Form M11l - Insurance Premium Tax Return For Life And Health Companies - 2016 Page 2
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5M11L
2016 Insurance Premium Tax Return for Life and Health Companies
(continued)
Page 2
A
B
State of Incorporation Basis
Minnesota Basis
Part 1 — Life Premiums
24 Net taxable business (enter amount from line 17) . . . . . . . . . . . . . . . . . . . 24
%
1.5%
25 Premium tax percentage rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5
26 Life premium tax liability (multiply line 24 by percentage on line 25) . . 2 6
Part 2 — Accident and Health
27 Net taxable business — Part 2 (enter amount from line 20) . . . . . . . . . . . 27
%
2%
28 Premium tax percentage rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 8
29 Accident and health premium tax liability
(multiply line 27 by the percentage on line 28) . . . . . . . . . . . . . . . . . . . . 2 9
30 Total premium tax liability (add lines 26 and 29) . . . . . . . . . . . . . . . . . . . 3 0
31 Other taxes (itemize on a separate schedule) . . . . . . . . . . . . . . . . . . . . . . 31
32 Licenses and fees (from M11B, line 10. Attach form M11B) . . . . . . . . . 3 2
33 Total taxes, licenses and fees (add lines 30 thru 32) . . . . . . . . . . . . . . . 3 3
34 Enter amount from line 33, Column A or B, whichever is greater . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4
35 Total licenses and fees paid to Minnesota (from M11B, line 11. Attach form M11B) . . . . . . . . . . . 3 5
36 Subtract line 35 from line 34 (if zero or less,
skip line 37 and enter this amount on line 38) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
37 Minnesota Guaranty Fund Association offset (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
38 Tax before refundable credits. If line 36 is zero or less, enter the amount from line 36. If line 36
is positive, subtract any amount on line 37 from line 36. (If result is less than zero, enter zero) . 38
39
Historic structure rehabilitation credit
(must attach credit certificate) enter NPS project number: . . . . . . . . .
3 9
40 Tax liability (subtract line 39 from line 38) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0
41 a Prior year’s overpayment . . . . . . . . . . . . . . . . . . 41 a
b Estimated payment March 15 . . . . . . . . . . . . . . 41 b
c
Estimated payment June 15 . . . . . . . . . . . . . . . 41 c
d Estimated payment Sept. 15 . . . . . . . . . . . . . . . 41 d
e Estimated payment Dec. 15 . . . . . . . . . . . . . . . . 41 e
Add lines 41a through 41e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
42 Tax due (or overpaid) (subtract line 41 from line 40). Enter on line 21, page 1 . . . . . . . . . . . . . . . 4 2
43 a
Additional charge for underpaying estimated tax
(determine from worksheet in the instructions) 43a
b
Penalty (see instructions) . . . . . . . . . . . . . . . . . 43b
c
Interest (see instructions) . . . . . . . . . . . . . . . . . 43c
Total additional charge, penalty and interest (add lines 43a through 43c). Enter on line 22, page 1 4 3
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