Form 63-20p - Premium Excise Return For Life Insurance Companies - 2013 Page 2

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Excise after credits

26 Excise due before voluntary contribution. Subtract line 25 from line 4 or line 12, whichever applies. Not less than “0”. . . . . . 26

27 Voluntary contribution for endangered wildlife conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 27

28 Total excise plus voluntary contribution. Add lines 26 and 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 28

Payments

29 2012 overpayment applied to 2013 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 29

30 2013 Massachusetts estimated tax payments (do not include amount from line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 30

31 Payments made with extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 31

32 Pass-through entity withholding. Payer Identification number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . 3 32

33 Refundable Film Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 33

34 Refundable Dairy Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 34

35 Refundable Life Science Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 35

36 Refundable Economic Development Incentive Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 36

37 Refundable Conservation Land Credit. Certificate number 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 37

38 Total payments. Add lines 29 through 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Refund or balance due

39 Amount overpaid. Subtract line 28 from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

40 Amount overpaid to be credited to 2014 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 40

41 Amount overpaid to be refunded. Subtract line 40 from line 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 41

42 Balance due. Subtract line 38 from line 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

43 M-2220 penalty 3 $ _______________________ ; Other penalties 3 $_______________________. . . . . . . . Total penalty 43

44 Interest on unpaid balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 44

45 Total payment due at time of filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 45

Part 1. Domestic Life Premium Excise Calculation

–

Life insurance –

–

ccident and health insurance –

Jurisdictions where

no insurance

Massachusetts

excise paid

Massachusetts

excise paid

11 All new and renewal (direct) premiums for

Massachusetts residents . . . . . . . . . . . . . . . . . . . . 1 3

12 Dividends applied to:

a Purchase paid-up additions . . . . . . . . . . . . . . . 2a 3

b Shorten premium paying period. . . . . . . . . . . . 2b 3

13 Total. Add lines 1 through 2b . . . . . . . . . . . . . . . . . 3

Include only what has been returned as receipts on this return or on a previous return.

Deductions.

14 Returned premiums but not including cash

surrender values (enclose schedule) . . . . . . . . . . . 4 3

15 Premiums for company employees’ group

life and accident and health plans if included

in line 1* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 3

16 Gross premiums for authorized preferred

provider arrangements . . . . . . . . . . . . . . . . . . . . . . 6 3

17 Dividends:

a Paid in cash . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a 3

b Applied in reduction of renewal premiums. . . . 7b 3

c Left to accumulate at interest. . . . . . . . . . . . . . 7c 3

d Applied to purchase paid-up additions . . . . . . . 7d 3

e Applied to shorten premium paying period . . . 7e 3

18 Total deductions. Add lines 4 through 7e . . . . . . . . 8

19 Amount taxable. Subtract line 8 from line 3 . . . . . . 9

10 Total life amount taxable. Add line 9, columns a and b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Total accident and health amount taxable. Add line 9, columns c and d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

*Premiums under the company employees’ group plans for annuity consideration and retirement benefits shall not be deducted.