Page 1 of 3
2024 Form 6I - Wisconsin Adjustment for Insurance Companies
Designated Agent Name                                          Federal Employer ID Number

Part I  Additions Specific to Insurance Companies

                               Corporation Name:
                                                                                             Elimination         Combined
                               FEIN:                                                         Adjustments         Totals

  1  Loss carryforward deducted in the
     calculation of federal taxable income  ...    1     .00   .00                       .00             .00 1           .00
2  Dividend income received to the extent not
     included in the amount on Form 6, Part I,
     line 4  ............................          2     .00   .00                       .00             .00 2           .00
3  Additional federal deduction for insurers
     required to discount unpaid losses  .....     3     .00   .00                       .00             .00 3           .00
4  Add lines 1 through 3. Enter this amount
     on Form 6, Part II, line 2i  .............    4     .00   .00                       .00             .00 4           .00

Part II  Nontaxable Income from Life Insurance Operations

  5  Insurance company’s federal taxable
     income as reported or included on
     Form 6, Part II, line 1 ................      5     .00   .00                       .00             .00 5           .00
    6Insurance company’s total addition modi-
     fications from Form 6, Part II, line 2k ....  6     .00   .00                       .00             .00 6           .00
7  Add lines 5 and 6 ...................           7     .00   .00                       .00             .00 7           .00
8  Insurance company’s total subtraction
     modifications from Form 6, Part II, lines
     4a through 4m plus line 4n-e ..........       8     .00   .00                       .00             .00 8           .00
9  Subtract line 8 from line 7  ............       9     .00   .00                       .00             .00 9           .00
10a  Enter net gain from operations other
     than life insurance  ..................   10a   Sample.00 .00                       Form.00         .00 10a         .00
10b  Enter total net gain from operations  .... 10b      .00   .00                       .00             .00 10b         .00
11  Divide line 10a by line 10b and enter
     result as a percentage (see instructions) 11    .    %  .  %  .                      %  .            %  11  .        %
12  Multiply line 9 by line 11 .............. 12         .00   .00                       .00             .00 12          .00
13  Subtract line 12 from line 9. Enter this
     amount on Form 6, Part II, line 4o ...... 13        .00   .00                       .00             .00 13          .00
IC-402 (R. 8-24)
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                                                                                                             Page 2 of 3
2024 Form 6I - Wisconsin Adjustment for Insurance Companies
Designated Agent Name                                                     Federal Employer ID Number

Part III  Net Business Loss Adjustment for Insurance Companies

                                       Corporation Name:
                                                                                                           Combined
                                       FEIN:                                                               Totals

14  Enter amount from the insurance company’s
    Form 6, Part III, line 2, net of any amount
    on line 3 of that same form .............                  14   .00   .00                       .00 14         .00
15  Enter amount from the insurance
    company’s Form 6, Part III, line 4 ........                15   .00   .00                       .00 15         .00
    16Add lines 14 and 15  . . . . . . . . . . . . . . . . . . 16   .00   .00                       .00 16         .00
    17Enter net capital loss adjustment from Form
    6, Part III, line 5 (enter as a positive amount)  17            .00   .00                       .00 17         .00
  18  Subtract line 17 from line 16. If the amount 
    on line 18 is positive, there is no net busi-
    ness loss adjustment. If this amount is
    negative, complete lines 19 to 24  ........                18   .00   .00                       .00 18         .00
    19Enter the total dividends received deduction
    from Schedule 6Y, computed as explained in
    the instructions. Enter as a negative number               19   .00   .00                       .00 19         .00
  20  Enter the member’s Wisconsin percentage from
    Form 6, Part III, line 1d, or if a member of a
    100% Wisconsin group, enter “100.0000%.”                   20 .  %  .  %  .                      %  20 .        %
    21Multiply line 19 by line 20  ..............              21   .00   .00                       .00 21         .00
    22Enter the dividends received deduction
    attributable to dividends reported on Form N, 
         computed as explained in the instructions.
    Enter as a negative number  ............                   22   .00   .00                       .00 22         .00

  23  Add lines 21 and 22  . . . . . . . . . . . . . . . . . . 23Sample.00 .00                      Form.00 23     .00
    24If the absolute value of the amount on line 23
    exceeds the absolute value of the amount on
    line 18, enter the amount from line 18 as a
    positive number. If the absolute value of the 
         amount on line 18 exceeds the absolute value
    of the amount on line 23, enter the amount
    from line 23 as a positive number. Enter or 
         include this amount on Form 6, Part III,
   line 6   ..............................                     24   .00   .00                       .00 24         .00
                                                                  File Electronically

                                                                                                                   Page 3 of 3
2024 Form 6I - Wisconsin Adjustment for Insurance Companies
Designated Agent Name                                            Federal Employer ID Number

Part IV Tax Computation for Insurance Companies

                      Corporation Name:
                                                                                               Elimination         Combined
                      FEIN:                                                                    Adjustments         Totals

25 Use the amounts on Form 6, Part III to
   compute the insurance company’s share
   of the combined Wisconsin net income.
   See instructions  ...................                 25  .00 .00                       .00             .00 25          .00

26 Multiply line 25 by 7.9%  . . . . . . . . . . . . .   26  .00 .00                       .00             .00 26          .00

27a  Insurance company’s gross premiums
   as defined in s. 76.62, Wis. Stats ......             27a .00 .00                       .00             .00 27a         .00

27b  Multiply line 27a by 2% ..............              27b .00 .00                       .00             .00 27b         .00

28a  Wisconsin income realized from lottery
   prizes as reported on Form N, line 5  ...             28a .00 .00                       .00             .00 28a         .00

28b  Multiply line 28a by 7.9%  . . . . . . . . . . . .  28b .00 .00                       .00             .00 28b         .00

29 Add lines 27b and 28b  . . . . . . . . . . . . . .    29  .00 .00                       .00             .00 29          .00

30 Enter the lesser of the amounts on line
   26 or line 29. This is the amount to enter
   on Form 6, Part III, line 9  ............             30  .00 .00                       .00             .00 30          .00

                                                            Sample Form 

                                                             File Electronically