Form 63-23p - Premium Excise Return For Insurance Companies

Credits.

Do not claim any credit here if claimed on Form 63-29A.

21 Domestic casualty insurers only. Retaliatory surtax credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 21

22 Domestic casualty insurers only. Enter 1.5% of company’s total capital contributions in excess of the full proportionate

share in investment in the Massachusetts property and casualty initiative. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 22

23 Credit against premium excise. Add lines 21 and 22. Enter total here, but do not exceed the amount in line 1 . . . . . . . . . . . . 23

24 Enter 10% of Massachusetts Life and Health Insurance Guaranty Association assessment paid previously . . . . . . . . . . . . . 3 24

25 Economic Opportunity Area Credit (enclose Schedule EOAC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 25

26 Economic Development Incentive Program Credit. Certificate number 3

. . . . . . . . . . . . . . . . . 3 26

27 Low-Income Housing Credit. Building Identification number 3

. . . . . . . . . . . . . . . . . . . . . . . . . 3 27

28 Historic Rehabilitation Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 28

29 Film Incentive Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 29

30 Medical Device Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 30

31 Brownfields Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 31

32 Life Science Company Investment Tax Credit under section 38U . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 32

33 Life Science Company FDA User Fee Credit under section 31M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 33

34 Life Science Company Research and Development Credit under section 38W. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 34

35 Total credits. Add lines 23 through 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Excise After Credits

36 Excise due before voluntary contribution. Subtract line 35 from line 5, 14 or 20, whichever is applicable. Not less than “0” . . . 36

37 Voluntary contribution for endangered wildlife conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 37

38 Total excise plus voluntary contribution. Add lines 36 and 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 38

Payments

39 2011 overpayment applied to 2012 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 39

40 2012 Massachusetts estimated tax payments (do not include amount from line 39) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 40

41 Payments made with extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 41

42 Pass-through entity withholding. Payer Identification number 3

. . . . . . . . . . . . . . . . . . . . . . . . 3 42

43 Refundable Film Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 43

44 Refundable Dairy Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 44

45 Refundable Life Science Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 45

46 Refundable Life Science Jobs Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 46

47 Refundable Economic Development Incentive Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 47

48 Refundable Conservation Land Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . 3 48

49 Total payments. Add lines 39 through 48 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Refund or Balance Due

50 Amount overpaid. Subtract line 38 from line 49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

51 Amount overpaid to be credited to 2013 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 51

52 Amount overpaid to be refunded. Subtract line 51 from line 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 52

53 Balance due. Subtract line 49 from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

54 M-2220 penalty 3 $ _______________________ ; Other penalties 3 $_______________________. . . . . . . . . Total penalty 54

55 Interest on unpaid balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 55

56 Total payment due at time of filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 56

Part 1. Premium Excise.

Domestic casualty insurers only must complete this schedule.

01 Total of all net direct premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1

02 Net direct premiums for insurance of property or interests in other states or countries where a tax is actually paid by said

company or its agents (Supporting schedule is required showing by states the total business written. Copy of Schedule T

is accepted, if admitted states are designated.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2

b. States or

countries in which

Total

Massachusetts

company pays no tax

add col’s. a and b

03 Total net direct premiums subject to tax. Subtract line 2 from line 1 . . . . . . 3

04 Premiums returned or credited to policyholders. . . . . . . . . . . . . . . . . . . . . . 4

05 Taxable premiums. Subtract line 4 from line 3. Enter the amount in

5c on page 1, line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

06 Are net direct premiums reported in lines 1 and 3?

Yes