Massachusetts Department of Revenue
                                                                  Form 63-23P
               Premium Excise Return for Insurance Companies                                                                                                                                                       2020

For calendar year 2020.
Name of company                                                                                            Federal Identification number                             State of incorporation

Mailing address

City/Town                                                                                                         State              Zip                                                 Phone number

Name of treasurer                                                                                            Domestic insurers, check applicable gross investment income tax rate (for line 2)
                                                                                                          .01      .008          .006      .004      .002                                              .000
Fill in if:
  Amended return (see “Amended Return” in instructions)                                                   Federal amendment      Federal audit
  Enclosing Schedule TDS      Final return                    Initial return                                   Name change       Address change
Fill in if federal government has changed your taxable income for any prior year which has not yet been reported to Massachusetts

Domestic casualty insurers. Enclose a copy of Schedule T of NAIC annual statement.
11  Taxable premiums (from Part 1, line 5, col. c). . . . . . . .                                                  × .0228. . . . . . . . . . . . . . . . .  =                                       1
12  Gross investment income (from Part 2, line 10). . . . . .                                                      ×         applicable rate from above =                                            2
13  FAIR Plan disbursement received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         3
14  Credit recapture (enclose Credit Recapture Schedule) and/or additional tax on installment sales (see instructions). . . .                                                                        4
15  Excise due before credits. Add lines 1 through 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                5

Foreign casualty insurers. Enclose a copy of Schedule T of NAIC annual statement.
16  Total net direct premiums for insurance of property or interests in Massachusetts, excluding any FAIR Plan premiums                                                                              6
17  Other premiums, including FAIR Plan premiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                    7
18  Total premiums. Add lines 6 and 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
19  Dividend deduction. Premiums returned or credited to policyholders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10  Taxable premiums. Subtract line 9 from line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                 10
11  Tax calculation. Multiply line 10 by .0228. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                            11
12  Tax computed under retaliatory provisions (enter full amount from Part 3, line 1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13  Credit recapture (enclose Credit Recapture Schedule) and/or additional tax on installment sales (see instructions). . .                                                                          13
14  Excise due before credits. Enter the larger of line 11 plus line 13 or line 12 plus line 13. . . . . . . . . . . . . . . . . . . . . . . . .                                                     14

Declaration
Under penalties of perjury, I declare that to the best of my knowledge and belief, this return and enclosures are true, correct and complete.
Signature of appropriate corporate officer (see instructions)                                             Date     Social Security number                                                              Phone number

Signature of paid preparer                                                                                Date     Employer Identification number                                                      Address

If you are signing as an authorized delegate of the appropriate corporate officer, fill in oval                                  and enclose Massachusetts Form M-2848, Power of
  Attorney. The Privacy Act Notice is available upon request. Mail to Massachusetts Department of Revenue, PO Box 7052, Boston, MA 02204.

                                                                                                              2020 FORM 63-23P, PAGE 2

Name of company                                                                                            Federal Identification number                             State of incorporation

Preferred provider arrangements
15  Gross premiums received for coverage of covered persons residing in Massachusetts (premiums for Medicare 
  supplemental coverage are excludable). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   15
16  Premiums returned or credited to policyholders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    16
17  Taxable amount. Subtract line 16 from line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   17
18  Tax calculation. Multiply line 17 by .0228. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              18
19  Credit recapture (enclose Credit Recapture Schedule) and/or additional tax on installment sales (see instructions). . . .                                                          19
20  Excise due before credits. Add lines 18 and 19. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    20

Credits. Do not claim any credit here if claimed on Form 63-29A.
21  Domestic casualty insurers only. Retaliatory surtax credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                  21
22  Domestic casualty insurers only. Enter 1.5% of company’s total capital contributions in excess of the full 
  proportionate share in investment in the Massachusetts property and casualty initiative. . . . . . . . . . . . . . . . . . . . . . . . .                                             22
23  Credit against premium excise. Add lines 21 and 22. Enter total here, but do not exceed the amount in line 1. . . . . . .                                                          23
24  Enter 10% of Massachusetts Life and Health Insurance Guaranty Association assessment paid previously. . . . . . . . .                                                              24
25  Other credits (from Credit Manager Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    25
26  Total credits. Add lines 23 through 25. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            26

Excise after credits
27  Excise due before voluntary contribution. Subtract line 26 from line 5, 14 or 20, whichever is applicable. 
  Not less than 0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
28  Voluntary contribution for endangered wildlife conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          28
29  Total excise plus voluntary contribution. Add lines 27 and 28. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                           29

Payments
30  2019 overpayment applied to 2020 estimated tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        30
31  2020 Massachusetts estimated tax payments (do not include amount from line 30) . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                             31
32  Payments made with extension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              32
33  Payment with original return. Use only if amending return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         33
34  Pass-through entity withholding. . . . . . . . . . . . . . . . . . . . . . .  Payer Identification number                                                                          34
35  Refundable credits (from Credit Manager Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         35
36  Total payments. Add lines 30 through 35. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 36

                     2020 FORM 63-23P, PAGE 3

Name of company                                                                                            Federal Identification number                             State of incorporation

Refund or balance due
37  Amount overpaid. If line 36 is greater than line 29, subtract line 29 from line 36. Otherwise, go to line 40. . . . . . . . . . .                                              37
38  Amount overpaid to be credited to 2021 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                     38
39  Amount overpaid to be refunded. Subtract line 38 from line 37. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         39
40  Balance due. Subtract line 36 from line 29. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            40
41a M-2220 penalty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  41a
41b Other penalties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41b
41  Total penalty. Add lines 41a and 41b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
42  Interest on unpaid balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    42
43  Total payment due at time of filing. Add lines 40, 41 and 42. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                      43

                                                                                                                                             2020 FORM 63-23P, PAGE 4

Name of company                                                                                            Federal Identification number                             State of incorporation

Part 1. Premium excise. Domestic casualty insurers only must complete this schedule.
11  Total of all net direct premiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        1
12  Net direct premiums for insurance of property or interests in other states or countries where a tax is actually paid by 
      said company or its agents (Supporting schedule is required showing by states the total business written. Copy of 
      Schedule T is accepted, if admitted states are designated.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         2
                                                                                                                                                                             b. States or                              c.
                                                                                                                                            a.                        countries in which                      Total
                                                                                                                                Massachusetts          company pays no tax                 add col’s. a and b
13  Total net direct premiums subject to tax. Subtract line 2 from line 1                       3
14  Premiums returned or credited to policyholders. . . . . . . . . . . . . . . .               4
15  Taxable premiums. Subtract line 4 from line 3. Enter the amount 
      in line 1, column 5c on page 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
16  Fill in if net direct premiums are reported in line 1 and 2  .  If No, explain
17  Fill in if all dividends claimed as a deduction in line 4 have been included as taxable premiums on this return or on a previous Massachusetts return
        .  If No, explain

Part 2. Gross investment income.      Domestic casualty insurers only must complete this schedule.
From Exhibit of Net Investment Income.
11  Interest on bonds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
12  Dividends on preferred stocks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         2
13  Dividends on common stocks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            3
14  Interest on mortgage loans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        4
15  Real estate income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    5
16  Interest on collateral loans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    6
17  Cash on deposit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
18  Other invested assets (describe)
      a                                                                                                                                      8a
      b                                                                                                                                      8b
      c                                                                                                                                      8c
19  Total invested assets. Add lines 8a through 8c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  9
10  Gross investment income. Add lines 1 through 7 and line 9. Enter here and on page 1, line 2. . . . . . . . . . . . . . . . . . . .       10

Part 3. Computation on retaliatory tax. Foreign casualty insurers only must complete this schedule.
11  Use the space below to calculate your excise using the identical method and the same rate used by the state in 
      which you are incorporated in taxing a like Massachusetts insurance company, or its agents, if doing business to 
      the same extent. If the computation in the state of your incorporation is in every respect the same as your 
      Massachusetts computation, a statement to that effect should be made. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1