Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 17
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2017
Form 1024 (Rev. 1-2018)
Page
Schedule I
Organizations described in section 501(c)(15) (Small insurance companies or associations)
1
Is the organization a member of a controlled group of corporations as defined in section 831(b)(2)(B)(ii)? (Disregard
section 1563(b)(2)(B) in determining whether the organization is a member of a controlled group.)
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Yes
No
If “Yes,” include on lines 2 through 5 the total amount received by the organization and all other members of the
controlled group.
If “No,” include on lines 2 through 5 only the amounts that relate to the applicant organization.
(a) Current Year
3 Prior Tax Years
From
(b)
(c)
(d)
To
2
Direct written premiums .
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3
Reinsurance assumed
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4
Reinsurance ceded
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5
Net written premiums ((line 2 plus line 3) minus line 4)
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6
If you entered an amount on line 3 or line 4, attach a copy of the
reinsurance agreements the organization has entered into.
Instructions
Line 1.—Answer “Yes,” if the organization would be
Line 2.—In addition to other direct written premiums,
considered a member of a controlled group of
include on line 2 the full amount of any prepaid or
corporations if it were not exempt from tax under section
advance premium in the year the prepayment is received.
501(a). In applying section 1563(a), use a “more than
For example, if a $5,000 premium for a 3-year policy was
50%” stock ownership test to determine whether the
received in the current year, include the full $5,000
applicant or any other corporation is a member of a
amount in the Current Year column.
controlled group.
1024
Form
(Rev. 1-2018)
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