Form 4599 - Michigan Business Tax For Financial Institutions Booklet - 2012 Page 20

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4752, Page 2

Designated Member FEIN or TR Number

PART 2B: MEMBER DATA FOR COMBINED RETURN

Complete a separate copy of Part 2B for each UBG member listed in Part 1. Enter the combined totals of line 25 of this form on Form 4590, line 20, and

skip lines 11 through 19 on Form 4590.

4. Member Name

7. Organization Type

S Corporation /

5. Member FEIN or TR Number

Fiduciary

LLC S Corporation

C Corporation /

Partnership /

6. Member Address (Street)

LLC C Corporation

LLC Partnership

City

State

ZIP/Postal Code

Beginning

Ending

Check if Nexus with Michigan

12.

Federal Tax Period Included in

Return (MM-DD-YYYY) ........................

Check if Registered for MBT

13.

If part year member, enter

membership dates (MM-DD-YYYY) .....

10. NAICS Code

11. If discontinued, effective date

Check if New Member

14.

15. Nature of business activities or operations resulting in a flow of value between members, or integration, dependence or contribution to other members

FRANCHISE TAX BASE

2008

2009

2010

2011

2012

Lines 16-19: If less than zero, enter zero.

16.

16. Equity Capital ......................

17.

17. Goodwill ............................

18. Average daily book value

of Michigan obligations ........

18.

19. Average daily book value

of U.S. obligations ...............

19.

20. Subtotal. Add lines 17

through 19 ...........................

20.

21. Net Capital. Subtract line

20 from line 16 .....................

21.

22. a. Authorized insurance co.

subsidiary: enter actual

capital fund amount ........ 22a.

b. Minimum regulatory

amount required ............ 22b.

c. Multiply line 22b by

125% (1.25) ................... 22c.

d. Subtract line 22c from

22a. If less than zero,

enter zero ...................... 22d.

23. Add lines 21 and 22d ..........

23.

24. Add lines 23A, 23B, 23C, 23D and 23E .................................................................................................................

24.

25. Net Capital for Current Taxable Year. Divide line 24 by number of tax years reported above ................................

25.

0000 2012 85 02 27 5

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