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    3                                                                                             FINAL DRAFT 10/2/23                                                                                                                                                  3
    4                                                                                                                                                                                                                                                                  4
    5                                                                                                                                                                                                                                                                  5
                                                                                                                                                                                                *226281*
    6  2023 M11, Insurance Premium Tax Return for Property and Casualty Companies                                                                                                                                                                                      6
    7  Due March 1, 2024                                                                                                            Check if:                                        Amended Return                                                                    7
    8                                  Name of Insurance Company                                                                    FEIN                                          X                                                    Minnesota Tax ID(required)      8

    9                                  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 0123456789                                                                                                                                              0123456789                      9
    10                                 Mailing Address                                              Check if New Address            NAIC Number                                                                                        State/Country of Incorporation  10
                                                                                                                             X
    11                                 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 0123456789                                                                                                                                              0123456789                      11
    12                                 City                                                     State         Zip Code              Contact Person                                                                                                                     12
    13                                 XXXXXXXXXXXXXXXXXXXXXXXX XX     XXXXX                                                        XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 13
    14                                 Email Address                                            Daytime Phone                       Fax Number                                                                                                                         14
             Print or Type
    15                                 XXXXXXXXXXXXXXXXXXXXXXXX 12345678900                                                         012345678900                                                                                       012345678900                    15
    16                                 Type of Company:          Stock          Mutual         Other:                                                                                                                                                                  16
                                                              X          X             X
    17                                 Type of Premiums (Check All That Apply) X Auto  X Fire/Property        X Bail Bonds     X Title                                            X Liability X Other                                    XXXXXXXXXXXXXX                17
    18                                 This Return Includes:  X  M11B    X  IG259      X  IG258       X  M11AR                                                                                                                                                         18
    19                                    Property, Casualty and Title Premiums                                                                                           A - State of Incorporation Basis       B - Minnesota Basis                                   19
    20                                   1  Minnesota fire and other premiums (see instructions)   . . .  . . . . . .  . . . . .  . . . . .  1                                    0123456789                                              0123456789                   20
    21                                                                                                                                                                                                                                                                 21
    22                                   2  Accident and health premiums    . . . .  . . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . .  . . . . . .  2                  0123456789                                              0123456789                   22
    23                                                                                                                                                                                                                                                                 23
    24                                   3  Total Minnesota direct business (add lines 1 and 2)  . . .  . . . . . .  . . . . .  . . . . . . .  .  3                               0123456789                                              0123456789                   24
    25                                                                                                                                                                                                                                                                 25
    26       Premiums                    4  Minnesota business assumed from unauthorized insurers (reinsurance)    . . .  .  4                                                                                                                                         26
                                                                                                                                                                                  0123456789
    27                                                                                                                                                                                                                                                                 27
    28                                   5  Other additions (itemize on a separate schedule)    . . . .  . . . . .  . . . . . .  . . . . .  . . .  5                              0123456789                                              0123456789                   28
    29                                                                                                                                                                                                                                                                 29
    30                                   6  Gross taxable business (add lines 3 through 5)  . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  6                            0123456789                                              0123456789                   30
    31                                                                                                                                                                                                                                                                 31
    32                                   7  Direct ocean-marine premiums   . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . .  .  7                  0123456789                                                                           32
    33                                                                                                                                                                                                                                                                 33
    34                                   8  Dividends paid in cash (see instructions)  . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . .  8                      0123456789                                              0123456789                   34
    35                                                                                                                                                                                                                                                                 35
    36       Deductions                  9  Other nontaxable business and dividends (attach a schedule)   . . .  . . . . . . .  . . .  9                                          0123456789                                              0123456789                   36
    37                                                                                                                                                                                                                                                                 37
    38                                   10  Total deductions (add lines 7 through 9)   . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . .  .  10                     0123456789                                              0123456789                   38
    39                                                                                                                                                                                                                                                                 39
    40                                   11 Net taxable business (subtract line 10 from line 6)  . . .  . . . . . .  . . . . .  . . . . . . .  .                    11            0123456789                                              0123456789                   40
    41                                      Continue on line 15 of page 2.                                                                                                                                                                                             41
    42                                   12  Tax due (or overpaid) . Enter amount from line 35   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 12 0123456789                   42
    43                                   13 a  Additional charge for underpaying estimated tax                                                                                                                                                                         43
    44                                         (determine from worksheet in the instructions, page 5)  . . .  . . . . . .  . . . . .                               13a            0123456789                                                                           44
    45                                        b  Penalty (see instructions)    . .  . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . . .  . .  13b            0123456789                                                                           45
    46                                        c  Interest (see instructions)   . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . . . .  . . . . .  . . . .  . 13c           0123456789                                                                           46
    47                                      Total (add lines 13a through 13c)   . . .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . . .  . 13                         0123456789                   47
    48                                                                                                                                                                                                                                                                 48
    49                                   14 TOTAL AMOUNT DUE (or overpaid  ) (add lines 12 and 13)   . . .  . . . . . .  . . . .  . 14                                            0123456789                                                                           49
    50                                        If you owe additional tax:                                                                                                                                                                                               50
    51       Amount Due/Overpaid            Payment method:              Electronic payment         Check (payable to Minnesota Revenue; write MN tax ID number on check; attach voucher)                                                                              51
                                                                   X                            X
    52                                        Enter amount paid    0123456789                   Date paid 0123456789                                                                                                                                                   52
    53                                      (If amount paid is different from amount due on line 14, attach an explanation.)                                                                                                                                           53
    54                                      If you overpaid:                                                                                                                                                                                                           54
    55                                      Amount on line 14 to be credited to next year’s estimated tax      . . .  . . . . . .  . . . . .  . . . . . . .  .                    0123456789                                                                           55
    56                                      Amount on line 14 to be refunded   . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . .  0123456789                                                                           56
    57                                 I declare that this return is correct and complete to the best of my knowledge and belief.                                                                                                                                      57
    58                                 I confess judgment to the state of Minnesota for the amount of tax shown due to the extent not timely paid.                                                                                                                     58
    59                                 Authorized Signature                            Title                                  Date                                                Daytime Phone                                                                        59
                                                                                                                                                                                                                                          X  I authorize the Minnesota 
    60                                                                                                                                                                                                                                    Department of Revenue to     60
    61                                 Signature of Preparer XXXXXXXXXXXXXXXXXXXX      Print Name of Preparer XXXXXXXXXXXXXXXDate XXXXXXXDaytime Phone XXXXXXXXXXX                                                                        discuss this tax return with 61
                          Sign Here                                                                                                                                                                                                       the preparer .
    62                                 XXXXXXXXXXXXXXXXXXXX                            XXXXXXXXXXXXXXX XXXXXXX XXXXXXXXXXX                                                                                                                                             62
    63                                 Mail to: Minnesota Department of Revenue, Mail Station 1780, 600 N. Robert St., St. Paul, MN 55145-1780. Do not send to the Minnesota Department of Commerce.                                                                   63
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    65                                                                                                                                                                                                                                                                 65

    1                                                                                                                                                                                                                                                      1
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    3                                                                                                                                                                                                                                                      3
    4                                                                                                                                                                                                                                    M11               4
    5                                                                                                                                                                                                                                    Page 2            5
    6  2023 M11, Insurance Premium Tax Return for Property and Casualty Companies (Continued)                                                                                                                                                              6
    7                                                                                                                                                                                                A                                   B                 7
    8                                                                                                                                                                                State of Incorporation Basis                 Minnesota Basis          8
    9                                                15    Net taxable business (enter amounts from line 11)    . . . . . .  . . . . .  . . . . .  . . . .  15                      0123456789                                    0123456789               9
    10                                                                                                                                                                                                                                                     10
    11                                               16    Premium tax percentage rate*           .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 16.  . 0123456789.  .  .  .  .  .  .  .  .      %  0123456789%*             11
    12                                                                                                                                                                                                                                                     12
    13                                               17    Premium tax liability (multiply line 15 by percentage on line 16)    . . . .  . . . . .  17                              0123456789                                    0123456789               13
    14                                                                                                                                                                                                                                                     14
    15                                               18  Fire insurance tax liability (from M11AR, line 12. Attach M11AR)  . . .  . . . . . .  18                                   0123456789                                                             15
    16                                                                                                                                                                                                                                                     16
    17                                               19  Other taxes (itemize on a separate schedule)   . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  19                   0123456789                                                             17
    18                                                                                                                                                                                                                                                     18
    19                                               20  Total premium tax liability (add lines 17, 18 and 19)    . . . .  . . . . . .  . . . . . .  . . .  20                      0123456789                                    0123456789               19
    20                                                                                                                                                                                                                                                     20
    21                                               21    Licenses and fees (from M11B, line 10. Attach M11B)   . .  . . . . .  . . . . . . .  . . . .  21                         0123456789                                    0123456789               21
    22                                                                                                                                                                                                                                                     22
    23                                               22  Total taxes, licenses and fees (add lines 20 and 21)   . . . . .  . . . . .  . . . . . .  . . . .  22                      0123456789                                    0123456789               23
    24                                                                                                                                                                                                                                                     24
    25                                               23    Enter amount from line 22, Column A or B, whichever is greater   . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . .  23                                0123456789               25
    26                                                                                                                                                                                                                                                     26
    27                                               24    Total licenses and fees (from M11B, line 11. Attach M11B)                            . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . .  24 0123456789               27
    28                                               25    Subtract line 24 from line 23 (if zero or less, skip lines 26 through 30,                                                                                                                       28
    29                                                   and enter this amount on line 31)  . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . . .  . . .        25 0123456789               29
    30   Calculate Your Adjusted Liability                                                                                                                                                                                                                 30
    31                                               26    Minnesota Guaranty Fund Association offset (see instructions)   . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  26                               0123456789               31
    32                                                                                                                                                                                                                                                     32
    33                                               27    Minnesota Joint Underwriting Association (JUA) assessment (see instructions)   . . .  . . . . . .  . . . . . .  . . . .  27                                            0123456789               33
    34                                                                                                                                                                                                                                                     34
    35                                               28    Short Line Railroad Transfer Credit (attach credit certificate)  . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . .  28                       0123456789               35
    36                                                                                                                                                                                                                                                     36
    37                                               29    Film Production Credit (attach credit certificate)  . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . .  29              0123456789               37
    38                                               30    Minnesota Housing Tax Credit                                                                                                                                                                    38
    39                                                     Enter the credit certificate number from Minnesota Housing: SHTC -                                       1234 -          5678900000  .30                               0123456789               39
    40                                               31    Tax before refundable credits . If line 25 is zero or less, enter the amount from line 25 . If line 25 is                                                                                       40
    41                                                   positive, subtract any amounts on lines 26-30 from line 25.                                                                                                                                       41
    42                                                   (If result is less than zero, enter zero)    . . . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . . . . . .  . .  31      0123456789               42
    43                                               32    Credit for historic structure rehabilitation                                                                                                                                                    43
    44                                                     (must attach credit certificate) and enter NPS project number:   . .  . . . . . .  .                                 0123456789                          32            0123456789               44
    45                                                                                                                                                                                                                                                     45
    46                                               33    Tax liability (subtract line 32 from line 31)   . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . .         33 0123456789               46
    47                                               34    a  Prior year’s overpayment   . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . .  .  34a      0123456789                                                             47
    48                                                                                                                                                                                                                                                     48
    49                                                   b  Estimated payment March 15             . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  .  .   34b 0123456789                                                             49
    50                                                                                                                                                                                                                                                     50
    51                                                   c  Estimated payment June 15   . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . .  34c            0123456789                                                             51
    52                                                                                                                                                                                                                                                     52
    53                                                   d  Estimated payment Sept. 15             . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . .  34d 0123456789                                                             53
    54                                                                                                                                                                                                                                                     54
    55                                                   e  Estimated payment Dec. 15    . . .  . . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . . .  . . .  34e           0123456789                                                             55
    56                                                   Add lines 34a through 34e   . . . .  . . . . .  . . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . .  . . .  34 0123456789               56
    57   Tax Prepayments and Amount Due/Overpaid                                                                                                                                                                                                           57
    58                                               35  Tax due (or overpaid) (subtract line 34 from line 33) Enter on line 12 on page 1.    . .  . . . . .  . . . . .  . . . . . .  35                                          0123456789               58
    59 *  Line 16 — Tax Rates for Minnesota Basis (check one)                                                                                                                                                                                              59
    60                                           X  1% for mutual property and casualty insurance companies with total assets of $5 million or less at the end of the calendar year . Enter total assets at end of year: $                                 60
    61                                           X  1.26% for mutual insurance companies that sell both property and casualty insurance that had total assets greater than $5 million at the end of the calendar year, but less than                       61
    62                                              $1.6 billion on Dec. 31, 1989.                                                                                                                                                                         62
    63                                           X  2% for insurance companies not listed above .                                                                                                                                                          63
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    65                                                                                                                                                                                                                                                     65

2023 Insurance Premium Tax Return for Property and Casualty Companies

For insurance tax laws, see Minnesota Statutes, Chapter 297I at www.leg.state.mn.us.

  GFA and JUA Assessments
  If you were assessed and made a payment to The Guaranty Fund Assessment (GFA) and/or The Joint Underwriting Association (JUA), you 
may be able to claim a credit on line 26 and/or line 27. See lines 26 and 27 instructions.

Before You File
You Need a Minnesota Tax ID
Your Minnesota tax ID is the seven-digit number you’re assigned when you register with the Department of Revenue. You must include your 
Minnesota tax ID on your return so that your filing and any payments you make are properly credited to your account.
If you do not have a Minnesota tax ID, apply online at www.revenue.state.mn.us or call 651-282-5225 or 1-800-657-3605. 
It is also important to enter your federal ID number and NAIC number on your return, but not in place of your Minnesota tax ID number.

Filing Requirements
All insurance companies licensed in Minnesota during the tax year must file a premium tax return even if they have not actually transacted 
insurance business in Minnesota during the tax year. Unlicensed insurance companies collecting premiums on Minnesota risks must also file a 
premium tax return. Insurers with a premium tax liability of more than $500 must also make estimated tax payments. 
Insurance companies are exempt from Minnesota corporation franchise tax. (M.S. 290.05, subd. 1c)
Annual Financial Statements. Insurance companies that do not file statements with the NAIC are required to file a copy of their statement 
with the Department of Revenue (9” x 14” version). If any premiums or deductions reported on Form M11 cannot be verified from the annual 
statement, you must attach documentation to your tax return substantiating the amounts.

File Electronically
The premium tax return (Form M11) may be filed electronically using TriTech Software.

Which Form to File
Property, casualty and title insurance companies use Form M11 to file premium taxes, unless they are required to file Form M11L, M11H, or 
M11T (see below).
•  Life and health insurance companies use Form M11L to file premium taxes.
•  Health-care providers, such as nonprofit health-plan corporations, health-maintenance organizations or community integrated service 
networks use Form M11H. 
•  Minnesota township mutual insurance companies use Form M11T, a combined premium tax return and firetown premium report.

Due Date
File your Form M11 with all required attachments and pay any tax due by March 1. Payment extensions are not allowed.
The U.S. postmark date, or date recorded or marked by a designated delivery service, is considered the filing date (private postage meter 
marks are not valid). When the due date falls on a Saturday, Sunday or legal holiday, returns and payments electronically made or postmarked 
the next business day are considered timely. When a return or payment is late, the date it is received at the Department of Revenue is treated 
as the date filed or paid.
Extension for Filing Return. If good cause exists, you may request a filing extension.

Payments
Electronic Payments
If your total insurance taxes and surcharges due for the last 12-month period ending June 30 is $10,000 or more, you are required to pay your 
tax electronically in all subsequent years.
You must also pay electronically if you’re required to pay any Minnesota business tax electronically, such as withholding tax.
To pay electronically, go to the department’s website at www.revenue.state.mn.us and log in to e-services. You’ll need your user name, 
password and bank routing and account numbers. You cannot use a foreign bank account.
If you use other electronic payment methods, such as Automated Clearing House (ACH) credit method or Fed Wire, instructions are available 
on our website or by calling Business Registration Office at 651-282-5225 or 1-800-657-3605.
Check or Money Order
If you are not required to pay electronically and you choose to pay by check, you must mail a personalized payment voucher along with your 
estimated tax payment to help ensure the payment is credited correctly. Go to www.revenue.state.mn.us and select Make a Payment. Select 
Check or Money Order. Use the Payment Voucher System to create a voucher.
                                                                                                                    Continued                  1

2023 Form M11 Instructions (Continued)

When you pay by check, your check authorizes us to make a one-time electronic fund transfer from your account. You will not receive your 
canceled check. 
Note: If you make your payments electronically, do not send in a voucher. 
Estimated Tax Payments
If your total tax liability for premium is more than $500, you must make estimated payments based on the entire estimated amount. To avoid 
an additional charge for underpaying the tax, your payments must be made on time and be at least one-fourth of the total annual prior year’s 
tax liability, or one-fourth of 80% of the total annual current year’s tax liability. 
Estimated payments are due quarterly on March 15, June 15, Sept. 15 and Dec. 15. When the due date falls on a weekend or legal holiday, 
payments made electronically or postmarked on the next business day are considered timely.
If you make your payments electronically, do not send in the vouchers. 
If you do not pay the correct amount of estimated tax by the due dates and your tax liability is more than $500, you may have to pay an 
additional charge for underpaying. Complete the worksheet on page 4. Overpayments from prior years or prior estimated overpayments should 
be applied before underpayment charges are figured.
Return Payment
If there is an amount due on Form M11, either pay it electronically or by check. 
Note: If no amount is due or if you pay electronically, do not send in a voucher. 

Completing Form M11
Check Boxes
At the top of the form, check if the return is:
•  an Amended Return: Check only if you are amending a previously filed return for the same period. Include all original and corrected 
policies on the amended return.
Columns A and B
All domestic, foreign and alien insurers must complete Column B (Minnesota basis). 
Foreign and alien insurers (except Arizona, Hawaii, Massachusetts, New York, and Rhode Island domiciled companies) must also complete 
Column A (for purposes of applying Minnesota retaliatory laws) and Schedule M11B. 
Note: All premiums, deductions and resulting taxes listed in Column A must be in accordance with the laws of the state or country of 
incorporation as they would apply to a Minnesota insurer licensed and doing business in that state or country. If the taxing authority of the state 
or country of incorporation requires a supplemental schedule to support tax computations, the same type of schedule (applying to business in 
Minnesota) must be attached to Minnesota Form M11.
In Column B (Minnesota basis), include direct premiums; stop-loss premiums; assessments; deposits; policy, membership and survey fees; 
finance and service charges; and dues, dividends and interest applied to reduce current premiums, pay renewal premiums, shorten the premium 
paying period or provide extended and paid-up additional insurance. 
Exclude premiums received, contributed or credited for the insurer’s employees’ and agents’ life, accident and health insurance plans; and all 
return premiums on policies not taken, except cash surrender values paid upon the cancellation and surrender of policies or certificates of life 
insurance. If these premiums were included in line 6, see line 9 instruction.

Line Instructions
Round amounts to the nearest dollar. Decrease any amount less than 50 cents and increase any amount that is 50 cents or more to the next 
higher dollar.
If the reported premiums are different from the premiums on the state page or schedule T, attach a schedule reconciling the difference.
Lines 1 and 2
Include finance and service charges on lines 1 and 2.
On line 1, include direct fire, casualty, worker’s compensation, ocean marine, bail bonds, title and other premiums. On line 2, include accident, 
health, stop-loss and other premiums.
Line 5
Other Additions
Workers compensation “Special Compensation Fund” surcharges collected is one example of what should be included on this line. Attach a 
separate schedule itemizing the additions and amounts included on this line.

                                                                                                                  Continued                  2

2023 Form M11 Instructions (Continued)

Line 7
Ocean-Marine Premiums
In Column A, enter the amount of ocean-marine premiums included on line 1 that are allowable deductions under state of incorporation basis. 
Line 8
Dividends
Enter dividends only if returned to the insured person or entity paying the premium. 
Line 9
Other Nontaxable Business and Dividends
Enter other nontaxable business and dividends only if included on line 6. Attach a separate schedule itemizing the amounts included on this 
line.
Line 13a
Additional Charge for Underpaying Estimated Tax
If you did not pay the correct amount of estimated tax by the due dates and your tax liability on line 30 is more than $500, you may have to 
pay an additional charge for underpaying. Complete the worksheet on page 5 to determine the amount to enter on line 13a. 
Line 13b
Penalty
Late Payment. If you do not pay all the tax due by the due date, a late payment penalty is due. The penalty is 5% of the unpaid tax for any part 
of the first 30 days the payment is late, and 5% for each additional 30-day period, up to a maximum of 15%.
Late Filing. Add a late filing penalty to the late payment penalty if your return is not filed by the due date. The penalty is 5% of the unpaid tax. 
When added to the late payment penalty, the maximum combined penalty is 20%. 
Payment Method. If you are required to pay electronically and do not, an additional 5% penalty applies to payments not made electronically, 
even if a paper check is sent on time.
Line 13c
Interest
You must pay interest on the unpaid tax plus penalty from the due date until the total is paid. The interest rate for calendar year 2024 is 5%. 
The rate may change for future years. To figure how much interest you owe, use the following formula with the appropriate interest rate:
 Interest =  (tax + penalty) × # of days late × interest rate ÷ 365
Line 16
Tax Rate
If premiums are taxed at more than one rate in home state, enclose a schedule showing rates and premiums. 
The tax rate is 1% for mutual property and casualty insurance companies with total assets of $5 million or less at the end of the calendar year.
The tax rate is 1.26% for mutual insurance companies that sell both property and casualty insurance that had total assets greater than $5 million 
at the end of the calendar year, but less than $1.6 billion on Dec. 31, 1989.
The tax rate is 2% for insurance companies not listed above.
Lines 26 through 30 
Non-Refundable Credits 
If assessments and credits are more than your tax before refundable credits (positive amount on line 25), use only the amount necessary to 
reduce your tax to zero; the remaining amount may be deducted in future tax years. 
If you receive a refund for a GFA and/or JUA assessment from the association, the refund must be subtracted from the paid assessment 
amount. If a refund is more than the assessment, the excess must be paid to Minnesota. 
Line 26 
Guaranty Fund Assessment. Twenty percent of assessments (less any refunds) made and paid to the Minnesota Life and Health Guaranty 
Association or the Minnesota Insurance Guaranty Association are allowable offsets against the tax liability for the five years following the 
payment of the assessment.  

Line 27 
JUA Assessment. Assessments (less any refund from the association) paid to the JUA under M.S. Chapter 621 are allowable offsets against the 
tax liability up to the extent of the tax liability in the year paid. The remaining offsets may be carried forward. 
Line 28  
Short Line Railroad Transfer Credit. Enter the credit amount indicated on the Short Line Railroad Infrastructure Certificate. If the amount 
exceeds liability, the excess is a carryforward to each of the five succeeding taxable years. 
                                                                                                                    Continued                   3

2023 Form M11 Instructions (Continued)

Line 29 
Film Production Credit. Enter the credit amount indicated on the Film production credit certificate statement. If the amount of the credit 
exceeds liability, the excess is a credit carryforward to each of the five succeeding taxable years.
Line 30
Minnesota Housing Tax Credit. Enter 85 percent of the contribution amount indicated on the Minnesota Housing Tax Credit certificate. The 
credit must be claimed for the taxable year in which the contribution payment is received by the account. If the amount of the credit exceeds 
liability, the excess is a credit carryforward to each of the ten succeeding taxable years. 
Line 31 
Tax Before Refundable Credits 
The amount on line 30 can only be negative due to return premiums. It cannot be negative due to the non-refundable credit exceeding the tax 
liability. 
Line 32 
Refundable Credit 
Historic Structure Rehabilitation Credit. To qualify for this credit, you must be eligible for the federal Historic Rehabilitation Credit for 
improving a certified historic structure located in Minnesota and have your application approved by the State Historic Preservation Office 
(SHPO) of the Minnesota Historical Society. For details, go to www.mnhs.org/shpo. 
Enter the five-digit NPS project number from the credit certificate you received from SHPO and the amount of your credit on line 31. 
•  If your credit application was submitted to SHPO on or before December 31, 2017, report the credit amount shown on your credit certificate. 
•  If your credit application was submitted to SHPO after December 31, 2017, report one-fifth of the credit amount shown on your credit 
certificate. 
Include the credit certificate when you file your return.
Lines 34a through 34e
Estimated Tax Payments
If any line contains more than one payment you must attach a schedule.
If payments are included from a merged company, attach a schedule listing the merged company name, NAIC number, payment amounts and 
payment dates. 

Mailing Your Return
Organize your Form M11 and all required schedules in the order of the attachment number provided in the top right corner (e.g., M11B is #1, 
IG259 is #2; IG258 is #3; and M11AR is #4). At the end, place any required documentation in the order it was completed. If you owe tax and 
are paying by check, place your voucher and check on top of Form M11. Use a paperclip; do not staple.
Mail your return and all required attachments to: 
Minnesota Department of Revenue 
Mail Station 1780
600 N. Robert St. 
St. Paul, MN 55146-1780 
For express deliveries, use our street address: 
Minnesota Department of Revenue 
600 N. Robert St. 
St. Paul, MN 55146

Business Information Changes
Be sure to let us know within 30 days if you change mailing addresses, phone numbers, or any other business information. To do so, go to our 
website, login to e-Services and update your profile information. By notifying us, we will be able to let you know of any changes in Minnesota 
tax laws and filing requirements. 

Information and Assistance
Website: www.revenue.state.mn.us
Email:   insurance.taxes@state.mn.us 
Phone:  651-556-3024     This material is available in alternate formats.
For questions about licensing and regulations, contact the Minnesota Department of Commerce:
Website: www.mn.gov/commerce
Email:     licensing.commerce@state.mn.us
Phone:  651-539-1599 or 1-800-657-3978                                                               Continued                                4
Fax:       651-539-0107

2023 Form M11 Instructions (Continued)

Worksheet: Additional Charge for Underpaying Estimated Tax

  1  Enter 80% of your total annual tax liability from line 30 of your 2023 Form M11.  
    If your tax liability was $500 or less, you do not owe an additional charge  . . .  . . . . . .  . . . . .  . . . . . . .  . . . .  . 1 
  2  Enter the amount from line 30 of your 2022 Form M11. If you were not required to file a 
    2022 return, you do not owe an additional charge   . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . . .  . . . . . .  . . . .  . 2 
                                                                                                                                     Due Dates
                                                                                                                           March 15  June 15               Sept. 15  Dec. 15
  3  Enter one-fourth of step 1 or step 2 (whichever is less)  
    in each column   . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . .  . . . . . .    3                                           
  4  Amounts paid on or before the due date for each period . Include 
    credits applied, such as prior year’s overpayment  . . .  . . . . . .  . . . . .  . . .  4                                                                       
 5   Overpayment of previous estimated payment  
     (see worksheet instructions)    . .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . . .  . . .  .5                                                   
  6  Add steps 4 and 5   . . . .  . . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . .  6                                             
  7  Underpayment (or overpayment) . Subtract step 6 from step 3   . . . . .  .  7                                                                                   
 8   Date underpayment is paid or March 1, 2024, whichever is earlier  . . .  .  .8                                                                                  
    9Number of days from the due date to the date on step 8  . . .  . . . . . .  . .  9                                                                              
  10 Additional charge (step 9 ÷ 365  interest (see below)  step 7)× ×   . . .  . . 10                                                                               
 11  TOTAL. Add amounts in each column on step 10. 
    Enter the result here and on Form M11, line 13a   .  . . . . .  . . . . . . .  . . .  11 
If step 11 is zero, keep this worksheet for your records. If it is more than zero, attach a copy of the worksheet to your Form M11.
Interest: 2023 = 5% (0.05); 2024 = 5% (0.05)

Worksheet Instructions

Step 5 
Payments of estimated tax are applied against any underpayments of required estimated payments in the order that the estimated payments 
were due.
For example, if your first estimated payment is underpaid by $100 and you deposit $200 for your second estimated payment $100 of your 
second payment is applied to the first estimated payment. The additional charge for the first estimated payment is computed from the first 
estimated payment’s due date to the date the second payment is made.
Also, the second estimated payment will then be underpaid by $100 (assuming that the second payment is $200) until sufficient repayments 
are received to eliminate the underpayment.
If more than one payment has been made for a required estimated payment, attach a separate computation for each payment. 
If there are payments included from a merged company, attach a schedule listing the merged company name, NAIC number, payment 
amounts and payment dates. 
Credit the excess of any overpayment for a period on step 5 of the next payment period.
Step 10
If there is no underpayment on step 7, enter “none” on step 10 for that period.

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