Form 1120-Pc - U.s. Property And Casualty Insurance Company Income Tax Return - 2015 Page 7

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7
Form 1120-PC (2015)
Page
Schedule I
Other Information (see instructions)
Yes No
Yes No
1
Check method of accounting:
7
Has the corporation elected to use its own payout
a
pattern for discounting unpaid losses and unpaid
Cash
loss adjustment expenses? .
.
.
.
.
.
.
b
Accrual
c
Other (specify)
8 a
Enter the total unpaid losses shown on the
corporation’s annual statement:
2
Check box for kind of company:
$
a
Mutual
(1) for the current tax year:
$
b
Stock
(2) for the previous tax year:
b
Enter the total unpaid loss adjustment expenses
shown on the corporation’s annual statement:
3
At the end of the tax year, did the corporation own,
$
(1) for the current tax year:
directly or indirectly, 50% or more of the voting
$
stock of a domestic corporation? (For rules of
(2) for the previous tax year:
attribution, see section 267(c).) .
.
.
.
.
.
9
Does the corporation discount any of the loss
If “Yes,” attach a statement showing:
reserves shown on its annual statement? .
.
.
(a) name and employer identification number (EIN);
(b) percentage owned; and (c) taxable income or
10
Enter the amount of tax-exempt interest received or
(loss) before NOL and special deductions of such
accrued during the tax year
$
corporation for the tax year ending with or within
your tax year.
11
If the corporation has an NOL for the tax year
4
Is the corporation a subsidiary in an affiliated group
and is electing to forgo the carryback period,
or a parent-subsidiary controlled group? .
.
.
check here .
.
.
.
.
.
.
.
.
.
If “Yes,” enter name and EIN of the parent
If the corporation is filing a consolidated return, the
corporation
statement
required
by
Regulations
section
1.1502-21(b)(3) must be attached or the election
will not be valid.
12
Enter the available NOL carryover from prior tax
5
At the end of the tax year, did any individual,
years. (Do not reduce it by any deduction on line
partnership, corporation, estate, or trust own, directly
36b, Schedule A.) .
.
.
$
or indirectly, 50% or more of the corporation’s voting
stock? (For rules of attribution, see section 267(c).)
If “Yes,” attach a statement showing name and
13
Is the corporation required to file Schedule UTP
identifying number. (Do not include any information
(Form 1120), Uncertain Tax Position Statement (see
already entered in 4 above.)
instructions)?
If
"Yes,"
complete
and
attach
Schedule UTP .
.
.
.
.
.
.
.
.
.
.
Enter percentage owned
14
If the corporation is a Blue Cross or Blue Shield
6
At any time during the tax year, did one foreign
organization described in section 833(c)(2), or other
person own, directly or indirectly, at least 25% of:
organization described in section 833(c)(3), did it
(a) the total voting power of all classes of stock of
meet the medical loss ratio (MLR) requirements of
the corporation entitled to vote, or (b) the total value
section 833(c)(5)? .
.
.
.
.
.
.
.
.
.
of all classes of stock of the corporation? If “Yes,”
enter:
(a) Percentage owned
and (b) Owner’s
Enter:
(a) Section 833(c)(5)
country
$
MLR numerator:
(c) The corporation may have to file Form 5472,
(b) Section 833(c)(5)
$
Information Return of a 25% Foreign-Owned U.S.
MLR denominator:
Corporation or a Foreign Corporation Engaged in a
%
(c) Section 833(c)(5) MLR:
U.S. Trade or Business. Enter number of Forms
5472 attached
1120-PC
Form
(2015)

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