Enlarge image | Form 83-391-22-8-1-000 (Rev. 04/22) Reset Form Mississippi Print Form Insurance Company Income Tax Return 833912281000 2022 Tax Year Beginning Tax Year Ending mm dd yyyy mm dd yyyy FEIN Mississippi Secretary of State ID Legal Name and DBA CHECK ALL THAT APPLY Address Amended Return Accident and Health Final Return Fire and Casualty City State Zip +4 Life Insurance Accrual Basis County Code NAICS Code Receipts and Disbursements Basis COMPUTATION OF TAX (ROUND TO THE NEAREST DOLLAR) Combined income tax return (enter FEIN of reporting company) 1 Mississippi net taxable income (from page 2, line 17A or Form 83-310, page 1, line 5, column C) 1 .00 2 Income tax 2 .00 3 Retaliatory taxes paid to other states (Mississippi corporations only; from page 4, part V, line 1) 3 .00 4 Income tax credits (from Form 83-401, line 3 or Form 83-310, page 1, line 5, column B) 4 .00 5 Net income tax due (line 2 minus line 3 and line 4) 5 .00 PAYMENTS AND TAX DUE 6 Overpayment from prior year 6 .00 7 Estimated tax payments and payment with extension 7 .00 8 Total payments (line 6 plus line 7) 8 .00 9 Net total income tax due (line 5 minus line 8) 9 .00 10 Interest and penalty on underestimated income tax payments (from Form 83-305, line 19) 10 .00 11 Late payment interest 11 .00 12 Late payment penalty 12 .00 13 Late filing penalty (minimum $100) 13 .00 14 Total balance due (if line 5 is larger than line 8, add lines 9 through 13) 14 .00 15 Total overpayment (if line 8 is larger than line 5, subtract line 5 from line 8) 15 .00 16 Total overpayment credited to next year (from line 15) 16 .00 17 Total overpayment refunded (line 15 minus line 16) 17 .00 See instructions for electronic payment options or attach check or money order for balance due. |
Enlarge image | Form 83-391-22-8-2-000 (Rev. 04/22) Mississippi Page 2 Insurance Company Income Tax Return 833912282000 2022 FEIN COMPUTATION OF NET INCOME A MISSISSIPPI B COMPANY-WIDE 1 Direct premiums (except accident and health premiums) .00 Less: return premiums .00 1A .00 1B .00 2 Direct accident and health premiums 2A .00 2B .00 3 Reinsurance assumed 3A .00 3B .00 4 Considerations for annuities 4A .00 4B .00 5 Considerations for supplementary contracts 5A .00 5B .00 6 Unearned premiums (December 31st, prior year) 6A .00 6B .00 7 Gross investment income 7A .00 7B .00 8 Other income 8A .00 8B .00 9 Total net income (add line 1 through line 8) 9A .00 9B .00 DEDUCTIONS 10 Unearned premiums (December 31st, current year) 10A .00 10B .00 11 Reinsurance ceded 11A .00 11B .00 12 Dividends to policy holders 12A .00 12B .00 13 Total deductions (add line 10 through line 12) 13A .00 13B .00 MISSISSIPPI NET TAXABLE INCOME 14 Gross income (line 9 minus line 13) 14A .00 14B .00 15 Total deductions allocated and apportioned (from page 4, part III, line 23) 15A .00 15B .00 16 Less: Mississippi net operating loss (from Form 83-155, part I, line 2) 16A .00 16B .00 17 Net taxable income (loss) (line 14 minus line 15 and line 16; enter amount 17A .00 17B .00 from 17A on page 1, line 1 or Form 83-310, page 1, line 5, column C) Check box if return may be discussed with preparer I declare, under penalties of perjury, that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, this is a true, correct and complete return. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Officer Signature and Title Date Business Phone Paid Preparer Signature Date Paid Preparer Address Paid Preparer PTIN Paid Preparer Phone City State Zip Code Mail Return To: DEPARTMENT OF REVENUE P.O. BOX 23191 JACKSON, MS 39225-3191 |
Enlarge image | Form 83-391-22-8-3-000 (Rev. 04/22) Mississippi Page 3 Insurance Company Income Tax Return 2022 FEIN PART I: EXPENSE APPORTIONMENT RATIOS A MISSISSIPPI B COMPANY-WIDE C MISSISSIPPI RATIO Applicable ratio(s) used on page 4, part IV, line 2 1 Loss adjustment expenses (direct losses) 1A 1B 1C . % 2 Accident and health expenses (direct premiums and reinsurance assumed) 2A 2B 2C . % 3 Other underwriting expenses (direct premiums (less return premiums), annuity considerations and 3A 3B 3C . % reinsurance assumed) 4 Investment expenses (gross investment income) 4A 4B 4C . % PART II: DEDUCTIONS ALLOCATED A MISSISSIPPI B COMPANY-WIDE 5 Losses, death benefits, accident and health benefits (less applicable recoveries) a Paid 5Aa .00 5Ba .00 b Unpaid at December 31st, current year 5Ab .00 5Bb .00 c Unpaid at December 31st, prior year 5Ac .00 5Bc .00 6 Loss adjustment expenses allocated 6A .00 6B .00 7 Matured endowments 7A .00 7B .00 8 Annuity benefits 8A .00 8B .00 9 Disability benefits 9A .00 9B .00 10 Surrender benefits 10A .00 10B .00 11 Payments on supplementary contracts 11A .00 11B .00 12 Net additions to reserve funds (required by law for liquidating policies at maturity) 12A .00 12B .00 13 Commissions 13A .00 13B .00 14 Gross premium privilege tax 14A .00 14B .00 15 Other allocable taxes 15A .00 15B .00 16 Rent, allocated 16A .00 16B .00 17 Agency expense (attach schedule) 17A .00 17B .00 18 Medical and inspection fees, allocated 18A .00 18B .00 19 Other allocable deductions (attach schedule) 19A .00 19B .00 20 Total allocable deductions 20A .00 20B .00 |
Enlarge image | Form 83-391-22-8-4-000 (Rev. 04/22) Mississippi Page 4 Insurance Company Income Tax Return 2022 FEIN PART III: DEDUCTIONS APPORTIONED A MISSISSIPPI B COMPANY-WIDE 21 Non-allocable loss adjustment expenses 21A .00 21B .00 22 Total apportioned expenses (from page 4, part IV, line 3) 22A .00 22B .00 23 Total allocated and apportioned deductions (line 20 plus line 21 plus line 22; enter on page 2, line 15) 23A .00 23B .00 PART IV: DEDUCTIONS APPORTIONED (FROM ANNUAL STATEMENT) Expenses must be separately apportioned. Attach supplementary pages to return as needed. Page Line Description A Column ( ) B Less Allocable C Balance Expenses Apportionable 1 Totals (total column A minus total column B) 2 Applicable expense apportionment ratio (from page 3, part I) . % 3 Total apportioned to Mississippi (multiply line 1, column C by line 2, enter amount on page 4, part III, line 22) PART V: RETALIATORY TAXES PAID (MISSISSIPPI CORPORATIONS ONLY) Itemize retaliatory taxes paid by state and attach copies of returns documenting amounts. Attach supplementary schedules as needed. A Taxing Authority B Amount A Taxing Authority B Amount 1 Total amounts (total amounts from column B; enter amount on page 1, line 3) |