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Line 8: Enter receipts on sales of annuities to the extent these • Michigan Basic Property Insurance Association
receipts were included in line 5. • Michigan Automobile Insurance Placement Facility
Line 9: Enter receipts on reinsurance premiums assumed to • Property and Casualty Guaranty Association
the extent these receipts were included in line 5, and only if tax • Michigan Life and Health Insurance Guaranty Association
was paid on the original premiums.
• Catastrophic Claims Association
DISABILITY INSURANCE EXEMPTION • Assessment under Health Insurance Claims Assessment Act
Line 12: “Disability insurance” includes any policy or contract (HICAA).
of insurance against loss resulting from sickness or from bodily
death by accident, both, or including also the granting Line 31: Enter the tax a Michigan company would pay to
injury or
of specific hospital benefits and medical, surgical and sick- the
taxpayer’s state of incorporation if it conducted the
care benefits to any person, family or group, subject to certain same
amounts and types of business there as the taxpayer
is conducting in Michigan. Attach a copy of the state of
exclusions.
incorporation’s tax form on which this pro forma tax on the
The exclusion for disability insurance premiums does not hypothetical Michigan company was calculated.
include credit insurance or disability income insurance
Lines 33 through 43: In column A, “State of Incorporation,”
premiums.
enter the amounts that would be paid by a hypothetical
Line 22, Column A: Multiply line 21 by 0.4835 percent Michigan insurance company doing the same types and
(0.004835). amounts of business in the taxpayer’s home state that the
Line 22, Column B: Multiply line 21 by 1.25 percent (0.0125). taxpayer
is doing in Michigan.
Lines 38 and 40-43: In column B, “Michigan,” enter the actual
CREDITS amounts paid by the taxpayer to Michigan.
Line 24: Enter the amounts paid to the listed facilities
or associations from January 1, 2020, to December 31, Line 43: Attach a detailed schedule of assessments.
2020, including special assessments. Net the amounts paid Line 45: Subtract line 44, column B, from line 44, column A.
and refunds received during 2020 for the same facility or If less than zero, enter zero.
association. If refunds received exceed the amount paid in the
year for the same facility association, or enter zero. PAYMENTS, REFUNDABLE CREDITS, AND TAX DUE
Line 48: Enter the total tax paid with the quarterly estimated
Line 24c: For tax years beginning on and after January 1, tax returns.
2020, amounts paid to the Michigan Automobile Insurance
Placement Facility (MAIPF) that are attributable to the Line 50:
Report here Michigan Tax withheld for deferred
assigned claims plan shall not be included the in calculation of compensation
plans, life insurance and/or lottery annuities
this credit. issued
to a business account number through MCL 206.703(1).
Taxpayers can enter the Michigan Tax withheld reported on the
Line 26: Enter the amount of Michigan Examination Fees or W-2G and/or 1099R.
Regulatory Fees paid 2021 in (under Michigan Compiled Law
Line 51: The Worker’s Disability Supplemental Benefit
500.224).
(WDSB) Credit is available to an insurance company subject
Line 29: Enter the Total Recapture of Certain Business Tax to the Worker’s Disability Compensation Act of 1969. The
Credits from Form 4902. Include acopy Form of 4902. credit is equal to the amount paid during that tax year by the
insurance company pursuant to Section 352 of the act, as
Retaliatory Instructions certified by the director of the Worker’s Compensation Agency,
For foreign and alien insurers only; domestic insurers skip Department of Licensing and Regulatory Affairs (LARA),
lines 31 through 45. during the tax year. The amount of the credit is provided to
Do not mail this return with the Michigan Annual Financial taxpayers by LARA. For more information on WDSB credit
Statement. eligibility, contact LARA, Workers’ Compensation Agency, by
phone at 1-888-396-5041, by email at wcinfo@michigan.gov ,
Foreign insurers must pay to Michigan the same type of or visit the LARA Web site atwww.michigan.gov/wca.
obligation a similar Michigan insurer is required to pay in the
company’s state of domicile. Enter all items that are required Line 54: If penalty and interest are owed for not filing
of a Michigan insurance company. Some taxes and obligations estimated returns or for underestimating tax, complete the CIT
imposed other in states may have no corresponding requirement Penalty and Interest Computation for Underpaid Estimated
in Michigan; however, this does not relieve the foreign insurer Tax (Form 4899), to compute penalty and interest due. If a
from the obligation computingof and paying the correct amount taxpayer chooses not to file Form 4899, Treasury will compute
of the tax. penalty and interest and bill for payment. (Form 4899 is
available on the Web at www.michigan.gov/treasuryforms.)
Do not include the following Michigan assessments,
or comparable assessments in the company’s state of Line 55: Refer to the “Computing Penalty and Interest” section
incorporation, thein retaliatory calculation: in Form 4904 to determine the annual return penalty rate and
use the following Overdue Tax Penalty worksheets.
• Michigan Worker’s Compensation Placement Facility
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