Form 1366 - Insurance Company Annual Return For Sbt And Retaliatory Tax - 2004
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2Reset Form
2004
Michigan Department of Treasury
1366 (Rev. 10-04)
Insurance Company Annual Return for SBT and Retaliatory Tax
Check appropriate box.
This is an original return
Issued under authority of P.A. 228 of 1975, as amended.
This is an amended return
4
2. Federal Employer ID Number (FEIN) or TR Number
1. Company Name
4
3. Insurer Type (Check one)
Address (No., Street)
Foreign
Domestic
City, State, ZIP Code
4
4. State of Incorporation
Contact Person
Contact Person Telephone Number
(2 letters)
ADJUSTED RECEIPTS
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5.
5.
Enter the amount of the total company adjusted receipts for calendar year 2004
APPORTIONMENT
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6.
Enter Michigan gross direct premiums received
6.
7.
Enter total gross direct premiums received everywhere
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7.
8.
%
8.
Michigan apportionment percentage. Divide line 6 by line 7
9.
9.
Apportioned Tax Base. Multiply line 5 by line 8
DISABILITY INSURANCE EXEMPTION
10.
Enter the disability insurance premiums written in Michigan, not including
4
credit insurance or disability income, OR $130,000,000, whichever is smaller
10.
11.
Enter total gross direct premiums from all lines of
11.
insurance carrier services received everywhere
-
$180,000,000
12.
12.
Subtract $180,000,000. If less than zero, enter zero
13.
Exemption reduction. Multiply line 12 by 2
13.
14.
Allowable exemption. Subtract line 13 from line 10. This amount can't be less than zero
14.
15.
ADJUSTED TAX BASE. Subtract line 14 from line 9
15.
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16.
TAX BEFORE CREDITS. Multiply line 15 by 1.0735% (.010735)
16.
CREDITS
17.
Enter amounts paid from 1/1/2003 to 12/31/2003 to each of the following:
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17a.
a. Michigan Workers' Compensation Placement Facility
4
b.
b. Michigan Basic Property Insurance Association
4
c.
c. Michigan Automobile Insurance Placement Facility
4
d.
d. Property and Casualty Guaranty Association
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e.
e. Life and Health Guaranty Association
18.
18.
Add lines 17a through 17e
19.
19.
This year's credit is 100%. Carry the amount from line 18 here
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20.
20.
Michigan Regulatory Fees Credit ______________ x 50%
21.
Add lines 19 and 20
21.
22.
Subtract line 21 from line 16. If less than zero, enter zero
22.
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23a.
23a.
Contributions to COMMUNITY FOUNDATIONS
b.
CREDIT. Enter the smaller of 50% of line 23a, $5,000 or 5% of the tax on line 16
23b.
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23c.
c.
Enter the code for the foundation contributed to here. See instructions
24.
Subtract line 23b from line 22
24.
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25a.
25a.
Contributions to HOMELESS SHELTER/FOOD BANKS
b.
CREDIT. Enter the smaller of 50% of line 25a, $5,000 or 5% of the tax on line 16
25b.
26.
Subtract line 25b from line 24
26.
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27a.
27a.
Contributions to COLLEGES AND PUBLIC LIBRARIES
b.
CREDIT. Enter the smaller of 50% of line 27a, $5,000 or 5% of the tax on line 26
27b.
28.
Subtract line 27b from line 26
28.
29.
Nonrefundable credits from C-8000MC, line 82. See instructions
29.
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30.
TAX AFTER CREDITS. Subtract line 29 from line 28
30.
Domestic insurers go to page 2, line 47. Foreign and alien insurers go to page 2, line 31.
PAYMENT
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61.
61. Write the amount entered on page 2, line 57
PAY THIS AMOUNT
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Parent category: Financial