Schedule 800a - Virginia Insurance Premiums License Tax Worksheet - 2014
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1Schedule 800A
2014 Virginia Insurance Premiums License Tax Worksheet
Transfer the amounts on Lines 12 and 13 for Columns C, D and E to Lines 6, 7 and 8 of Form 800.
Column A
Column B
Column C
Column D
Column E
Direct Premium
Insurance Type
Net Additions/
Premiums Taxed
Premiums Taxed
Premiums Taxed
Income Reported
Subtractions
at 2.25%
at 1.00%
at 0.75%
on Schedule T
. . . . . . . . . . . . .
1.
Property, Casualty and Title Insurers - All types of insurance
2.
Life, Accident and Sickness Insurers
. . . . . . . . . . . . . . . . . . . . . . . . . . .
a. Life, Disability and Double Indemnity
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Accident and Sickness
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Industrial Sick Benefit
. . . . . . . .
3.
Legal Service Plans - Gross amount of all Virginia subscriber income
4.
Limited Health Service Organizations/Dental and Optometric Service Plans
a. Income Derived from Primary Small Groups
. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Income Derived from Large Groups
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. All Other Income
5.
Health Service Plans
. . . . . . . . . . . . . . . . . . . . . . .
a. Income Derived from Primary Small Groups
b. Income Derived from Large Groups
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. All Other Income
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.
Risk Retention Groups
7.
Mutual Assessment Property and Casualty Insurers
. . . . . . . . . . . . . . . . . . . .
If exempt, enter “0” for tax and attach Schedule 844
8.
Cooperative Nonprofit Life Benefit Companies; Mutual Assessment Life,
. . . . . . . . . . . . . . . . . . . . .
Accident & Sickness Insurers; Burial Societies
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
Dental Plan Organizations
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Home Service Contract Providers
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.
Joint Underwriting Associations
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Taxable Premium Amount
Multiply Column C, Line
Multiply Column D, Line
Multiply Column E, Line
12 by 2.25%. Also enter
12 by 1.00%. Also enter
12 by 0.75%. Also enter
on Form 800, Line 6b.
on Form 800, Line 7b.
on Form 800, Line 8b.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Insurance Premiums License Tax
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