Form 1120-L - U.s. Life Insurance Company Income Tax Return - 2012
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81120-L
U.S. Life Insurance Company Income Tax Return
OMB No. 1545-0128
Form
2012
For calendar year 2012 or tax year beginning
, 2012, ending
, 20
Department of the Treasury
Internal Revenue Service
Information about Form 1120-L and its separate instructions is at
▶
Name
B Employer identification number
A
Check if:
1
Consolidated return
Please
(attach Form 851) .
Number, street, and room or suite no. If a P.O. box, see instructions.
C Date incorporated
print
Life-nonlife consoli-
2
or
dated return .
.
type
City or town, state, and ZIP code
D Check applicable box if an election
3
Schedule M-3
(Form 1120-L)
has been made under section(s):
attached .
.
.
Final return
Name change
Address change
Amended return
E
Check if:
(1)
(2)
(3)
(4)
953(c)(3)(C)
953(d)
1
1
Gross premiums, etc., less return premiums, etc. Enter balance .
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2
Net decrease, if any, in reserves (see instructions) .
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10% of any decrease in reserves under section 807(f)(1)(B)(ii) .
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Investment income (Schedule B, line 8) (see instructions) .
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Net capital gain (Schedule D (Form 1120), line 17) .
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Income from a special loss discount account (attach Form 8816) .
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7
Other income (attach statement)
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7
Life insurance company gross income. Add lines 1 through 7 .
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8
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9
Death benefits, etc. .
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9
10
Net increase, if any, in reserves (Schedule F, line 35)
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10
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10% of any increase in reserves under section 807(f)(1)(B)(i)
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12
12
Deductible policyholder dividends (Schedule F, line 18e)
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13
Assumption by another person of liabilities under insurance, etc., contracts
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Dividends reimbursable by taxpayer
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14
15a
Interest
b Less tax-exempt interest expense
c Bal
15c
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16
Deductible policy acquisition expenses (Schedule G, line 20) .
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Additional deduction (attach Form 8816) .
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18
Other deductions (see instructions) (attach statement) .
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18
19
Add lines 9 through 18 .
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19
20
Subtotal. Subtract line 19 from line 8 .
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20
21a
Dividends-received deduction (Schedule A, line 16, column (c))
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21a
Plus: b Operations loss deduction (see instructions) (attach statement) .
21b
21c
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22
22
Gain or (loss) from operations. Subtract line 21c from line 20 .
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23
Small life insurance company deduction (Schedule H, line 17) .
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23
24
Life insurance company taxable income (LICTI). Subtract line 23 from line 22
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24
25
Limitation on noninsurance losses (Schedule I, line 9) .
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25
Amount subtracted from policyholders surplus account (Schedule J, Part II, line 10)
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Taxable income. Add lines 24, 25, and 26 (see instructions) .
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28
Total tax (Schedule K, line 10) .
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28
29a
2011 overpayment credited to 2012
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29a
b
Prior year(s) special estimated tax payments to be applied
29b
c
2012 estimated tax payments .
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29c
d
29d
2012 special estimated tax payments (Do not include on line 29f)
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29e (
) 29f
e
Less 2012 refund applied for on Form 4466 .
g
Tax deposited with Form 7004 .
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29g
h
Credits:
29h
(1) Form 2439
(2) Form 4136
i
U.S. income tax paid or withheld at source (attach Form 1042-S) .
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29i
j
29j
29k
Refundable credit from Form 8827, line 8c
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30
30
Estimated tax penalty. Check if Form 2220 is attached .
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31
Amount owed. If line 29k is smaller than the total of lines 28 and 30, enter amount owed
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32
Overpayment. If line 29k is larger than the total of lines 28 and 30, enter amount overpaid .
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32
33
Enter amount from line 32: Credited to 2013 estimated tax
Refunded
33
▶
▶
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
Sign
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
Here
with the preparer shown below
Yes
No
(see instructions)?
Signature of officer
Date
Title
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
▶
▶
Firm's address
Phone no.
▶
1120-L
For Paperwork Reduction Act Notice, see separate instructions.
Form
(2012)
Cat. No. 11480E
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