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                                                                                                                                                                                          M11L
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                                                                                                                                                               *226281*
    6  2023 M11L, Insurance Premium Tax Return for Life and Health Companies                                                                                                                                  6
    7  Due March 1, 2024                                                                                                                                                                                      7
    8                                                                                                                                Check if:           Amended Return                                       8
    9                            Name of Insurance Company                                                                          FEIN         X                       Minnesota Tax ID (required)          9

    10                           XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 0123456789                                                                                      0123456789                           10
    11                           Mailing Address                                                  Check if New Address              NAIC Number                          State/Country of Incorporation       11
                                                                                                                               X
    12                           XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 0123456789                                                                                      XXXXXXXXXXXXXXX 12
    13                           City                                           State             Zip Code                          Contact Person                                                            13
    14                           XXXXXXXXXXXXXXXXXXXX XX     XXXXX                                                                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 14
    15    Print or Type          Email Address                                                                                      Daytime Phone                         Fax Number                          15
    16                           XXXXXXXXXXXXXXXXXXXXXXXX 12345678900                                                             012345678900                           012345678900                         16
    17                           Type of Premiums (Check All that Apply)                          Type of Company                                                                                             17
    18                           X  Health/Accident     X  Life     X  Other                      X   Stock        X  Mutual                                                                                  18
    19                              Part 1 — Life Premiums                                                                                   A - State of Incorporation Basis        B - Minnesota Basis      19
    20                             1     Life premiums   .... ....... ..... ..... ...... ...... ..... ....... ..... ..  1                   0123456789                         0123456789                     20
    21                             2     Annuity considerations  ... ...... ..... ....... ..... ...... ..... ..... ...  2                   0123456789                                                        21
    22                             3  Total Minnesota direct business (add lines 1 and 2) ... ...... ..... ....... .  3                     0123456789                                                        22
    23                             4  Minnesota business assumed from unauthorized insurers (reinsurance) ... ..  4                         0123456789                                                        23
    24    Premiums                 5  Current dividends applied (see instructions) ... ...... ..... ....... ..... ..  5                     0123456789                         0123456789                     24
    25                             6  Dividends previously left on deposit applied   ... ...... ...... ..... ...... .  6                    0123456789                         0123456789                     25
    26                             7  Other additions (itemize on a separate schedule)   .... ..... ...... ..... ...  7                     0123456789                         0123456789                     26
    27                             8  Gross taxable business (add lines 3 through 7)       ... ...... ..... ....... .....  8                0123456789                         0123456789                     27
    28                                                                                                                                                                                                        28
    29                             9  Deductible annuity considerations ... ...... ..... ....... ..... ...... ....  9                       0123456789                                                        29
    30                             10  Dividends paid in cash (see instructions)        ... ...... ..... ....... ..... ....  10             0123456789                         0123456789                     30
    31                             11    Dividends to pay renewal premiums or reduce current premiums ... ......  11                        0123456789                         0123456789                     31
    32                             12  Dividends applied to provide extended and paid-up additions                                                                                                            32
    33                                   or shorten the premium paying period  ... ...... ..... ....... ..... .....  12                     0123456789                         0123456789                     33
    34                             13  Dividends left on deposit to accumulate interest ... ...... ..... ....... ..  13                     0123456789                         0123456789                     34
          Deductions
    35                             14  Unabsorbed portion of premiums credited to policyholders   ..... ...... ..  14                       0123456789                         0123456789                     35
    36                             15  Other nontaxable business and dividends (attach a schedule)  ... ...... ...  15                                                                                        36
    37                             16  Total deductions (add lines 9 through 15)          ... ...... ..... ....... ..... ...  16            0123456789                         0123456789                     37
    38                             17    Net taxable business — Part 1 (subtract line 16 from line 8) ... ...... .....              17      0123456789                         0123456789                     38
    39                                                                                                                                                                                                        39
    40                                   Part 2 — Accident and Health                                                                                                                                         40
    41                             18    Gross accident, health and other premiums         ... ...... ..... ....... ..... .  18             0123456789                         0123456789                     41
    42    Part 2  19                     Nontaxable premiums and dividends paid in cash           ... ...... ..... ....... .        19      0123456789                         0123456789                     42
    43                             20    Net taxable business — Part 2 (subtract line 19 from line 18) ... ...... ....              20      0123456789                         0123456789                     43
    44                                   Continue on line 24 of page 2.                                                                                                                                       44
    45                                                                                                                                                                                                        45
    46                             21  Tax due (or overpaid) (enter amount from line 45)  .. ..... ...... ..... ....... ..... ...... ..... ..  21                              0123456789                     46
    47                            22  Total additional charge, penalty and interest (enter amount from line 45)  ..... ....... ..... ..... ..  22                              0123456789                     47
    48                             23    TOTAL AMOUNT DUE (or            overpaid)  (add lines 21 and 22)        ... ...... ..... ....... ..... ...... ....  23                0123456789                     48
    49                              If you owe additional tax:                                                                                                                                                49
    50                                   Payment method:    X    Electronic payment        X     Check (payable to Minnesota Revenue; write MN tax ID number on check; attach voucher)                        50
    51                              Enter amount paid           0123456789   Date paid                 0123456789  (If amount paid is different from line 23, attach an explanation.)                         51
    52                                   If you overpaid:                                                                                                                                                     52
    53    Amount Due/Overpaid            Amount on line 23 to be credited to next year’s estimated tax  ..... ....... .                                                                                       53
                                                                                                                                            0123456789
    54                                   Amount on line 23 to be refunded   . ..... ...... ..... ..... ...... ...... ..                     0123456789                                                        54
    55                                                                                                                                                                                                        55
    56                            I declare that this return is correct and complete to the best of my knowledge and belief.                                                                                  56
    57                            I confess judgment to the state of Minnesota for the amount of tax shown due to the extent not timely paid.                                                                 57
                                                                                                                                                                                  
    58                            Authorized Signature                          Title                                          Date              Daytime Phone                 X     I authorize the          58
    59              Sign Here    XXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXX XXXXXXX 0123456789                                                                                             Minnesota Department     59
    60                            Signature of Preparer                         Print Name of Preparer                         Date              Daytime Phone                       of Revenue to discuss    60
                                                                                                                                                                                     this tax return with the 
    61                                                                                                                                                                               preparer.                61
                                 XXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXX XXXXXXX 0123456789
    62                                                                                                                                                                                                        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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    7  2023 Insurance Premium Tax Return for Life and Health Companies (continued)                                                                                                                                                                                                                            7
    8                                                                                                                                                                                                                                                                                                         8
                                                                                                                                                                                                                                                   A                                        B
    9                                                                                                                                                                                                                                 State of Incorporation Basis                      Minnesota Basis       9
    10                                                                                                                Part 1 — Life Premiums                                                                                                                                                                  10
    11                                                                                                         24     Net taxable business (enter amount from line 17) ... ...... ..... ....... .  24                                0123456789                                      0123456789               11
    12                                                                                                         25     Premium tax percentage rate  .... ..... ....... ..... ...... ..... ......                               25     0123456789 %                                                  1.5%       12
    13                                                                                                         26     Life premium tax liability (multiply line 24 by percentage on line 25)  . .....  26                            0123456789                                      0123456789               13
    14                                                                                                                                                                                                                                                                                                        14
    15                                                                                                            Part 2 — Accident and Health                                                                                                                                                                15
    16                                                                                                         27  Net taxable business — Part 2 (enter amount from line 20)                       ... ...... .....  27              0123456789                                      0123456789               16
    17                                                                                                         28  Premium tax percentage rate  .... ..... ....... ..... ...... ..... ......  28                                     0123456789 %                                                       2%    17
    18                                                                                                         29     Accident and health premium tax liability                                                                                                                                               18
    19                                                                                                                (multiply line 27 by the percentage on line 28)  .. ..... ...... ..... ......  29                              0123456789                                      0123456789               19
    20                                                                                                         30     Total premium tax liability (add lines 26 and 29) ... ...... ..... ....... ..  30                              0123456789                                      0123456789               20
    21                                                                                                         31  Other taxes (itemize on a separate schedule)   .. ..... ....... ..... ......  31                                  0123456789                                                               21
    22                                                                                                         32     Licenses and fees (from M11B, line 10. Attach form M11B)                     ... ...... .....  32              0123456789                                      0123456789               22
    23                                                                                                         33  Total taxes, licenses and fees (add lines 30 thru 32)  ... ...... ..... ......  33                                0123456789                                      0123456789               23
    24                                                                                                         34     Enter amount from line 33, Column A or B, whichever is greater  . ..... ...... ..... ...... ...... ..  34                                                      0123456789               24
    25                                                                                                         35     Total licenses and fees paid to Minnesota (from M11B, line 11. Attach form M11B) ... ...... ..... ..  35                                                       0123456789               25
    26                                                                                                         36     Subtract line 35 from line 34 (if zero or less,                                                                                                                                         26
    27                                                                                                               skip lines 37 though 39 and enter this amount on line 40) ...                ...... ..... ....... ..... ...... .....                                     36     0123456789               27
    28                                                    Calculate Your Adjusted Liability                    37     Minnesota Guaranty Fund Association offset (see instructions) ... ...... ..... ....... ..... ...... .  37                                                      0123456789               28
    29                                                                                                         38     Short Line Railroad Transfer Credit (attach credit certificate) ..... ..... ...... ...... ..... ...... ..  38                                                  0123456789               29
    30                                                                                                         39     Film Production Credit (attach credit certificate) ... ....... ..... ..... ...... ..... ...... ...... ..  39                                                   0123456789               30
    31                                                                                                         40     Minnesota Housing Tax Credit .. ..... ...... ..... ....... ..... ...... ..... ...... ..... ...... ...40                                                        0123456789               31
    32                                                                                                                Enter the credit certificate number from Minnesota Housing: SHTC -                            1234 -    123456789                                                                       32
    33                                                                                                         41     Tax before refundable credits. If line 36 is zero or less, enter the amount from line 36. If line 36 is                                                                                 33
    34                                                                                                               positive, subtract any amounts on lines 37-40 from line 36.                                                                                                                              34
    35                                                                                                                (If result is less than zero, enter zero) ... ...... ..... ....... ..... ...... ..... ..... ...... ......  41                                                  0123456789               35
    36                                                                                                         42  Historic structure rehabilitation credit                                                                                                                                                   36
    37                                                                                                               (must attach credit certificate) enter NPS project number:                       ... ...... ...    0123456789                       42                          0123456789               37
    38                                                                                                         43  Tax liability (subtract line 42 from line 41)  ...... ..... ...... ...... ..... ...... ..... ...... .....  43                                                     0123456789               38
    39                                                                                                                                                                                                                                                                                                        39
    40                                                                                                         44     a  Prior year’s overpayment  .. ..... ....... ..... .  44a                      0123456789                                                                                              40
    41                                                                                                               b  Estimated payment March 15 ... ...... ..... ...  44b                          0123456789                                                                                              41
    42                                                                                                               c  Estimated payment June 15  .... ..... ....... ..                        44c   0123456789                                                                                              42
    43                                                                                                               d  Estimated payment Sept. 15  ... ...... ..... ....  44d                        0123456789                                                                                              43
    44                                                                                                               e  Estimated payment Dec. 15   ... ....... ..... ...  44e                        0123456789                                                                                              44
    45                 Tax Prepayments                                                      and Amount Due           Add lines 44a through 44e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  44     0123456789               45
    46                                                                                                         45  Tax due (or overpaid) (subtract line 44 from line 43). Enter on line 21, page 1  .. ...... ..... ...... .  45                                                     0123456789               46
    47                                                                                                                                                                                                                                                                                                        47
    48                                                                                                         46     a  Additional charge for underpaying estimated tax                                                                                                                                      48
    49                                                                                                                    (determine from worksheet in the instructions)...  46a                      0123456789                                                                                              49
    50                                                                                                               b  Penalty (see instructions)  ... ...... ..... ......  46b                      0123456789                                                                                              50
    51                                                                                                               c    Interest (see instructions)  . . . . . . . . . . . . . . . . . . . .  46c   0123456789                                                                                              51
    52                                                                                      Penalty, Interest        Total additional charge, penalty and interest (add lines 46a through 46c). Enter on line 22, page 1 ... ... 46                                                  0123456789               52
    53                                 Additional Charge,                                                                                                                                                                                                                                                     53
    54                                                                                                                                                                                                                                                                                                        54
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                                           FINAL DRAFT 10/2/23
2023 Insurance Premium Tax Return for Life and Health Companies

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

GFA Assessment
If you were assessed and made a payment to The Guaranty Fund Assessment (GFA) in 2016, and/or 2018, you may be able to claim a credit 
on line 37. See line 37 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 life and health insurance companies licensed in Minnesota during the tax year must file a premium tax return even if they have not 
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. (M.S. 297I.05, 
subd. 14)
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 M11L 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 M11L) may be filed electronically using TriTech Software.

Which Form to File
Life and health insurance companies use Form M11L to file premium taxes.
Property, casualty and title insurance companies use Form M11 to file premium taxes.

Due Date
File your Form M11L 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.
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.                                                                                                      Continued                 1

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FINAL DRAFT 10/2/23
2023 Form M11L Instructions (Continued)

Note: If you make your payments electronically, do not send in a voucher.
Estimated Tax Payments
If your total annual tax liability is more than $500, you must make estimated payments. To avoid an additional charge for underpaying the
tax, your payments must be made on time and be at least one-fourth of the prior year’s total annual tax liability, or one-fourth of 80% of the
current year’s total annual 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 a voucher.
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 3. 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 M11L, 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 M11L
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
premiums 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 M11L.
In Column B (Minnesota basis), include direct premiums; stop-loss premiums; assessments; deposits; policy, membership and survey fees;
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 employer contributions 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 on line 8, you may deduct them on line 15; if they were included on line 18, you may deduct
them on line 19.

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 5 and 6
Dividends
Enter the dividends to be included in the gross taxable business. If dividends listed differ from your annual statement, attach a statement
explaining the differences.
Line 7
Other Additions
Attach a separate schedule itemizing the additions and amounts included on this line.
Lines 10 through 15
Dividends
Enter dividends only if returned to the insured person or entity paying the premium.

Continued 2

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FINAL DRAFT 10/2/23
2023 Form M11L Instructions (Continued)

Lines 25 and 28
Premium Tax Percentage Rate
If premiums are taxed at more than one rate, enclose a schedule showing rates and premiums. Life insurance premiums are taxed at 1.5% and
accident and health premiums are taxed at 2%.
Lines 37 through 40
Non-Refundable Credits
If assessments and credits are more than your tax before refundable credits (positive amount on line 36), use only the amount necessary to
reduce your tax to zero; the remaining amount may be deducted in future tax years.
Line 37
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.
If you receive a refund for an 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 38
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.
Line 39
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 40
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 41
Tax Before Refundable Credits
The amount on line 41 can only be negative due to return premiums. It cannot be negative due to the non-refundable credit exceeding the tax
liability.
Line 42
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 42.
• 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 44a Through 44e
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.
Line 46a
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 40 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 46a.

Continued 3

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                                                  FINAL DRAFT 10/2/23
2023 Form M11L Instructions (Continued)

Line 46b
Penalty
Late Payment. If you file on time but 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 46c
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

Mailing Your Return
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 55101

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.

                                                                                                  Continued                                     4

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FINAL DRAFT 10/2/23
2023 Form M11L Instructions (Continued)

Worksheet: Additional Charge for Underpaying Estimated Tax

1 Enter 80% of your total annual tax liability from line 40 of your 2023 Form M11L.
If your tax liability was $500 or less, you do not owe an additional charge. ..... ...... ..... ...... ... 1
2 Enter the amount from line 40 of your 2022 Form M11L. 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 installment (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
9 Number 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 of step 10.
Enter the result here and on Form M11L, line 43a . ...... ..... .... 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 M11L.
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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