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Form 4910 - Michigan Corporate Income Tax Unitary Business Group Combined Filing Schedule For Financial Institutions - 2012 Page 2

4910, Page 2

Designated Member FEIN or TR Number

PART 2B: MeMBeR DATA FOR COMBINeD ReTURN —

Complete a separate copy of Part 2B for each UBG member listed in Part 1.

4. Member Name

Member FEIN or TR Number

5. Member Address (Street)

10. Organization Type

S Corporation /

City

State

ZIP/Postal Code

Fiduciary

LLC S Corporation

C Corporation /

Partnership /

Beginning

Ending

LLC C Corporation

LLC Partnership

6. Federal Tax Period Included in

Return (MM-DD-YYYY) ........................

11.

Check if Nexus with Michigan

7. If part year member, enter

membership dates (MM-DD-YYYY) .....

8. NAICS Code

9. If discontinued, effective date

12.

Check if New Member

13. Nature of business activities or operations resulting in a flow of value between members, or integration, dependence or contribution to other members

FRANCHISe TAx BASe

Lines 14-16: If less than 0,

2008

2009

2010

2011

2012

enter 0.

14. Equity Capital .... 14.

Average daily

15.

book value of MI

obligations ......... 15.

Average daily

16.

book value of

U.S. obligations ..

16.

17. Subtotal. Add

lines 15 and 16 .. 17.

18. Net Capital.

Subtract line 17

from line 14 ........ 18.

19. a. Authorized

insurance co.

subsidiary: enter

actual capital

fund amt ............ 19a.

b. Minimum

regulatory amt.

required ........... 19b.

c. Multiply line 19b

by 125% (1.25) . 19c.

d. Subtract line

19c from 19a.

If less than

zero, enter

zero................. 19d.

20. Add lines 18

and 19d.............. 20.

21. Add lines 20A, 20B, 20C, 20D and 20E ................................................................................................................. 21.

22. Net Capital for Current Taxable Year. Divide line 21 by number of tax years reported above ................................ 22.

MeMBeR BUSINeSS

23. Michigan Gross Business. Carry combined total of line 23 entries to Part 2A, line 2A........................................... 23.

24. Total Gross Business. Carry combined total of line 24 entries to Part 2A, line 3A ................................................. 24.

PAyMeNTS.

See instructions

25. Overpayment credited from prior tax return (MBT or CIT) ...................................................................................... 25.

26. Estimated tax payments ......................................................................................................................................... 26.

27. Flow-Through Withholding payments ....................................................................................................................

27.

28. Tax paid with request for extension ........................................................................................................................ 28.

0000 2012 46 02 27 7

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