Schedule U-Ins - Payment To Insurance Companies Under Common Ownership - 2012

2012

Schedule U-INS

Massachusetts

Payment to Insurance Companies

Department of

Under Common Ownership

Revenue

For calendar year 2012 or taxable period beginning

2012 and ending

Name of member

Federal Identification number

Name of insurance affiliate

Federal Identification number, if applicable

Name of principal reporting corporation

Federal Identification number

Type of U.S. tax return filed by the insurance affiliate, if any

Type of Massachusetts tax return filed, if any

1120

1120F

Filed other

DId not file

63-20P

63-23P

Filed other

DId not file

1 Amount deducted for premiums paid directly or indirectly to insurance affiliate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1

2 Deductions for all other amounts paid directly or indirectly to insurance affiliate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2