Form 63-20p - Premium Excise Return For Life Insurance Companies

Excise after credits

29 Excise due before voluntary contribution. Subtract line 28 from line 6 or line 14, whichever applies. Not less than “0”. . . . . . 29

30 Voluntary contribution for endangered wildlife conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 30

31 Total excise plus voluntary contribution. Add lines 29 and 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 31

Payments

32 2011 overpayment applied to 2012 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 32

33 2012 Massachusetts estimated tax payments (do not include amount from line 32) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 33

34 Payments made with extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 34

35 Pass-through entity withholding. Payer Identification number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . 3 35

36 Refundable Film Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 36

37 Refundable Dairy Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 37

38 Refundable Life Science Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 38

39 Refundable Life Science Jobs Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 39

40 Refundable Economic Development Incentive Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 40

41 Refundable Conservation Land Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 41

42 Total payments. Add lines 32 through 41 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Refund or balance due

43 Amount overpaid. Subtract line 31 from line 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

44 Amount overpaid to be credited to 2013 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 44

45 Amount overpaid to be refunded. Subtract line 44 from line 43 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 45

46 Balance due. Subtract line 42 from line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

47 M-2220 penalty 3 $ _______________________ ; Other penalties 3 $_______________________. . . . . . . . Total penalty 47

48 Interest on unpaid balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 48

49 Total payment due at time of filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 49

Part 1. Domestic Life Premium Excise Calculation

–

Life insurance –

– Accident and health insurance –

Jurisdictions where

no insurance

Massachusetts

excise paid

Massachusetts

excise paid

11 All new and renewal (direct) premiums for

Massachusetts residents . . . . . . . . . . . . . . . . . . . . 1 3

12 Dividends applied to:

a Purchase paid-up additions . . . . . . . . . . . . . . . 2a 3

b Shorten premium paying period. . . . . . . . . . . . 2b 3

13 Total. Add lines 1 through 2b . . . . . . . . . . . . . . . . . 3

Deductions.

Include only what has been returned as receipts on this return or on a previous return.

14 Returned premiums but not including cash

surrender values (enclose schedule) . . . . . . . . . . . 4 3

15 Premiums for company employees’ group

life and accident and health plans if included

in line 1* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 3

16 Gross premiums for authorized preferred

provider arrangements . . . . . . . . . . . . . . . . . . . . . . 6 3

17 Dividends:

a Paid in cash . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a 3

b Applied in reduction of renewal premiums. . . . 7b 3

c Left to accumulate at interest. . . . . . . . . . . . . . 7c 3

d Applied to purchase paid-up additions . . . . . . . 7d 3

e Applied to shorten premium paying period . . . 7e 3

18 Total deductions. Add lines 4 through 7e . . . . . . . . 8

19 Amount taxable. Subtract line 8 from line 3 . . . . . . 9

10 Total life amount taxable. Add line 9, columns a and b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Total accident and health amount taxable. Add line 9, columns c and d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

*Premiums under the company employees’ group plans for annuity consideration and retirement benefits shall not be deducted.