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4700, Page 4 FEIN or TR Number
UBG Member FEIN or TR Number
PART 5: EXCLUSIONS FROM GROSS RECEIPTS (CONT.)
59. Amounts attributable to an ownership interest in a pass-through entity, regulated investment company, real estate
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UHFHLSWV WD[ RU ZRXOG EH VXEMHFW WR WKH PRGL¿HG JURVV UHFHLSWV WD[ LI WKH EXVLQHVV DFWLYLWLHV ZHUH LQ WKLV VWDWH(f) ..... 59. 00
60. )RU D UHJXODWHG LQYHVWPHQW FRPSDQ\ DV WKDW WHUP LV GH¿QHG XQGHU ,5& UHFHLSWV GHULYHG IURP LQYHVWPHQW
activity by that regulated investment company ...................................................................................................... 60. 00
61. 2QO\ +HDOWK 0DLQWHQDQFH 2UJDQL]DWLRQV +02V KROGLQJ FRQWUDFW ZLWK WKH 6WDWH IRU 0HGLFDLG VHUYLFHV PD\
complete this line: If applicable per MCL 208.1111(1) (dd), enter amounts received during the period that is
both within the tax year and within October 1, 2021, through September 30, 2022, for Medicaid premium or
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'LUHFWRU KDV XQWLO -DQXDU\ WR FHUWLI\ WKDW QHFHVVDU\ UDWHV SURYLGH H[SOLFLW DGMXVWPHQW IRU 0%7 REOLJDWLRQV
LQ ZKLFK FDVH 12 GHGXFWLRQ ZLOO EH DOORZHG IRU DQ\ +02 KROGLQJ FRQWUDFW ZLWK WKH 6WDWH IRU 0HGLFDLG VHUYLFHV(g).. 61. 00
62. For a taxpayer that provides health care management consulting services, amounts received by the taxpayer as
fees from its clients that are expended by the taxpayer to reimburse those clients for labor and nonlabor services
that are paid by the client and reimbursed to the client pursuant to a services agreement ........................................ 62. 00
63. Bad Debt amounts deducted for Federal Income Tax that correspond to items included in MGR tax base for
current or prior MBT return .................................................................................................................................... 63. 00
64a. Dividends and royalties received or deemed received from a foreign operating entity or a person other than a
8 6 SHUVRQ LQFOXGLQJ EXW QRW OLPLWHG WR WKH DPRXQWV GHWHUPLQHG XQGHU ,5& RU WKURXJK ................ 64a. 00
64b. Exclusion of amounts attributed to the taxpayer pursuant to a discharge of indebtedness as described under
IRC 61(a)(12), including forgiveness of a nonrecourse debt. 64b. 00
65. Add lines 32 through 47, 48c, 49c, 50c, and 51 through 64b ............................................................................... 65. 00
To the extent INCLUDED in arriving at line 31, and to the extent NOT deducted as purchases from other
¿UPV RQ WKH MBT Annual Return, Form 4567, lines 13, 14 or 15, (or, for UBG standard members, the MBT
UBG Combined Filing Schedule for Standard Members, Form 4580, lines 18, 19 or 20) enter:
66. Sales or use taxes collected from or reimbursed by a consumer or other taxes collected from or reimbursed by
a purchaser and remitted to a local, state, or federal tax authority........................................................................ 66. 00
67. In the case of receipts from the sale of motor fuel by a person with a motor fuel tax license or a retail dealer, the amount
HTXDO WR IHGHUDO DQG VWDWH H[FLVH WD[HV SDLG E\ DQ\ SHUVRQ RQ VXFK PRWRU IXHO XQGHU ,5& RU DSSOLFDEOH VWDWH ODZ ... 67. 00
68. In the case of receipts from the sale of beer, wine, or intoxicating liquor by a person holding a license to sell,
distribute, or produce those products, the amount equal to federal and state excise taxes paid by any person
on or for such products under IRC Subtitle E or applicable state law ................................................................... 68. 00
69. In the case of receipts from the sale of communication, video, internet access and related services and
equipment, any government imposed tax, fee, or other imposition in the nature of a tax or fee required by law,
and authorized to be charged on a customer’s bill or invoice, but not including net income taxes, net worth
taxes, property taxes, or the MBT ......................................................................................................................... 69. 00
70. In the case of receipts from the sale of electricity, natural gas, or other energy source, any government imposed
tax, fee, or other imposition in the nature of a tax or fee required by law, and authorized to be charged on a
customer’s bill or invoice, but not including net income taxes, net worth taxes, property taxes, or the MBT ............ 70. 00
71. Any deposit required under the following:
a. ,/ 0&/ WR ............................................................................................................... 71a. 00
b. R 436.1629 of the Michigan administrative code............................................................................................... 71b. 00
c. R 436.1723a of the Michigan administrative code............................................................................................. 71c. 00
d. Any substantially similar beverage container deposit law of another state ....................................................... 71d. 00
72. ([FLVH WD[ FROOHFWHG IURP RU UHLPEXUVHG E\ D FRQVXPHU DQG UHPLWWHG SXUVXDQW WR 0&/ WR ... 72. 00
In the case of receipts from the sale of cigarettes or tobacco products by a wholesale dealer, retail dealer,
73. distributor, manufacturer, or seller, the amount equal to the federal and state excise taxes paid by any person
on or for such products under IRC Subtitle E or applicable state law ................................................................... 73. 00
74. SUBTOTAL Add lines 66 through 73............................................................................................................... 74. 00
GROSS RECEIPTS FOR MBT PURPOSES
75. Subtract lines 65 and 74, from line 31. Carry this amount to Form 4567, line 12. Standard members of a UBG
will carry this amount to Form 4580, Part 2A, line 17 ............................................................................................ 75. 00
Superscript Explanations on Page 5
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