Form Dexm - Domestic Companies Annual Report - 2009 Page 4
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5DEXM (10-09)
Page 4
SCHEDULE C----CALCULATION OF GUARANTY FUND ASSESSMENT CREDIT
Eligibility-Provided for by the New Jersey Life and Health Insurance Guaranty Association Act (N.J.S.A. 17B:32A-18),
a member Life and Health insurer may offset against its premium tax liability, attributable to premiums written in that
year, any assessments for which a certificate of contribution has been issued, to the extent of 10% of the amount of
those assessments for each of the f ive calendar years following the second year after the year in which those
assessment were paid, except that no member insurer may offset its premium tax liability by more than 20% of its
tax liability in any one year.
Be sure to include proof of payment for all assessments listed below.
YEAR S IN WHICH A C REDIT FOR AN
MAXIMUM
YEAR
ASSESSMENT CAN BE CLAIMED
AMOUNT
ALLOW AB LE CREDIT
ASSESSM EN T
(CR EDIT IS 10% OF ASSESSMENT)
OF
10% OF
PAID
1
2
3
4
5
6
7
ASSESSMENT
ASSESSMENT
2002
XX
XX
2005 2006 2007 2008 2009
1.
2003
XX
XX
2006 2007 2008 2009 2010
2.
2004
XX
XX
2007 2008 2009 2010 2011
3.
2005
XX
XX
2008 2009 2010 2011 2012
4.
2006
XX
XX
2009 2010 2011 2012 2013
5.
Maximum Credit Available for this Return (add lines 1 through 5 above)
6.
Enter 20% of the tax liability reported on Schedule A, Line 18
7.
Enter the lesser of line 6 or 7 here and on Schedule A, Line 21
8.
DOMESTIC COMPANIES
GENERAL FILING INSTRUCTIONS
Please note that material changes have been made to the tax form due to computerization of Department of Banking
and Insurance and Division of Taxation records. Listed below you will find instructions which highlight special areas of
concern when completing the tax return.
1. NAIC code—At the top left side of the first page of the return is a space to provide the insurer’s five digit NAIC
(National Association of Insurance Commissioners) code. This space must be completed by all taxpayers.
2. Peel Off Labels—Will no longer be provided.
3. Schedule A—Please note that Schedule A, including lines 1 to 14, must be completed by all taxpayers, even if
the taxpayer is calculating the tax based on the 12.5% limitation indicated in Schedule B.
4. Penalty and Interest—Any taxpayer which shall fail to file its return when due or fail to pay any tax when due
shall be subject to penalties and interest as provided for in the State Tax Uniform Procedure Law N.J.S.A. 54:48-
1 et seq. and N.J.S.A. 18:2-2.1 et seq.
5. Overpayment – Please note, any overpayment indicated on Line 28 must first be applied to the prepayment due
st
June 1
before any refund will be issued.
Please note that attachments must be included with the return being filed with the Division of Taxation and with
6.
the duplicate original return which is simultaneously being filed with the Department of Banking and Insurance.
INSTRUCTIONS FOR THE DETERMINATION OF TAXABLE
PREMIUMS AS PROVIDED IN N.J.S.A. 54:18A-6
(SCHEDULE B)
If the company was licensed subsequent to 6/30/84 and the amount indicated at Section I, Line 4, Column C is not
greater than the amount indicated at Section I, Line 4, Column B, then the company does not qualify to use this limitation.
Taxable Premiums are then those included at Line 14 of Schedule A.
If the company was licensed subsequent to 6/30/84 and the amount indicated at Section I, Line 4, Column C is greater
than the amount indicated at Section I, Line 4, Column B, then taxable premiums are the amounts indicated at Section II,
Column B. These amounts should be entered at the applicable Line(s) (15, 16, 17) of Schedule A. A detailed schedule of
Worldwide and New Jersey Premiums of the Company and each affiliate must also be submitted with this schedule.
If the company was licensed prior to 7/1/84 and if the amount indicated at Section II, Line 4, Column B is less than
taxable premiums indicated at Line 14 of Schedule A, then enter amounts from Column B at the applicable Line(s) (15, 16, 17)
of Schedule A. If the amount indicated at Section II, Line 4, Column B is not less than taxable premiums indicated at Line 14
of Schedule A, then taxable premiums are those included at Line 14 of Schedule A.
SMART MOVES FOR BUSINESS PROGRAM TAX CREDIT
The legislation expired for this credit effective December 31, 2007 and was not extended.
ELECTRONIC FUNDS TRANSFERS
The Division of Taxation has established procedures to allow the remittance of tax payments through electronic funds
transfer (EFT). Taxpayer’s with a prior year’s liability of $10,000 or more in any one tax are required to remit all tax payments
using EFT.
If you have any questions concerning the EFT program, call 609-984-9830 or write to the N.J. Division of Revenue,
EFT Section, PO Box 191, Trenton, N.J. 08646-0191.
If remitting payment by EFT, the Total Amount Due indicated at line 27 must be transmitted in one transaction with
an applicable year of 2009. The prepayment of the 2010 tax liability included in this amount will automatically be credited to
the 2010 tax year when the taxpayer files the 2010 Insurance Premium Tax Return. A separate transaction for the amount of the
2010 prepayment at line 26 is not required.
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