Form 4i - Insurance Company Franchise Tax Return - 2005
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4I
Form
Wisconsin Insurance Company
2005
Franchise Tax Return
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For 2005 or taxable year beginning
and ending
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M D
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Y
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M D
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Y Y
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Complete form using BLACK INK
Due Date: 15th day of 3rd month following close of taxable year.
Corporation Name
A Federal Employer ID Number
Number and Street
B Business Activity (NAICS) Code
City
State
C State and Year of Incorporation
ZIP Code
D Check box if applicable and attach explanation:
1
First return - new corporation or entering Wisconsin
3
Short period - change in accounting period
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Final return - corporation dissolved or redomesticated
4
Short period - stock purchase or sale
Check box if applicable and see instructions:
E
If this is an amended return, attach an explanation of the changes.
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F
If you have an extension of time to file, enter the extended due date
.
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Y
G
If no business was transacted in Wisconsin during the taxable year, attach a complete copy of your federal return and annual statement.
H
If you filed a federal consolidated return, enter Parent’s federal EIN
.
Read instructions before completing lines 1 through 15
1 Adjusted federal taxable income (from page 2, Schedule A, line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2 Net gain from operations, other than life insurance . . . . . . . . . . . . . . . . . . . . . . . . . .
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3 Total net gain from operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
.
%
4 Divide line 2 by line 3. This is the percentage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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5 Multiply line 1 by line 4. This is total income other than life insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6 Premiums written on property and risks, other than life insurance, located
outside Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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7 Premiums written on property and risks, other than life insurance, wherever located 7
8 Payroll, exclusive of life insurance payroll, paid outside Wisconsin . . . . . . . . . . . .
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9 Payroll, exclusive of life insurance payroll, paid everywhere . . . . . . . . . . . . . . . . . .
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.
%
10 Divide line 6 by line 7. This is percent of premiums outside Wisconsin . . . . . . . . .
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%
11 Divide line 8 by line 9. This is percent of payroll outside Wisconsin . . . . . . . . . . . .
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%
12 Add line 10 and line 11. This is total of premium and payroll percentages . . . . . . .
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%
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13 Divide line 12 by 2. This is average of premium and payroll percentages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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14 Multiply line 5 by line 13. This is total income, other than life insurance, outside Wisconsin . . . . . . . . . . . . . . . . .
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15 Subtract line 14 from line 5. This is Wisconsin net income before net business loss offset . . . . . . . . . . . . . . . . . .
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16 Wisconsin net business loss carryforward (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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17 Subtract line 16 from line 15. This is Wisconsin net income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
18 Gross tax (see instructions). If subject to 2% maximum tax, check box
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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19 Nonrefundable credits (from Schedule C1, line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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20 Subtract line 19 from line 18. If line 19 is more than line 18, enter zero (0). This is net tax . . . . . . . . . . . . . . . . . .
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21 Recycling surcharge (for insurance companies whose gross receipts from all activities are $4 million or more,
enter at least $25 but not more than $9,800 – see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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22 Endangered resources donation (decreases refund or increases amount owed) . . . . . . . . . . . . . . . . . . . .
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23 Veterans trust fund donation (decreases refund or increases amount owed) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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24 Add lines 20 through 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
25 Estimated tax payments less refund from Form 4466W.
If this is an amended return, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Refundable credits (from Schedule C2, line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27 Add lines 25 and 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
28 Interest, penalty, and late fee due (from Form 4U, line 17 or 26).
If you annualized income on Form 4U, check box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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29 Tax due. If the total of lines 24 and 28 is larger than line 27, enter amount owed . . . . . . . . . . . . . . . . . . . . . . . . .
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30 Overpayment. If line 27 is larger than the total of lines 24 and 28, enter amount overpaid . . . . . . . . . . . . . . . . .
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31 Enter amount of line 30 you want credited on 2006 estimated tax . . . . . . . . . . . . . 31
32 Subtract line 31 from line 30. This is your refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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33 Enter total company gross receipts from all activities (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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For Department Use Only
IC-020
Go to Page 2
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