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Michigan Department of Treasury                                                                                                            Attachment 11 
4896 (Rev. 03-22) 

2022 Michigan Corporate Income Tax Unitary Business Group Affiliates Excluded 
from the Return of a Standard Taxpayer 
Issued under authority of Public Act 38 of 2011. 
Designated Member Name                                                                         Federal Employer Identification Number (FEIN) 

List every C Corporation (or entity taxed federally as such), insurance company, or financial institution, with or without nexus, for which the “greater than 
50%” ownership test of a Michigan Unitary Business Group (UBG) is satisfied, and which is not included on the combined standard return of the taxpayer.  
Using the reason codes for exclusion listed in the instructions, identify in column D why each entity is not included in the combined return. If any entity listed 
here is a member of an affiliated group that elects to file a consolidated return, attach a copy of federal Form 851. 

1.        A                                      B                                        C                  D               E                   F 
   Number from                                                                                               Reason          Enter (X) if  
Federal Form 851                                                                                             Code for        Nexus with  
   (if applicable)                               Name                                     FEIN               Exclusion       Michigan      NAICS Code 

If more space is needed, include additional copies of Form 4896. Repeat the Designated Member Name and FEIN at the top of every copy. 

+  0000 2022 22 01 27 8 



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                                                                         Instructions for Form 4896 
                Corporate Income Tax Unitary Business Group Affiliates Excluded  
                                                       from the Return of Standard Taxpayers 
                                                                                                                  NOTE:   A       taxpayer that                is a UBG must         file         a combined return               
Purpose 
                                                                                                                  using   the  tax year  of      the  Designated             Member          (DM).           The                  
The  purpose             of this  form          is to identify        every      C Corporation                    combined return             of the  UBG  must  include  each  tax  year      of each  
(or   entity  taxed federally           as  such),     insurance         company,              and                member  whose  tax  year  ends  with      or within  the  tax  year      of the  
financial   institution  that meets              the   Unitary        Business           Group                    DM.  For  example,  Taxpayer  ABC          is a UBG  comprised      of three  
(UBG)   control  test of            MCL     206.611(6)       or                     is a member          of       standard  members:  Member      A, the  DM  with      acalendar                                 tax  year,  
   a group    for    which  the Affiliated             Group        Election          of MCL                      and  Members      B and      C with             fiscal     years     ending  March  31  and                     
206.691(2)      is applicable  for  the  tax  year  but      is not  included  on                                 September  30,  respectively. Taxpayer                      ABC’s           tax       year      is that      of
the  standard  group  return  supported      by this  form.                                                       its  DM. 
NOTE:   If      any  entity listed          on   this    form                      is a member     of      a      Line  1A:  If an      entity   being    listed           here is  listed  on                                    
federal  consolidated  return   , attach      acopy      of federal  Form  851.                                   federal  Form  851,  enter the          identifying           number              for  that   entity            
                                                                                                                  that      is called  “Corp.  No.”      at the  left  edge      of pages          1, 2, and          3 of
Line-by-Line Instructions                                                                                         federal  Form  851. 
Lines not listed are explained on the form.                                                                       Line  1D: Reason  codes for             affiliates         being     excluded              from    the          
For   guidance  on UBGs              for   the   purpose     of this         form,        see                     current  combined  return: 

the   “Supplemental Instructions                    for  Standard        Members             in                                  business         activities        resulting                    in a flow      of value   or   
                                                                                                                  1       Lacks
UBGs”   section  in the                Corporate Income Tax (CIT) Forms                                                   integration, dependence                       or contribution      to group.* 
and Instructions for Standard Taxpayers                                        (Form 4890)                   
and   the Michigan           Department          of Treasury          Web site          at                        2       Foreign operating          entity.       
www.michigan.gov/taxes.                                                                                           3       Foreign entity.      
UBG  means      a group of              United      States   persons          that are                            4       Member has      no      CIT  tax         year      (as   a   member               of this UBG)       
corporations,   insurance  companies, or                     financial        institutions,                               ending  with      or within  this  filing  period. 
other  than      a foreign        operating  entity,  that satisfies                    the    control            5       Insurance     company.       (Insurance companies                           with      nexus          
test  and  relationship  test.                                                                                            always  file  separately.) 
                             is   satisfied  when  one      of the  persons  owns      or                         6       Financial  institution.  (Financial  institutions  and  standard  
The control test 
controls,   directly  or indirectly,             more      than       50  percent          of the                         taxpayers   generally are               not    included      on the          same                    
ownership  interest  with voting                 rights    (or      rights   comparable                        to         combined return.)           
voting  rights)      of the  other  members.                                                                      9       Other. 
The  relationship               test   is  satisfied  in one          of  two         ways:     The               *NOTE:                                                                                                   
                                                                                                                                 Reason code number 1   does not apply to a     member 
UBG   has     operations  which result                           in a flow      of value       between            of                                                                                                       
                                                                                                                        an affiliated group that          has       made     the       Affiliated        Group             
the members              in the UBG,          or has operations           that   are        integrated            Election. 
with,   are  dependent  upon,                    or contribute      to each             other.    Flow        
                                                                                                                     A taxpayer      is required      to  retain records               to    substantiate            the          
of  value       is determined         by  reviewing the             totality                of facts  and  
                                                                                                                  reason(s)  for a      member’s  exclusion  from  the  UBG  return. 
circumstances      of business  activities and                operations.                
                                                                                                                     If you    have   questions, call          Treasury,        Technical              Services                   
   If eligible,      a UBG  may  alternatively be            determined                      by  way        of   
                                                                                                                  Section,       at 517-636-4230, to      discuss an      appropriate  entry. 
an  Affiliated  Group  Election                 (see  instructions for                  Form     4891         
for the  CIT   definition               of an affiliated    group,        and          for  eligibility           Line 1E:           If this  entity  has  nexus  with  Michigan,  enter  an  “X”  
and   other  details about          the    election).                    The “greater           than              in  this  box.  
50%   test”  for  the affiliated           group    may      be     different           than   the            
                                                                                                                  Line  1F:  Enter      the  entity’s  six-digit  North American                               Industry           
traditional control          test    discussed       above,   and         the  affiliated         group       
                                                                                                                  Classification  System  (NAICS)  code.  For a      complete  list of      six-
   is determined without             regard         to the relationship          test         discussed       
                                                                                                                  digit   NAICS      codes,  see the      U.S.       Census            Bureau         Web      site  at         
above. 
                                                                                                                  www.census.gov/eos/www/naics/   , or                       enter          the same           NAICS              
The purpose              of this  form          is to identify        entities        for    which  the           code   used  when  filing  the federal                 Form   1120,            Schedule          K;  or        
ownership test               is satisfied,  but  which  are not              included          on  the            federal  Form  1120S. 
combined      return  supported by               this  form,        either   because           the            
                                                                                                                  Include completed Form 4896 as part of the tax return filing. 
relationship  test             is not  satisfied (which                   is not  applicable to               
   a UBG    by     affiliated  group election)             or       because     the        entity             
   is excluded         by   statute    from   the  UBG or             from    the       standard              
combined  return.                 A member  whose business                   activity                 is not  
included      in the     current  combined return                   because           its  tax  year          
ends   after  the  filing period                 of the  UBG          should  also be            listed       
here. 
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