Form 1061 - Annual Premium Tax Statement - Louisiana Department Of Insurance - 2011 Page 5
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6NAIC NUMBER:
COMPANY NAME:
Schedule D: Schedule of Investment Tax Credit (L.R.S. 22§832)
L.R.S. 22§832 provides that any admitted insurer investing in qualifying Louisiana securities listed in that section may take a reduction
in premium taxes as listed in Table 1 below. Effective July 1, 2010 per Act 478 of the 2009 Regular Session of the
Louisiana Legislature, the tax credit shall be calculated by applying the average of the quarterly ratios of qualified
Louisiana investments to total admitted assets to the tax reduction percentages in Table 1 below. (Attach Form
1068C for the December 31, 2011 amounts only)
As of September
As of
Average
As of March 31,
As of June 30,
30, 2011
December
Louisiana
2011
2011
31,2011
to Total
Classification
Amount
Amount
Amount
Amount
Louisiana Investments
832C(1)
Certificates of Deposit
$
$
$
$
832C(2)
Bonds
$
$
$
$
832C(3)
Mortgages
$
$
$
$
832C(4)
Real Property
$
$
$
$
832C(5)
Policy Loans
$
$
$
$
832C(6)
Stocks
$
$
$
$
832C(7)
Cash
$
$
$
$
1. Total Admitted Assets Invested in Qualifying
$
$
$
$
Louisiana Securities
2. Total Admitted Assets
$
$
$
$
. Louisiana to Total Assets Ratio (Line 1/Line 2)
(Round to 4 decimal places) Calculate the average
%
of the four quarter ending columns and enter resultin
Average column.
4. Tax Reduction Percentage Taken from Table 1
(below) applied to the Average Louisiana to Total
Assets Ratio. Enter result in Average Column and
%
also on Page 1, Item A, Line 2 and/or Page 1, Item
B, Line 2 as appropriate.
Tax
Reduction
Table 1
Louisiana to Total Admitted Assets Ratio
Percentage
Allowed
.1666 - .1999
66.67%
.2000 - .2499
75.00%
.2500 - .3332
85.00%
.3333 – 1.0000
95.00%
SCHEDULE E NOTICE:
ALL REMAINING LOUISIANA INSURANCE GUARANTY ASSOCIATION PREMIUM TAX CREDITS
WERE REFUNDED IN DECEMBER, 2009 BY THE GUARANTY ASSOCIATION. THERE ARE NO
AVAILABLE CREDITS TO CLAIM ON THE 2011 FORM 1061. SCHEDULE E HAS BEEN REMOVED.
Schedule F:
Louisiana Life and Health Insurance Guaranty Association Assessment Credit Schedule - Title 22 Chapter 10 Part 2
(A) Assessment Amount
(B) Maximum Annual Deduction
(C) Amount of Credit
Year of Assessment
Class B only
Percentage
[Column A x Column B]
2006
$
20%
$
2007
$
20%
$
2008
$
20%
$
2009
$
20%
$
2010
$
20%
$
A. TOTAL - Add Column C
$
Form 1061 (Revised 10-11)
THIS DOCUMENT IS EXEMPT FROM PUBLIC RECORDS LAW UNDER L.R.S. 44§4
Page 5 of 6
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