Form 83-391-23-3-1-000 (Rev. 10/23)
06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80
04                                                                                          Mississippi                                                                                                                                                                                                                        04
05                                                            Insurance Company Income Tax Return                                                                                                                                                                                                                              05
06       833912331000                                                                                   2023                                                                                                                                                                                                                   06
07                                                                                                                                                                                                                                                                                                                             07
08 Tax Year Beginning         99999999                                                                                                                           Tax Year Ending                                                                                                                  99999999                     08
09                                                                                                                                                                                                                                                                                                                             09
10 FEIN    999999999                                                                                                                  Mississippi Secretary of State ID                     9999999999                                                                                                                         10
11                                                                                                                                                                                                                                                                                                                             11
12 Legal Name and DBA                                                                                                                                CHECK ALL THAT APPLY                                                                                                                                                      12
13 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9                                                                                                                                                                                                                                                                                  13
14 Address                                                                                                                            X     Amended Return                            X     Accident and Health                                                                                                                14
15 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9                                                                                                                                                                                                                                                                                  15
16                                                                                                                                    X     Final Return                              X     Fire and Casualty                                                                                                                  16
17 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9                                                                                                                                                                                                                                                                                  17
18 City                                                                               State       Zip +4                                                                                    Life Insurance                                                                                                                     18
                                                                                                                                                                                      X
19 X9X9X9X9X9X9X9X9X9X9X9X9X9X9                                                       XX          999999999                           X     Accrual Basis                                                                                                                                                                      19
20                                                                                                                                                                                                                                                                                                                             20
21 County Code                 99         NAICS Code                   99999                                                          X     Receipts and                                                                                                                                                                       21
22                                                                                                                                          Disbursements Basis                                                                                                                                                                22
23 COMPUTATION OF TAX                                                                                                                                             (ROUND TO THE NEAREST DOLLAR) 23
24                                                                                                                                                                                                                                                                                                                             24
25 X     Combined income tax return (enter FEIN of reporting company)                                            999999999                                                                                                                                                                                                     25
26                                                                                                                                                                                                                                                                                                                             26
27 1   Mississippi net taxable income (from page 2, line 17A or Form 83-310, page 1, line 5, column C)                                                                    1              99999999999                                                                                                                           27
28                                                                                                                                                                                                                                                                                                                             28
29 2   Income tax                                                                                                                                                         2                 9999999999                                                                                                                         29
30                                                                                                                                                                                                                                                                                                                             30
31 3   Retaliatory taxes paid to other states (Mississippi corporations only; from page 4, part V, line 1)                                                                3                 9999999999                                                                                                                         31
32                                                                                                                                                                                                                                                                                                                             32
33 4   Income tax credits (from Form 83-401, line 3 or Form 83-310, page 1, line 5, column B)                                                                             4                 9999999999                                                                                                                         33
34                                                                                                                                                                                                                                                                                                                             34
35 5   Net income tax due (line 2 minus line 3 and line 4)                                                                                                                5                 9999999999                                                                                                                         35
36                                                                                                                                                                                                                                                                                                                             36
37 PAYMENTS AND TAX DUE                                                                                                                                                                                                                                                                                                        37
38                                                                                                                                                                                                                                                                                                                             38
39 6   Overpayment from prior year                                                                                                                                        6                 9999999999                                                                                                                         39
40                                                                                                                                                                                                                                                                                                                             40
41 7   Estimated tax payments and payment with extension                                                                                                                  7                 9999999999                                                                                                                         41
42                                                                                                                                                                                                                                                                                                                             42
43 8   Total payments (line 6 plus line 7)                                                                                                                                8                 9999999999                                                                                                                         43
44                                                                                                                                                                                                                                                                                                                             44
45 9   Net total income tax due (line 5 minus line 8)                                                                                                                     9                 9999999999                                                                                                                         45
46                                                                                                                                                                                                                                                                                                                             46
47 10   Interest and penalty on underestimated income tax payments (from Form 83-305, line 19)                                                                            10                9999999999                                                                                                                         47
48                                                                                                                                                                                                                                                                                                                             48
49 11   Late payment interest                                                                                                                                             11                9999999999                                                                                                                         49
50                                                                                                                                                                                                                                                                                                                             50
51 12   Late payment penalty                                                                                                                                              12                9999999999                                                                                                                         51
52                                                                                                                                                                                                                                                                                                                             52
53 13   Late filing penalty (minimum $100)                                                                                                                                13                9999999999                                                                                                                         53
54                                                                                                                                                                                                                                                                                                                             54
55 14   Total balance due (if line 5 is larger than line 8, add lines 9 through 13)                                                                                       14                9999999999                                                                                                                         55
56                                                                                                                                                                                                                                                                                                                             56
57 15   Total overpayment (if line 8 is larger than line 5, subtract line 5 from line 8)                                                                                  15                9999999999                                                                                                                         57
58                                                                                                                                                                                                                                                                                                                             58
59 16   Total overpayment credited to next year                      (from line 15)                                                                                       16                9999999999                                                                                                                         59
60                                                                                                                                                                                                                                                                                                                             60
61      17   Total overpayment refunded (line 15 minus line 16)                                                                                                           17                9999999999                                                                                                                         61
62                                                                                                                                                                                                                                                                                                                             62
63                                                                                                                                                                                                                                                                                                                             63
06 07 08 09 10 11 12 13 14 15 16 17See instructions for electronic payment options or attach check or money order for balance due. 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80

Form 83-391-23-3-2-000 (Rev. 10/23)
  06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80
04                                                         Mississippi                                                                                                                                                            04
05                                                                                                                                 Page 2                                                                                         05
                                            Insurance Company Income Tax Return
06     833912332000                                                      2023                                                                                                                                                     06
07                                                                                                                                                                                                                                07
08FEIN                                                                                                                                                                                                                            08
       999999999
09                                                                                                                                                                                                                                09
10 COMPUTATION OF NET INCOME                                                            A  MISSISSIPPI                 B  COMPANY-WIDE                                                                                            10
111    Direct premiums (except accident and                                                                                                                                                                                       11
12      health premiums)                                                                                                                                                                                                          12
                                                     9999999999
13 Less: return premiums                            99999999999                   1A   9999999999                  1B  9999999999                                                                                                 13
14                                                                                                                                                                                                                                14
152    Direct accident and health premiums                                        2A   9999999999                  2B  9999999999                                                                                                 15
16                                                                                                                                                                                                                                16
173    Reinsurance assumed                                                        3A   9999999999                  3B  9999999999                                                                                                 17
18                                                                                                                                                                                                                                18
194    Considerations for annuities                                               4A   9999999999                  4B  9999999999                                                                                                 19
20                                                                                                                                                                                                                                20
215    Considerations for supplementary contracts                                 5A   9999999999                  5B  9999999999                                                                                                 21
22                                                                                                                                                                                                                                22
236    Unearned premiums (December 31st, prior year)                              6A   9999999999                  6B  9999999999                                                                                                 23
24                                                                                                                                                                                                                                24
257    Gross investment income                                                    7A   9999999999                  7B  9999999999                                                                                                 25
26                                                                                                                                                                                                                                26
278    Other income                                                               8A   9999999999                  8B  9999999999                                                                                                 27
28                                                                                                                                                                                                                                28
299    Total net income (add line 1 through line 8)                               9A   9999999999                  9B  9999999999                                                                                                 29
30                                                                                                                                                                                                                                30
31 DEDUCTIONS                                                                                                                                                                                                                     31
32                                                                                                                                                                                                                                32
3310  Unearned premiums (December 31st, current year)                             10A  9999999999                  10B 9999999999                                                                                                 33
34                                                                                                                                                                                                                                34
3511  Reinsurance ceded                                                           11A  9999999999                  11B 9999999999                                                                                                 35
36                                                                                                                                                                                                                                36
3712  Dividends to policy holders                                                 12A  9999999999                  12B 9999999999                                                                                                 37
38                                                                                                                                                                                                                                38
3913  Total deductions (add line 10 through line 12)                              13A  9999999999                  13B 9999999999                                                                                                 39
40                                                                                                                                                                                                                                40
41 MISSISSIPPI NET TAXABLE INCOME                                                                                                                                                                                                 41
42                                                                                                                                                                                                                                42
4314  Gross income (line 9 minus line 13)                                         14A  9999999999                  14B 9999999999                                                                                                 43
44                                                                                                                                                                                                                                44
4515  Total deductions allocated and apportioned (from page 4, part III, line 23) 15A  9999999999                  15B 9999999999                                                                                                 45
46                                                                                                                                                                                                                                46
4716  Less: Mississippi net operating loss (from Form 83-155, part I, line 2)     16A  99999999999                 16B 99999999999                                                                                                47
48                                                                                                                                                                                                                                48
4917  Net taxable income (loss) (line 14 minus line 15 and line 16; enter amount  17A  99999999999                 17B 99999999999                                                                                                49
        from 17A on page 1, line 1 or Form 83-310, page 1, line 5, column C)
50                                                                                                                                                                                                                                50
51                                                                                                                                                                                                                                51
52 X   Check box if return may be discussed with preparer                                                                                                                                                                         52
53                                                                                                                                                                                                                                53
54I declare, under penalties of perjury, that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,                                                                  54
55this is a true, correct and complete return. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.                                                                     55
56                                                                                                                                                                                                                                56
57     Officer Signature and Title                                                     Date                        Business Phone                                                                                                 57
58                                                                                                                                                                                                                                58
59     Paid Preparer Signature                        Date                             Paid Preparer Address                                                                                                                      59
60 9X9X9X9X9                                                                                                                                                                                                                      60
61     Paid Preparer PTIN                            Paid Preparer Phone          City                       State Zip Code                                                                                                       61
62                                  Mail Return To: DEPARTMENT OF REVENUE  P.O. BOX 23191 JACKSON, MS 39225-3191                                                                                                                  62
63                                                                                                                                                                                                                                63
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  Form 83-391-23-3-3-000 (Rev. 10/23)
  06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80
04                                                                  Mississippi                                                                                                                                                   04
05                                                                                                          Page 3                                                                                                                05
                                              Insurance Company Income Tax Return
06                                                                     2023                                                                                                                                                       06
07FEIN 999999999                                                                                                                                                                                                                  07
08                                                                                                                                                                                                                                08
09 PART I:   EXPENSE APPORTIONMENT RATIOS                           A   MISSISSIPPI     B  COMPANY-WIDE C  MISSISSIPPI RATIO                                                                                                      09
10                                                                                                                                                                                                                                10
11 Applicable ratio(s) used on page 4, part IV, line 2                                                                                                                                                                            11
12                                                                                                                                                                                                                                12
131     Loss adjustment expenses (direct losses)                 1A 9999999999      1B  9999999999      1C 999.9999                                                                                                               13
14                                                                                                                                                                                                                                14
152     Accident and health expenses (direct premiums and                                                                                                                                                                         15
16       reinsurance assumed)                                    2A 9999999999      2B  9999999999      2C 999.9999                                                                                                               16
173     Other underwriting expenses (direct premiums                                                                                                                                                                              17
18       (less return premiums), annuity considerations and      3A 9999999999      3B  9999999999      3C 999.9999                                                                                                               18
19       reinsurance assumed)                                                                                                                                                                                                     19
204    Investment expenses (gross investment income)             4A 9999999999      4B  9999999999      4C 999.9999                                                                                                               20
21                                                                                                                                                                                                                                21
22 PART II:  DEDUCTIONS ALLOCATED                                       A   MISSISSIPPI                 B  COMPANY-WIDE                                                                                                           22
23                                                                                                                                                                                                                                23
245    Losses, death benefits, accident and health                                                                                                                                                                                24
25      benefits (less applicable recoveries)                                                                                                                                                                                     25
26               a  Paid                                            5Aa 9999999999      5Ba             9999999999                                                                                                                26
27                                                                                                                                                                                                                                27
28               b  Unpaid at December 31st, current year           5Ab 9999999999      5Bb             9999999999                                                                                                                28
29                                                                                                                                                                                                                                29
30               c  Unpaid at December 31st, prior year             5Ac 9999999999      5Bc             9999999999                                                                                                                30
31                                                                                                                                                                                                                                31
326    Loss adjustment expenses allocated                           6A  9999999999      6B              9999999999                                                                                                                32
33                                                                                                                                                                                                                                33
347    Matured endowments                                           7A  9999999999      7B              9999999999                                                                                                                34
35                                                                                                                                                                                                                                35
368    Annuity benefits                                             8A  9999999999      8B              9999999999                                                                                                                36
37                                                                                                                                                                                                                                37
389    Disability benefits                                          9A  9999999999      9B              9999999999                                                                                                                38
39                                                                                                                                                                                                                                39
4010  Surrender benefits                                            10A 9999999999      10B             9999999999                                                                                                                40
41                                                                                                                                                                                                                                41
4211  Payments on supplementary contracts                           11A 9999999999      11B             9999999999                                                                                                                42
43                                                                                                                                                                                                                                43
4412  Net additions to reserve funds (required by law                                                                                                                                                                             44
45      for liquidating policies at maturity)                       12A 9999999999      12B             9999999999                                                                                                                45
46                                                                                                                                                                                                                                46
4713  Commissions                                                   13A 9999999999      13B             9999999999                                                                                                                47
48                                                                                                                                                                                                                                48
4914  Gross premium privilege tax                                   14A 9999999999      14B             9999999999                                                                                                                49
50                                                                                                                                                                                                                                50
5115  Other allocable taxes                                         15A 9999999999      15B             9999999999                                                                                                                51
52                                                                                                                                                                                                                                52
5316  Rent, allocated                                               16A 9999999999      16B             9999999999                                                                                                                53
54                                                                                                                                                                                                                                54
5517  Agency expense (attach schedule)                              17A 9999999999      17B             9999999999                                                                                                                55
56                                                                                                                                                                                                                                56
5718  Medical and inspection fees, allocated                        18A 9999999999      18B             9999999999                                                                                                                57
58                                                                                                                                                                                                                                58
5919  Other allocable deductions (attach schedule)                  19A 9999999999      19B             9999999999                                                                                                                59
60                                                                                                                                                                                                                                60
6120  Total allocable deductions                                    20A 9999999999      20B             9999999999                                                                                                                61
62                                                                                                                                                                                                                                62
63                                                                                                                                                                                                                                63
  06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80

  Form 83-391-23-3-4-000 (Rev. 10/23)
  06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80
04                                                                Mississippi                                                                                                                                                     04
                                                                                                                                        Page 4 
05                                                                                                                                                                                                                                05
                                     Insurance Company Income Tax Return
06                                                                                                                                                                                                                                06
07                                                                     2023                                                                                                                                                       07
08FEIN 999999999                                                                                                                                                                                                                  08
09                                                                                                                                                                                                                                09
10 PART III: DEDUCTIONS APPORTIONED                                        A   MISSISSIPPI                           B  COMPANY-WIDE                                                                                              10
11                                                                                                                                                                                                                                11
12 21   Non-allocable loss adjustment expenses                         21A 9999999999                            21B 9999999999                                                                                                   12
13                                                                                                                                                                                                                                13
14 22   Total apportioned expenses (from page 4, part IV, line 3)      22A 9999999999                            22B 9999999999                                                                                                   14
15                                                                                                                                                                                                                                15
16 23   Total allocated and apportioned deductions (line 20 plus                                                                                                                                                                  16
17         line 21 plus line 22; enter on page 2, line 15)             23A 9999999999                            23B 9999999999                                                                                                   17
18                                                                                                                                                                                                                                18
19 PART IV:  DEDUCTIONS APPORTIONED   (FROM ANNUAL STATEMENT)                                                                                                                                                                     19
20 Expenses must be separately apportioned.  Attach supplementary pages to return as needed.                                                                                                                                      20
21                                                                                                                                                                                                                                21
22     Page Line                                           Description        A   Column (  )9 B   Less Allocable                      C  Balance                                                                                 22
23                                                                                                 Expenses          Apportionable                                                                                                23
24 99999999 X9X9X9                   X9X9X9X9X9X9X9X9X9X9X9X9                 9999999999           9999999999        9999999999                                                                                                   24
25                                                                                                                                                                                                                                25
26 99999999 X9X9X9                   X9X9X9X9X9X9X9X9X9X9X9X9                 9999999999           9999999999        9999999999                                                                                                   26
27                                                                                                                                                                                                                                27
28 99999999 X9X9X9                   X9X9X9X9X9X9X9X9X9X9X9X9                 9999999999           9999999999        9999999999                                                                                                   28
29                                                                                                                                                                                                                                29
30 99999999 X9X9X9                   X9X9X9X9X9X9X9X9X9X9X9X9                 9999999999           9999999999        9999999999                                                                                                   30
31                                                                                                                                                                                                                                31
32 99999999 X9X9X9                   X9X9X9X9X9X9X9X9X9X9X9X9                 9999999999           9999999999        9999999999                                                                                                   32
33                                                                                                                                                                                                                                33
34 99999999 X9X9X9                   X9X9X9X9X9X9X9X9X9X9X9X9                 9999999999           9999999999        9999999999                                                                                                   34
35                                                                                                                                                                                                                                35
36                                                                                                                                                                                                                                36
371    Totals (total column A minus total column B)                         9999999999             9999999999        999999999937
38                                                                                                                                                                                                                                38
392    Applicable expense apportionment ratio (from page 3, part I)                                                  999.9999                                                                                                     39
40                                                                                                                                                                                                                                40
413    Total apportioned to Mississippi (multiply line 1, column C by                                                                                                                                                             41
42      line 2, enter amount on page 4, part III, line 22)                                                           999999999942
43                                                                                                                                                                                                                                43
44 PART V: RETALIATORY TAXES PAID    (MISSISSIPPI CORPORATIONS ONLY)                                                                                                                                                              44
45                                                                                                                                                                                                                                45
  Itemize retaliatory taxes paid by state and attach copies of returns documenting amounts.  Attach supplementary schedules as needed. 
46                                                                                                                                                                                                                                46
47                                                                                                                                                                                                                                47
       A   Taxing Authority                                B   Amount         A   Taxing Authority                   B   Amount
48                                                                                                                                                                                                                                48
49 X9X9X9X9X9X9X9X9X9X9X                       9999999999                  X9X9X9X9X9X9X9X9X9X9X                     9999999999                                                                                                   49
50                                                                                                                                                                                                                                50
51 X9X9X9X9X9X9X9X9X9X9X                       9999999999                  X9X9X9X9X9X9X9X9X9X9X                     9999999999                                                                                                   51
52                                                                                                                                                                                                                                52
53 X9X9X9X9X9X9X9X9X9X9X                       9999999999                  X9X9X9X9X9X9X9X9X9X9X                     999999999953
54                                                                                                                                                                                                                                54
55 X9X9X9X9X9X9X9X9X9X9X                       9999999999                  X9X9X9X9X9X9X9X9X9X9X                     9999999999                                                                                                   55
56                                                                                                                                                                                                                                56
57 X9X9X9X9X9X9X9X9X9X9X                       9999999999                  X9X9X9X9X9X9X9X9X9X9X                     9999999999                                                                                                   57
58                                                                                                                                                                                                                                58
59 X9X9X9X9X9X9X9X9X9X9X                       9999999999                  X9X9X9X9X9X9X9X9X9X9X                     999999999959
60                                                                                                                                                                                                                                60
61                                                                         1  Total amounts (total amounts from                                                                                                                   61
62                                                                              column B; enter amount on page                                                                                                                    62
                                                                                1, line 3)                           9999999999
63                                                                                                                                                                                                                                63
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