Form Dexm - Domestic Companies - 2013 Page 4
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5DEXM (11-13)
Page 4
SCHEDULE C----CALCULATION OF GUARANTY FUND ASSESSMENT CREDIT
Eligibility-Provided for by the New Jersey Life and Health Insurance Guaranty Association Act (N.J.S.A. 17B:32A-18),
a member Life and Health insurer may offset against its premium tax liability, attributable to premiums written in that
year, any assessments for which a certificate of contribution has been issued, to the extent of 10% of the amount of
those assessments for each of the five calendar years following the second year after the year in which those
assessment were paid, except that no member insurer may offset its premium tax liability by more than 20% of its
tax liability in any one year.
Be sure to include proof of payment for all assessments listed below.
YEARS IN WHICH A CREDIT FOR AN
MAXIMUM
YEAR
ASSESSMENT CAN BE CLAIMED
AMOUNT
ALLOWABLE CREDIT
ASSESSMENT
(CREDIT IS 10% OF ASSESSMENT)
OF
10% OF
PAID
1
2
3
4
5
6
7
ASSESSMENT
ASSESSMENT
2006
XX
XX
2009
2010
2011
2012
2013
1.
2007
XX
XX
2010
2011
2012
2013
2014
2.
2008
XX
XX
2011
2012
2013
2014
2015
3.
2009
XX
XX
2012
2013
2014
2015
2016
4.
2010
XX
XX
2013
2014
2015
2016
2017
5.
Maximum Credit Available for this Return (add lines 1 through 5 above)
6.
Enter 20% of the tax liability reported on Schedule A, Line 18
7.
Enter the lesser of line 6 or 7 here and on Schedule A, Line 21
8.
DOMESTIC COMPANIES
GENERAL FILING INSTRUCTIONS
Please note, listed below you will find instructions which highlight specific areas of concern when completing the tax return:
1.
NAIC code—At the top left side of the first page of the return is a space to provide the insurer’s five digit NAIC (National
Association of Insurance Commissioners) code. This space must be completed by all taxpayers.
2.
Email address has replaced the Contact Persons Fax number on the Front Page of the return.
3.
Schedule A—Please note that Schedule A, including lines 1 to 14, must be completed by all taxpayers, even if the taxpayer
is calculating the tax based on the 12.5% limitation indicated in Schedule B.
4.
All credits requested on Schedule A, require supporting documentation as proof of payment (i.e. copy of the check or front &
back of cancelled check). These documents MUST be submitted with the return or the credit will be denied.
5.
Penalty and Interest—Any taxpayer which fails to file its return when due or fails to pay any tax when due shall be subject to
penalties and interest as provided for in the State Tax Uniform Procedure Law N.J.S.A. 54:48-1 et seq. and N.J.S.A. 18:2-2.1 et
seq.
st
6.
Overpayment – Please note, any overpayment indicated on Line 28 must first be applied to the prepayment due June 1
before
any refund will be issued.
7.
Affiliate Schedule-A taxpayer determining its taxable premiums as provided in N.J.S.A. 54:18A-6, when completing Schedule
B Section 1, must include a separate schedule listing each affiliate and its applicable premiums, used in completing column A of
Section 1.
INSTRUCTIONS FOR THE DETERMINATION OF TAXABLE
PREMIUMS AS PROVIDED IN N.J.S.A. 54:18A-6
(SCHEDULE B)
If the company was licensed subsequent to 6/30/84 and the amount indicated at Section I, Line 4, Column C is not greater
than the amount indicated at Section I, Line 4, Column B, then the company does not qualify to use this limitation. Taxable Premiums
are then those included at Line 14 of Schedule A.
If the company was licensed subsequent to 6/30/84 and the amount indicated at Section I, Line 4, Column C is greater than
the amount indicated at Section I, Line 4, Column B, then taxable premiums are the amounts indicated at Section II, Column B. These
amounts should be entered at the applicable Line(s) (15, 16, and 17) of Schedule A. In addition, a detailed schedule of Worldwide
and New Jersey Premiums of the Company and each affiliate must be submitted with this schedule.
If the company was licensed prior to 7/1/84 and if the amount indicated at Section II, Line 4, Column B is less than taxable
premiums indicated at Line 14 of Schedule A, then enter amounts from Column B at the applicable Line(s) (15, 16, 17) of Schedule A.
If the amount indicated at Section II, Line 4, Column B is not less than taxable premiums indicated at Line 14 of Schedule A, then
taxable premiums are those included at Line 14 of Schedule A.
ELECTRONIC FUNDS TRANSFERS
The Division of Taxation has established procedures to allow the remittance of tax payments through electronic funds
transfer (EFT). A taxpayer’s with a prior year’s tax liability of $10,000 or more in any one tax, are required to remit all tax payments
using EFT.
For EFT program questions, visit the Division of Revenue website at ,
call the EFT Unit at (609) 292-9292 Opt #6, Fax (609) 984-6681 or write to the N.J. Division of Revenue, EFT Section, P.O. Box 191,
Trenton, N.J. 08646-0191.
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