Form 83-391-14-8-1-000 - Mississippi Insurance Company Income Tax Return - 2014 Page 3

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Form 83-391-14-8-3-000 (Rev. 05/14)
Mississippi
Insurance Company Income Tax Return
2014
Page 3
FEIN
PART I: EXPENSE APPORTIONMENT RATIOS
A MISSISSIPPI
B COMPANY-WIDE
C MISSISSIPPI RATIO
Applicable ratio(s) used on page 4, part IV, line 2
1A
1B
1C
1
Loss adjustment expenses (direct losses)
%
.
2
Accident and health expenses (direct premiums and
reinsurance assumed)
2A
2B
2C
%
.
3
Other underwriting expenses (direct premiums
(less return premiums), annuity considerations and
3A
3B
3C
%
.
reinsurance assumed)
4A
4B
4C
%
4
Investment expenses (gross investment income)
.
PART II: DEDUCTIONS ALLOCATED
A MISSISSIPPI
B COMPANY-WIDE
5
Losses, death benefits, accident and health
benefits (less applicable recoveries)
a Paid
5Aa
5Ba
.
.
00
00
b Unpaid at December 31st, current year
5Ab
5Bb
.
.
00
00
c Unpaid at December 31st, prior year
5Ac
5Bc
.
.
00
00
6
Loss adjustment expenses allocated
6A
6B
.
.
00
00
7
Matured endowments
7A
7B
.
.
00
00
8
Annuity benefits
8A
8B
.
.
00
00
9
Disability benefits
9A
9B
.
.
00
00
10 Surrender benefits
10A
10B
.
.
00
00
11 Payments on supplementary contracts
11A
11B
.
.
00
00
12 Net additions to reserve funds (required by law
for liquidating policies at maturity)
12A
12B
.
.
00
00
13 Commissions
13A
13B
.
.
00
00
14 Gross premium privilege tax
14A
14B
.
.
00
00
15 Other allocable taxes
15A
15B
.
.
00
00
16 Rent, allocated
16A
16B
.
.
00
00
17 Agency expense (attach schedule)
17A
17B
.
.
00
00
18 Medical and inspection fees, allocated
18A
18B
.
.
00
00
19 Other allocable deductions (attach schedule)
19A
19B
.
.
00
00
20 Total allocable deductions
20A
20B
.
.
00
00

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