Form 1120-Pc - U.s. Property And Casualty Insurance Company Income Tax Return - 2017 Page 6
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86
Form 1120-PC (2017)
Page
Schedule G
Other Capital Losses (see instructions)
(Capital assets sold or exchanged to meet abnormal insurance losses and to pay dividends and similar
distributions to policyholders.)
1
Dividends and similar distributions paid to policyholders
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1
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2
Losses paid
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3
Expenses paid .
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3
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Total. Add lines 1, 2, and 3 .
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4
Note: Adjust lines 5 through 8 to cash method if necessary.
5
Interest received .
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5
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Dividends-received (Schedule C, line 14) .
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6
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Gross rents, gross royalties, lease income, etc., and gross income from a trade
or business other than an insurance business including income from Form 4797
(include gains for invested assets only)
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7
8
Net premiums received .
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8
9
Total. Add lines 5 through 8 .
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10
Limitation on gross receipts from sales of capital assets. Line 4 less line 9. If zero or less, enter -0- .
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10
(g) Loss
(a) Description of capital
(b) Date
(c) Gross
(d) Cost or
(e) Expense
(f) Depreciation allowed
((d) plus (e) less
asset
acquired
sales price
other basis
of sale
(or allowable)
the sum of (c) and (f))
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Totals—column (c) must not be more
than line 10. (Enter amount from column
(g) in Schedule A, line 28, or Schedule
B, line 15, whichever applies.)
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Schedule H
Special Deduction and Ending Adjusted Surplus for Section 833 Organizations
(see instructions)
1
Health care claims incurred during the tax year and liabilities incurred during the tax year under cost-plus
contracts
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1
2
Expenses incurred during the tax year in connection with the administration, adjustment, or settlement of
health care claims or in connection with the administration of cost-plus contracts .
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3
Total. Add lines 1 and 2 .
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3
4
Multiply line 3 by 0.25
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4
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Beginning adjusted surplus .
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6
Special deduction. If you checked “No” on line 14 of Schedule I, enter -0- here; you can’t take the special
deduction. All others subtract line 5 from line 4. If zero or less, enter -0-. Enter amount here and on
Schedule A, line 34a. (See instructions for limitation.)
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Net operating loss deduction (Schedule A, line 36b) .
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8
Net exempt income:
a
Adjusted tax-exempt income
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8a
b
8b
Adjusted dividends-received deduction
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9
Taxable income (Schedule A, line 37) .
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Ending adjusted surplus. Add lines 5 through 9
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10
1120-PC
Form
(2017)
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