Form Iip-R - Annual Industrial Insurance (Workers Compensation) Reconciliation Premium Tax Return - 2012 Page 3
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4INDUSTRIAL INSURANCE PREMIUM TAX ANNUAL RECONCILIATION RETURN
(WORKERS COMPENSATION) INSTRUCTIONS
A COPY OF THE NEVADA PAGE FROM ANNUAL STATEMENT MUST BE ATTACHED
This form is to be used if you were required to file quarterly Industrial Insurance Premium Tax returns during the year. The Nevada
premium tax rate is 3.5%. (Retaliatory statues, NRS 680A.330 requires you to use the higher tax rate charged by your domiciliary
state).
Schedule 1
Line 1 Gross Premiums/Considerations. Defined as all direct premiums written during the year for workers compensation.
Line 2 Dividends Paid or Credited to Policy Holders
Line 3 Gross Premiums written minus Dividends paid or credited to policy holders.
Line 4 Taxes Payable. Amount of premium tax due.
Line 5 Retaliatory Assessment
Annual Reconciliation Return
Line 1 through Line 4 Total Premiums/Considerations If figures for columns A and B differ, penalty and interest may apply.
Line 5 Total Premium/Considerations Add Lines 1 through 4.
Line 6 Net Direct Premiums Enter Line 5 Column B. Must agree with Schedule 1, Line 4A and state (Nevada) page.
Line 7 Gross Industrial Insurance Premium Tax Enter the amount of Gross Premium Tax. Multiply Line 6 by 3.5% or .035.
Line 8 Industrial Insurance Credit Enter the amount paid to Division of Industrial Relations for the year. Each insurer providing
industrial insurance in this state is entitled to a credit against the premium tax paid equal to the assessment paid to Division of
Industrial Relations. (NRS 680B.036). This credit is to be applied only against the premium tax for the year in which the assessment
to the Division of Industrial Relations was paid. The Credit can not be applied against future premium tax liability.
Line 9. Subtotal Enter in premium tax due. Line 7 minus Line 8.
Line 10a Home Office Credit. 50% or .5 of Line 4. NRS 680B.050 provides that insurers who maintain a “home” or “regional” office
may be entitled to a credit against tax to be paid. It provides for a 50 percent credit for taxes due. Each insurer claiming a home or
regional home office credit must have a certified copy of the deed to the property in the name of the insurer on file with the
Department.
Line 10b Ad Valorem Taxes Enter the amount of ad valorem Taxes paid during this year. NRS 680B.050(1) provides for credit for
ad valorem taxes actually paid upon the home office or regional home office together with the land, as reasonably required for the
convenient use of the office, upon which the home office or regional home office is situated. Further, the insurer must provide
certified copies of the billing by local authorities for the ad valorem taxes in addition to a receipt for proof of payment.
Line 10c Max Credit allowed Enter max credit allowed. Multiply Line 7 by 80% or .80. NRS 680B.050(1) imposes a limit on the
total amount of the credit that may be obtained. The credits may not reduce the total amount of taxes payable to less than 20 percent
of the amount of gross premium taxes payable.
Line 10d Enter the available Home Office Credit and Ad Valorem taxes credit. Add lines 10a and 10b. Compare to line 10c. Enter
the lesser of the two.
Line 11 Enter the amount of Property/Casualty Guaranty Association credit to be used this year.
Line 12 Enter the amount of cash payments made on the Industrial Insurance quarterly premium tax returns.
Line 13 Net Premium Tax Due. Enter the amount of Net Premium Tax due. Line 9 minus Lines 10d through 13 plus Line 14.
IIP-R
Revised 12-06-12
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