Schedule 4i - Wisconsin Adjustments For Insurance Companies - 2015
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4I
Wisconsin Adjustments for
Schedule
Insurance Companies
2015
File with Wisconsin Form 4
Wisconsin Department
Read instructions before filling in this form
of Revenue
Corporation Name
Federal Employer ID Number
Part I Additions Specific to Insurance Companies
1
Loss carryforward deducted in the calculation of federal taxable income . . . . . . . . . . . 1
2
Dividend income received to the extent not included in the amount on Form 4,
line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3
Additional federal deduction for insurers required to discount unpaid losses . . . . . . . . 3
4
Add lines 1 through 3 . Enter this amount on Schedule 4V, line 9 . . . . . . . . . . . . . . . . . 4
Part II Nontaxable Income from Life Insurance Operations
5
Insurance company's federal taxable income as reported or included on
Form 4, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Insurance company's total addition modifications from Schedule 4V, line 11 . . . . . . . . 6
6
7
Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Insurance company's total subtraction modifications from Schedule 4W,
8
lines 1 through 13i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9
Subtract line 8 from line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10a Enter net gain from operations other than life insurance . . . . . . . . . . . . . . . . . . . . . . . 10a
10b Enter total net gain from operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10b
.
11
Divide line 10a by line 10b and enter result as a percentage (see instructions) . . . . . . 11
%
12
Multiply line 9 by line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13
Subtract line 12 from line 9 . Enter this amount on Schedule 4W, line 14 . . . . . . . . . . . 13
Part III Net Business Loss Adjustment for Insurance Companies
14
Enter net income or loss from Form 4, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15
Enter the net income or loss from Form 4, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16
Add lines 14 and 15 . If the amount is positive, there is no net business loss
adjustment . If the amount is negative, complete lines 17 to 20 . . . . . . . . . . . . . . . . . . . 16
17
Enter the total dividends received deduction from Schedule 4Y, computed as
explained in the instructions . Enter as a negative number . . . . . . . . . . . . . . . . . . . . . . 17
18
Enter the apportionment percentage from Form 4, line 8 . . . . . . . . . . . . . . . . . . . . . . . . 18
.
%
IC-020C
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