4752, Page 2
Designated Member FEIN or TR Number
PART 2B: MeMBeR DATA FOR COMBINeD ReTURN
Complete a separate copy of Part 2B for each UBG member listed in Part 1. After completing Part 2A and 2B, if all group members reporting on a
combined financial institution return have the same year end, and have four or more years of operating history prior to the current filing period, enter the
combined group data on Form 4590. Otherwise, enter the combined totals of line 25 of this form on Form 4590, line 20, and skip lines 11 through 19 on
Form 4590.
4. Member Name
7. Organization Type
S Corporation /
5. Member FEIN or TR Number
Fiduciary
LLC S Corporation
C Corporation /
Partnership /
6. Member Address (Street)
LLC C Corporation
LLC Partnership
City
State
ZIP/Postal Code
Beginning
Ending
Check if Nexus with Michigan
12.
8.
Federal Tax Period Included in
Return (MM-DD-YYYY) ........................
Check if Registered for MBT
13.
9.
If part year member, enter
membership dates (MM-DD-YYYY) .....
10. NAICS Code
11. If discontinued, effective date
Check if New Member
14.
15. Nature of business activities or operations resulting in a flow of value between members, or integration, dependence or contribution to other members
A
B
C
D
e
FRANCHISe TAx BASe
2005
2006
2007
2008
2009
16.
16. Equity Capital ......................
17.
17. Goodwill ...............................
18. Average daily book value
of Michigan obligations ........
18.
19. Average daily book value
of U.S. obligations ...............
19.
20. Subtotal. Add lines 17
through 19 ...........................
20.
21. Net Capital. Subtract line
20 from line 16 .....................
21.
22. a. Authorized insurance co.
subsidiary: enter actual
capital fund amount ........ 22a.
b. Minimum regulatory
amount required ............ 22b.
c. Multiply line 22b by
125% (1.25) ................... 22c.
d. Subtract line 22c from
22a. If less than zero,
enter zero ...................... 22d.
23. Add lines 21 and 22d ..........
23.
00
24. Add lines 23A, 23B, 23C, 23D and 23E. If less than zero, enter zero ....................................................................
24.
00
25. Net Capital for Current Taxable Year. Divide line 24 by number of years reported above ......................................
25.
+
0000 2009 85 02 27 2
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