Form 83-391-14-8-1-000 - Mississippi Insurance Company Income Tax Return - 2014 Page 2

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Form 83-391-14-8-2-000 (Rev. 05/14)

Mississippi

Insurance Company Income Tax Return

833911482000

2014

Page 2

FEIN

COMPUTATION OF NET INCOME

A MISSISSIPPI

B COMPANY-WIDE

Direct premiums (except accident and

health premiums)

Less: return premiums

Direct accident and health premiums

Reinsurance assumed

Considerations for annuities

Considerations for supplementary contracts

Unearned premiums (December 31st, prior year)

Gross investment income

Other income

Total net income (add line 1 through line 8)

DEDUCTIONS

10 Unearned premiums (December 31st, current year)

10A

10B

11 Reinsurance ceded

11A

11B

12 Dividends to policy holders

12A

12B

13 Total deductions (add line 10 through line 12)

13A

13B

MISSISSIPPI NET TAXABLE INCOME

14 Gross income (line 9 minus line 13)

14A

14B

15 Total deductions allocated and apportioned (from page 4, part III, line 23)

15A

15B

16 Less: Mississippi net operating loss (from Form 83-155, part I, line 2)

16A

16B

17 Net taxable income (loss) (line 14 minus line 15 and line 16; enter amount

17A

17B

from 17A on page 1, line 1 or Form 83-310, page 1, line 5, column C)

Check box if return may be discussed with preparer

I declare, under penalties of perjury, that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,

this is a true, correct and complete return. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Date

Business Phone

Officer Signature and Title

Date

Paid Preparer Address

Paid Preparer Signature

City

Paid Preparer PTIN

Paid Preparer Phone

State

Zip Code

Mail Return To: DEPARTMENT OF REVENUE P.O. BOX 23050 JACKSON, MS 39225-3050