Form M11l - Insurance Premium Tax Return For Life And Health Companies - Minnesota Department Of Revenue - 2013 Page 2
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5M11L
2013 Insurance Premium Tax Return for Life and Health Companies
Page 2
(continued)
A
B
State of Incorporation Basis
Minnesota Basis
Part 1 — Life Premiums and Other Taxes
24 Net taxable business (enter amount from line 17) . . . . . . . . . . . . . . . . . . . . 24
%
1.5%
25 Premium tax percentage rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Premium tax liability (multiply line 24 by percentage on line 25) . . . . . . . . 26
27 Other taxes (itemize on a separate schedule) . . . . . . . . . . . . . . . . . . . . . . . . 27
28 Life premium tax liability (add lines 26 and 27) . . . . . . . . . . . . . . . . . . . . . . 28
Part 2 — Accident and Health
29 Net taxable business — Part 2 (enter amount from line 20) . . . . . . . . . . . . 29
%
2%
30 Premium tax percentage rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
31 Accident and health premium tax liability
(multiply line 29 by the percentage on line 30) . . . . . . . . . . . . . . . . . . . . . . . 31
32 Total premium tax liability (add lines 28 and 31) . . . . . . . . . . . . . . . . . . . . . 32
33 Licenses and fees paid to the Minnesota Commerce Department
and home state (from M11B, line 10; or if domiciled in Minnesota,
Hawaii, Massachusetts, New York or Rhode Island, enter zero) . . . . . . . . . 33
34 Total taxes, licenses and fees (add lines 32 and 33) . . . . . . . . . . . . . . . . . . 34
35 Enter amount from line 34, Column A or B, whichever is greater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Total licenses and fees paid to Minnesota (from M11B, line 11; or if domiciled
in Minnesota, Hawaii, Massachusetts, New York or Rhode Island, enter zero) . . . . . . . . . . . . . . . . . . 36
37 Subtract line 36 from line 35 (if zero or less,
skip line 38 and enter this amount on line 39) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
38 Minnesota Guaranty Fund Association offset (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
39 Tax before refundable credits. If line 37 is zero or less, enter the amount from line 37. If line 37
is positive, subtract any amount on line 38 from line 37. (If result is less than zero, enter zero) . . . . 39
40 Historic structure rehabilitation credit (attach
credit certificate) and enter NPS project number: . . . . . . .
. . . . . . . . . . . . . 40
41 Tax liability (subtract line 40 from line 39) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
42 a Prior year’s overpayment . . . . . . . . . . . . . . . . . . . . 42a
b Estimated payment March 15 . . . . . . . . . . . . . . . . 42b
c Estimated payment June 15 . . . . . . . . . . . . . . . . . 42c
d Estimated payment Sept. 15 . . . . . . . . . . . . . . . . . 42d
e Estimated payment Dec. 15 . . . . . . . . . . . . . . . . . . 42e
Add lines 42a through 42e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
43 Tax due (or overpaid) (subtract line 42 from line 41). Enter on line 21, page 1 . . . . . . . . . . . . . . . . . 43
44 a Additional charge for underpaying estimated tax
(determine from worksheet in the instructions) . . 44a
b Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . 44b
c Interest (see instructions) . . . . . . . . . . . . . . . . . . . 44c
Total additional charge, penalty and interest (add lines 44a through 44c). Enter on line 22, page 1 . . 44
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