Form 4700 - Gross Receipts Worksheet (Page 4 of 5) in pdf

FEIN or TR Number

4700, Page 4

UBG Member FEIN or TR Number

PART 5: EXCLUSIONS FROM GROSS RECEIPTS (CONT.)

59. Amounts attributable to an ownership interest in a pass-through entity, regulated investment company, real estate

investment trust, or cooperative corporation whose business activities are taxable under the modified gross

receipts tax or would be subject to the modified gross receipts tax if the business activities were in this state

(f)

.....

59.

60. For a regulated investment company as that term is defined under IRC § 851, receipts derived from investment

activity by that regulated investment company ......................................................................................................

60.

61. Only Health Maintenance Organizations (HMOs) holding contract with the State for Medicaid services may

complete this line: If applicable per MCL § 208.1111(1) (dd), enter amounts received during the period that is

both within the tax year and within October 1, 2014, through September 30, 2015, for Medicaid premium or

reimbursement of costs associated with service provided to a Medicaid recipient or beneficiary. The State Budget

Director has until January 1, 2015, to certify that necessary rates provide explicit adjustment for MBT obligations,

in which case NO deduction will be allowed for any HMO holding contract with the State for Medicaid services

(g)

61.

62. For a taxpayer that provides health care management consulting services, amounts received by the taxpayer as

fees from its clients that are expended by the taxpayer to reimburse those clients for labor and nonlabor services

that are paid by the client and reimbursed to the client pursuant to a services agreement ........................................

62.

63. Bad Debt amounts deducted for Federal Income Tax that correspond to items included in MGR tax base for

current or prior MBT return ....................................................................................................................................

63.

64a. Dividends and royalties received or deemed received from a foreign operating entity or a person other than a

U.S. person, including, but not limited to, the amounts determined under IRC § 78, or 951 through 964 ................

64a.

64b. Exclusion of amounts attributed to the taxpayer pursuant to a discharge of indebtedness as described under

IRC 61(a)(12), including forgiveness of a nonrecourse debt.

64b.

Add lines 32 through 47, 48c, 49c, 50c, and 51 through 64b ...............................................................................

65.

To the extent INCLUDED in arriving at line 31, and to the extent NOT deducted as purchases from other

firms on the MBT Annual Return, Form 4567, lines 13, 14 or 15, (or, for UBG standard members, the MBT

UBG Combined Filing Schedule for Standard Members, Form 4580, lines 18, 19 or 20) enter:

66. Sales or use taxes collected from or reimbursed by a consumer or other taxes collected from or reimbursed by

a purchaser and remitted to a local, state, or federal tax authority........................................................................

66.

67. In the case of receipts from the sale of motor fuel by a person with a motor fuel tax license or a retail dealer, the amount

equal to federal and state excise taxes paid by any person on such motor fuel under IRC § 4081 or applicable state law ...

67.

68. In the case of receipts from the sale of beer, wine, or intoxicating liquor by a person holding a license to sell,

distribute, or produce those products, the amount equal to federal and state excise taxes paid by any person

on or for such products under IRC Subtitle E or applicable state law ...................................................................

68.

69. In the case of receipts from the sale of communication, video, internet access and related services and

equipment, any government imposed tax, fee, or other imposition in the nature of a tax or fee required by law,

and authorized to be charged on a customer’s bill or invoice, but not including net income taxes, net worth

taxes, property taxes, or the MBT .........................................................................................................................

69.

70. In the case of receipts from the sale of electricity, natural gas, or other energy source, any government imposed

tax, fee, or other imposition in the nature of a tax or fee required by law, and authorized to be charged on a

customer’s bill or invoice, but not including net income taxes, net worth taxes, property taxes, or the MBT ............

70.

71. Any deposit required under the following:

a. 1976 IL 1, MCL § 445.571 to 445.576 ............................................................................................................... 71a.

b. R 436.1629 of the Michigan administrative code............................................................................................... 71b.

c. R 436.1723a of the Michigan administrative code............................................................................................. 71c.

d. Any substantially similar beverage container deposit law of another state ....................................................... 71d.

72. Excise tax collected from or reimbursed by a consumer and remitted pursuant to MCL § 207.371 to 207.383 ...

72.

In the case of receipts from the sale of cigarettes or tobacco products by a wholesale dealer, retail dealer,

distributor, manufacturer, or seller, the amount equal to the federal and state excise taxes paid by any person

73.

on or for such products under IRC Subtitle E or applicable state law ...................................................................

73.

Add lines 66 through 73...............................................................................................................

SUBTOTAL

74.

GROSS RECEIPTS FOR MBT PURPOSES

75. Subtract lines 65 and 74, from line 31. Carry this amount to Form 4567, line 12. Standard members of a UBG

will carry this amount to Form 4580, Part 2A, line 17 ............................................................................................

75.

Superscript Explanations on Page 5

Form 4700 - Gross Receipts Worksheet Page 4

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