus 10 through 13, plus Line 14.

IPT-A

Revised 1-3-11