Form 63-23p - Premium Excise Return For Insurance Companies

Do not claim any credit here if claimed on Form 63-29A.

Credits.

21 Domestic casualty insurers only. Retaliatory surtax credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 21

22 Domestic casualty insurers only. Enter 1.5% of company’s total capital contributions in excess of the full proportionate

share in investment in the Massachusetts property and casualty initiative. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 22

23 Credit against premium excise. Add lines 21 and 22. Enter total here, but do not exceed the amount in line 1 . . . . . . . . . . . . 23

24 Enter 10% of Massachusetts Life and Health Insurance Guaranty Association assessment paid previously . . . . . . . . . . . . . 3 24

25 Economic Opportunity Area Credit (enclose Schedule EOAC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 25

26 Economic Development Incentive Program Credit. Certificate number 3

. . . . . . . . . . . . . . . . . 3 26

27 Low-Income Housing Credit. Building Identification number 3

. . . . . . . . . . . . . . . . . . . . . . . . . 3 27

28 Historic Rehabilitation Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 28

29 Film Incentive Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 29

30 Medical Device Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 30

31 Brownfields Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 31

32 Employee Wellness Program Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 32

33 Life Science Company Tax Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 33

34 Total credits. Add lines 23 through 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Excise

fter Credits

35 Excise due before voluntary contribution. Subtract line 34 from line 5, 14 or 20, whichever is applicable. Not less than “0” . . . 35

36 Voluntary contribution for endangered wildlife conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 36

37 Total excise plus voluntary contribution. Add lines 35 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 37

Payments

38 2012 overpayment applied to 2013 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 38

39 2013 Massachusetts estimated tax payments (do not include amount from line 38) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 39

40 Payments made with extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 40

41 Pass-through entity withholding. Payer Identification number 3

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

42 Refundable Film Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 42

43 Refundable Dairy Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 43

44 Refundable Life Science Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 44

45 Refundable Economic Development Incentive Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 45

46 Refundable Conservation Land Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . 3 46

47 Total payments. Add lines 38 through 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Refund or Balance Due

48 Amount overpaid. Subtract line 37 from line 47 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

49 Amount overpaid to be credited to 2014 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 49

50 Amount overpaid to be refunded. Subtract line 49 from line 48 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 50

51 Balance due. Subtract line 47 from line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

52 M-2220 penalty 3 $ _______________________ ; Other penalties 3 $_______________________. . . . . . . . . Total penalty 52

53 Interest on unpaid balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 53

54 Total payment due at time of filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 54

Form 63-23p - Premium Excise Return For Insurance Companies - 2013 Page 2

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