Michigan Department of Treasury 
4906 (Rev. 10-22), Page 1 of 2 

2022 Insurance Company Amended Return  
for Corporate Income and Retaliatory Taxes 
Issued under authority of Public Act 38 of 2011. 
1.  Taxpayer Name                                                                                                      2. Federal Employer Identification Number (FEIN) 

Address (Number, Street)                                                                                                                                      Reason code for amending (see instr.) 
                                                                                                                                 Check if  
                                                                                                                       3.        Foreign Insurer 
City                                             State  ZIP/Postal Code        Country Code  4. State of Incorporation (use 2 letter abbreviation) 

DIRECT PREMIUMS WRITTEN IN MICHIGAN                                                                                                        A                              B 
See instructions before completing lines 5 through 23.                                                                           Qualified Health Ins. Policies           All Other Policies 
5.  Gross direct premiums written in Michigan................................................................          5.                                          00                        00 
6.  Premiums on policies not taken.................................................................................    6.                                          00                        00 
7.  Returned premiums on canceled policies..................................................................           7.                                          00                        00 
8.  Receipts on sales of annuities ................................................................................... 8.                                          00                        00 
9.  Receipts on reinsurance assumed (see instructions) ................................................                9.                                          00                        00 
10.  Add lines 6 through 9.................................................................................................  10.                                   00                        00 
11.  Direct Premiums Written in Michigan.  Subtract line 10 from line 5.  
     If less than zero, enter zero .......................................................................................  11.                                    00                        00 
DISABILITY INSURANCE EXEMPTION 
12.  Disability insurance premiums written in Michigan, not including credit or disability  
     income insurance premiums (see instructions) ...........................................................  12.                                                 00                        00 
13.  Proportional share of limit and phase-out. 
     Column A: Divide line 12, column A, by the sum of line 12, columns A and B. 
     Column B: Divide line 12, column B, by the sum of line 12, columns A and B.........                               13.                                         %                         % 
14.  Enter the sum of all disability insurance premiums from both columns of line 12  
     OR $190,000,000, whichever is less ...............................................................................................  14.                              00 
15.  Gross direct premiums from insurance carrier services everywhere...............................................  15.                                                 00 
16.  Phase out  ........................................................................................................................................  16. 280,000,000 00 
17.  Subtract line 16 from line 15. If less than zero, enter zero  ..............................................................  17.                                    00 
18.  Exemption reduction. Multiply line 17 by 2  ......................................................................................  18.                              00 
19.  Subtract line 18 from line 14. If less than zero, enter zero  ..............................................................  19.                                    00 
20.  Allocated reduced exemption. 
     Column A: Multiply line 19 by the percentage on line 13, column A. 
     Column B:Multiply line 19 by the percentage on line 13, column B .......................  20.                                                                 00                        00 
21.  Adjusted tax base. 
     Column A: Subtract line 20, column A, from line 11, column A. 
     Column B: Subtract line 20, column B, from line 11, column B...............................        21.                                                        00                        00 
22.  Multiply line 21, column A, by 0.9391% and column B by 1.25% (0.0125)................  22.                                                                    00                        00 
23.  Tax before credits. Add line 22, columns A and B............................................................................  23.                                    00 
CREDITS 
24.  Enter amounts paid from 1/1/2021 to 12/31/2021 to each of the following: 
     a.  Michigan Workers’ Compensation Placement Facility .....................................................................................  24a.                                       00 
     b.  Michigan Basic Property Insurance Association ..............................................................................................  24b.                                  00 
     c.  Michigan Automobile Insurance Placement Facility  ........................................................................................  24c.                                    00 
     d.  Property and Casualty Guaranty Association ..................................................................................................  24d.                                 00 
     e.  Michigan Life and Health Insurance Guaranty Association  .............................................................................  24e.                                        00 
25.  Add lines 24a through 24e......................................................................................................................................  25.                    00 
26.  Michigan Examination Fees or Regulatory Fee......................................................................................................  26.                                  00 
27.  Credit. Multiply line 26 by 50% (0.50) .....................................................................................................................  27.                       00 
28.  Tax liability before recapture. Subtract line 25 and line 27 from line 23  .................................................................  28.                                       00 
29.  Tax Liability after Historic Preservation Credit from Form 5793, line 11. If less than or equal to $100, enter zero.  29.                                                               00 
30.  Total Recapture of Certain Business Tax Credits from Form 4902 .........................................................................  30.                                           00 
31.  Total Michigan Tax.        Add line 29 and line 30 .........................................................................................................  31.                       00 

+  0000 2022 40 01 27 0                                                                                                                                                Continue and sign on Page 2 

2022 Form 4906, Page 2 of 2                                                                                      Taxpayer FEIN 
Foreign and alien insurers complete lines 32 through 46. Use column A to report burdens that would be imposed by the taxpayer’s state of 
incorporation on a hypothetical Michigan company doing the same business in that state. Use column B to report actual burdens imposed by 
Michigan on the taxpayer. 
                                                                                                                 A                                                             B 
TAXES                                                                                                            State of Incorporation                                        Michigan 
32.  State of incorporation tax.......................................................................  32.                             X  X  X  X  X  X  X  X 
33.  Michigan Tax from line 31 ......................................................................  33.       X  X  X  X  X  X  X  X 
FEES AND ASSESSMENTS 
34.   Annual statement filing fee  ....................................................................  34.                            X  X  X  X  X  X  X  X
35.   Certificate of Authority renewal fee ........................................................  35.                                X  X  X  X  X  X  X  X 
36.   Certificate of Compliance  ......................................................................  36.                            X  X  X  X  X  X  X  X 
37.   Certificate of Deposit  .............................................................................  37.                        X  X  X  X  X  X  X  X 
38.   Certificate of Valuation ...........................................................................  38.                         X  X  X  X  X  X  X  X 

39.  Other fees. Include a detailed schedule of fees  ....................................  39. 
40.  Fire Marshall Tax  ...................................................................................  40.                        X  X  X  X  X  X  X  X 
41.  Second Injury Fund  ...............................................................................  41. 
42.  Silicosis and Dust Disease Fund ...........................................................  42. 
43.  Safety Education and Training Fund  .....................................................  43. 

44.  Other assessments. Include a detailed schedule of assessments ........  44. 
TOTAL 
45.  Total Taxes, Fees and Assessments.  Add lines 32 through 44 .............  45. 
46.  Retaliatory Amount. Subtract line 45, column B, from column A.  If less than zero, enter zero..............................  46.                                                   00 
47.   Total Tax Liability.  Add lines 31 and 46. Domestic insurers, enter amount from line 31.......................................  47.                                               00 
PAYMENTS AND TAX DUE 
48.  Overpayment credited from prior period return  ......................................................................................................  48.                         00 
49.  Estimated tax payments  .........................................................................................................................................  49.             00 
50.  Tax paid with request for extension  ........................................................................................................................  50.                 00 
51.  Michigan tax withheld  .............................................................................................................................................  51.          00 
52.   Workers’ Disability Supplemental Benefit (WDSB) Credit (attach document)  ........................................................  52.                                           00 
53.   Amount paid with original return plus additional tax paid after orginal return was filed ..........................................  53.                                          00 
54.  Total Payments. Add line 48 through line 53  ..........................................................................................................  54.                       00 
55.  Overpayment, if any, received on the original return and/or amended return(s)  ....................................................  55.                                           00 
56.  Total payments available. Subtract line 55 from line 54  .........................................................................................  56.                            00 
57.   TAX DUE. Subtract line 56 from line 47. If less than zero, leave blank ..................................................................  57.                                    00 
58.  Underpaid estimate penalty and interest from Form 4899, line 38. ........................................................................  58.                                     00 
59.  Annual Return Penalty (see instructions)  ...............................................................................................................  59.                     00 
60.  Annual Return Interest (see instructions)  ...............................................................................................................  60.                    00 
61.   PAYMENT DUE. If line 57 is blank, go to line 62. Otherwise add lines 57 through 60 ...........................................  61.                                               00 
OVERPAYMENT, REFUND OR CREDIT FORWARD 
62.   Overpayment. Subtract line 47, 58, 59 and 60 from line 54. If less than zero, leave blank (see instructions) ...........  62.                                                     00 
63.   CREDIT FORWARD. Amount on line 62 to be credited forward and used as an estimate for next tax year.............                   63.                                             00 
64.   REFUND. Subtract line 63 from line 62 ..................................................................................................................  64.                     00 

Taxpayer Certification.  I declare under penalty of perjury that the information in     Preparer Certification.  I declare under penalty of perjury that this 
this return and attachments is true and complete to the best of my knowledge.           return is based on all information of which I have any knowledge. 
                                                                                        Preparer’s PTIN, FEIN or SSN 
      By checking this box, I authorize Treasury to discuss my return with my preparer. 
Authorized Signature for Tax Matters                                                    Preparer’s Business Name (print or type) 

Authorized Signer’s Name (print or type)             Date                               Preparer’s Business Address and Telephone Number (print or type) 

Title                                      Telephone Number 

+  0000 2022 40 02 27 8 

                   Instructions for an amended Corporate Income Tax return 
                                             Forms 4892, 4906 and 4909 

Purpose                                                                          REASON CODE FOR AMENDING RETURN 
                                                                                 Include additional information on a separate sheet  
To calculate and file an amended Corporate Income Tax (CIT) 
return.                                                                          explaining the reason for amending the return. 
Standard  taxpayers  will  file  the CIT Amended Return   (Form            01    Amended a federal return. 
4892);  insurance  companies  will  file  theInsurance Company           02      Federal audit. 
Amended Return for Corporate Income and Retaliatory Taxes                03      Response to a Michigan Notice of Adjustment. 
(Form 4906); and financial institutions will file CIT Amended            04      Claiming a previously unclaimed credit or payment. 
Return for Financial Institutions (Form 4909). 
                                                                         05      Original return missing information/incomplete 
                                                                                 form. 
Amending a Return 
To amend a current or prior year annual return, use the amended          06      Correcting information/figures       originally  reported.  
return that is applicable for that tax year and taxpayer type.             07    Unitary Business Groups           : 
                                                                                 Adding or deleting member(s). 
Include  all  schedules  and  attachments  filed  with  the  original 
return, even if not amending them.   Do not  include a copy of           08      Due to litigation. 
the original return with the amended return.                             20      Other. 
Current and past year forms are available on Treasury’s Web              Amount paid with original return plus additional tax paid 
site atwww.michigan.gov/treasuryforms.                                   after original return was filed:   Enter all payments made with 
To amend a return to claim a refund, file within four years of           the  original  return  and  all  previous  returns  for  this  tax  year, 
the due date of the original return (including valid extensions).        as well as additional  payments made after those returns were 
Interest will be paid beginning 45 days after the claim is filed         filed.  
or the due date, whichever is later.                                     Overpayment, if any, received on the original return and/ 
If amending a return to report a deficiency, penalty and interest        or  amended return(s):  Enter the overpayment received (refund 
may apply from the due date of the original return.                      received plus credit forward created) on the original return and 
                                                                         all previous returns. 
If  any  changes  are  made  to  a  federal  income  tax  return  that 
affect CIT tax base, filing an amended return is  required. To           Standard Taxpayers Only 
avoid penalty, file the amended return within 120 days after the  
                                                                         “As Originally Filed or  Most Recently Amended” and 
final determination by the Internal Revenue Service. 
                                                                         “Correct   Amount”:   Where  the  amended  return  provides 
                                                                         a  Column  A  titled  “As  Originally  Filed  or  Most  Recently 
Line-by-Line Instructions 
                                                                         Amended,” provide the amount that was used on the taxpayer’s 
In most cases, the lines on the amended return match the lines           most  recent  return  that  the  new  return  will  amend.  Put  the 
on the originally filed return. Unless otherwise noted, use the          amended amounts in Column B, “Correct Amount.” 
instructions  for  the  original  return  to  complete  the  amended 
return.  Follow  the  instructions  for  the CIT Annual  Return          NOTE:   On  lines  9  through  11,  complete  only  with  amended 
(Form  4891)  to  complete  Form  4892;  follow  the  instructions       numbers. 
for  the Insurance Company Annual Return for Corporate             
                                                                         Insurance Companies and Financial Instituions 
Income and Retaliatory Taxes  (Form 4905) to complete Form 
4906; and follow the instructions for the CIT Annual Return for          Insurance  Companies  will  complete  all  lines  of  an  amended 
Financial Institutions (Form 4908) to complete Form 4909.                return  using  only  amended  numbers.  Financial  filers  will 
                                                                         complete an amended return with entries for both the original 
Federal  Employer  Identification  Number  (FEIN):         The      
                                                                         and   amended  figures   as  directed.  Taxpayers  must  file  using 
taxpayer FEIN from the top of page one must be repeated in                                                
                                                                         the appropriate amended return.
the space provided at the top of each succeeding page of the 
amended form. 
Reason code for amending return:       Using the following table, 
select  the  two-digit  code  that  best  represents  the  reason  for 
amending the return. Enter the code in the appropriate field in 
the taxpayer information at the top of page 1. Include additional  
explanation  on  a  separate  sheet  of  paper  and  attach  it  to  the 
amended return. 

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