Form
4I
Wisconsin Insurance Company Franchise Tax Return
*C14I08991*
andending
M M D D Y Y Y Y
2008
For2008ortaxableyearbeginning
CorporationName
Complete form using BLACK INK. DO NOT STAPLE OR BIND
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Y
Y
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Y
Due Date: 15thdayof3rdmonthfollowingcloseoftaxableyear.
A FederalEmployerIDNumber
NumberandStreet City D Check if applicable and attach explanation: 1 2 E F G H I Firstreturn-newcorporationorenteringWisconsin Finalreturn-corporationdissolvedorwithdrew 3 4 Shortperiod-changeinaccountingperiod Shortperiod-stockpurchaseorsale State ZIP(+4digitsuffixifknown)
BBusinessActivity(NAICS)Code CStateofIncorporation and Year
Enterabbreviationof stateinbox,orifaforeign country,enterbelow.
Check if applicable and see instructions: Ifthisisanamendedreturn,attachanexplanationofthechanges. Ifyouhaveanextensionoftimetofile,entertheextendedduedate
M M D D Y Y Y Y
IfnobusinesswastransactedinWisconsinduringthetaxableyear,attachacompletecopyofyourfederalreturnandannualstatement. Ifyoufiledafederalconsolidatedreturn,enterParentCompany'sfederalemployerIDnumber . . . . . . . . . . . . . . . . . IfyouhaverelatedentityexpensesandarerequiredtofileScheduleRTwiththisreturn. .
ENTER NEGATIvE NumBERS LIKE THIS 1000
NOT LIKE THIS (1000) 1 2 3 4 5
NO COmmAS; NO CENTS
1 Federaltaxableincomefromfederalreturn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Additions(frompage3,Schedule1,line5). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Addlines1and2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Subtractions(frompage3,Schedule2,line3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Subtractline4fromline3.Iftheinsurerwriteslifeandnonlifepremiums,checkhere andfillinlines6through9.Otherwise,entertheamountfromline5online9. . . . . . . . . . . . . . 6 Netgainfromoperations,otherthanlifeinsurance. . . . . . 6 7 Totalnetgainfromoperations . . . . . . . . . . . . . . . . . . . . . . 7
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%
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8 Divideline6byline7andmultiplyby100(carryto4placestotherightofthedecimalpoint). . . 9 Multiplyline5byline8.Thisisthetotalincomeotherthanlifeinsuranceincome . . . . . . . . . . .
8 9
.00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00
%
10 Wisconsinapportionmentpercentagefrompage3,Schedule3,line4(carryto4placestothe rightofthedecimalpoint). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Multiplyline9byline10.ThisisWisconsinincome(loss)beforenetbusinesslossoffset. . . . . 11 12 Wisconsinnetbusinesslosscarryforward(attachschedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . 13 Subtractline12fromline11.ThisisWisconsinapportionablenetincome. . . . . . . . . . . . . . . . . 13 14 Grosstax(seeinstructions).Ifsubjectto2%maximumtax,checkhere . . . . . . . . . . . . . . 14 15 MultiplytheamountonSchedule2,line2,by7.9%(0.079)andentertheresult . . . . . . . . . . . . 15 16 Addlines14and15.Thisisthetotaltax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Nonrefundablecredits(fromScheduleCR,line33) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . 18 Subtractline17fromline16.Ifline17ismorethanline16,enterzero(0).Thisisnettax . . . . 18 . 19 Recyclingsurcharge(seeinstructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 20 Endangeredresourcesdonation(decreasesrefundorincreasesamountowed). . . . . 21 Veteranstrustfunddonation(decreasesrefundorincreasesamountowed). . . . . . . . 23 EstimatedtaxpaymentslessrefundfromForm4466W. Ifthisisanamendedreturn,seeinstructions . . . . . . . . . . 23 . 24 Wisconsintaxwithheld. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 25 Refundablecredits(fromScheduleCR,line37) . . . . . . . . 25 20 21
22 Addlines18through21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
26 Addlines23through25. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
IC-020i
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26
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2008Form4I
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27 Interest,penalty,andlatefeedue(fromForm4U,line17or26). IfyouannualizedincomeonForm4U,checkthespaceafterthearrow..............
27
28 Tax due.Ifthetotaloflines22and27islargerthanline26,enteramountowed. . . . . . . . . . . 28 29 Overpayment.Ifline26islargerthanthetotaloflines22and27,enteramountoverpaid. . . . 29 30 Enteramountofline29youwantcreditedon2009estimatedtax 30 31 Subtractline30fromline29.This is your refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 32 Entertotalcompanygrossreceiptsfromallactivities(seeinstructions). . . . . . . . . . . . . . . . . . . 32 33 Ifthecorporationpaid,accrued,orincurredmorethan$100,000ofexpensestoarelated entity,thecorporationmustfileScheduleRTwiththisreturn.under Wisconsin law, certain related entity expenses may not be allowable unless disclosed on Schedule RT on a timelyfiledreturn.Seeinstructionsfordetails.Online33,entertotalrelatedentity expensesdisclosedonScheduleRT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 34a TotalWisconsinpayroll(seeinstructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34a 34b Totalcompanypayroll(seeinstructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34b
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Additional Information Required
1 Persontocontactconcerningthisreturn: Phone#: Yes No Fax#: Ifyes,attachalistofthenamesandfederalEINs Yes No Yes No Ifyes,attach 2 Cityandstatewherebooksandrecordsarelocatedforauditpurposes: 3 Areyouthesoleownerofanylimitedliabilitycompanies(LLCs)? ofyoursolelyownedLLCs.Didyouincludetheincomesoftheseentitiesinthisreturn?
4 Doyouown,directlyorindirectly,50%ormoreoftheoutstandingvotingstockofanycorporations? Yes Yes No No
alistofthenamesandfederalEINsofthesecorporations.Havetheincomesoftheseaffiliatedcorporationsbeenincludedinthisreturn? 5 Doanycorporations,individuals,partnerships,trusts,orassociationsown50%ormoreofyouroutstandingvotingstock? Ifyes,attachalistofthenamesandfederalEINsoftheseorganizations.Havetheincomesoftheseorganizations Yes No Yes No Ifyes,attacha
beenincludedinthisreturn? detailedexplanation.
6 Hasyourcorporationbeeninvolvedinanyreorganizationduringtheperiodcoveredbythisreturn?
7 Didyoupurchaseanytaxabletangiblepersonalpropertyortaxableservicesforstorage,use,orconsumptioninWisconsin withoutpaymentofastatesalesorusetax? reportusetax. 8 DidanyadjustmentsmadebytheInternalRevenueServicetoyourincomeforprioryearsbecomefinalizedduringthisyear? Yes No Ifyes,seeinstructionsandindicateyearsadjusted: Yes No Ifyes,youoweWisconsinusetax.Seeinstructionsforhowto
Under penalties of law, I declare that this return and all attachments are true, correct, and complete to the best of my knowledge and belief.
SignatureofOfficer Preparer'sSignature Title Preparer'sFederalEmployerIDNumber Date Date
Youmustfileacopyofyourfederalreturn,relatedschedules,andannualstatementwithyourForm4I.
Makeyourcheckpayabletoandmailyourreturnto: WisconsinDepartmentofRevenue POBox8908 MadisonWI53708-8908
*C24I08991*
2008Form4I
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of 3
Schedule 1 Additions to Federal Taxable Income 1 Losscarryforwarddeductedinthecalculationoffederaltaxableincome. . . . . . . . . . . . . . . . . 1 2 Dividendincomereceivedtotheextentusedasadeductionindeterminingfederal taxableincome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 AdditionsfromScheduleV,line12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Additionaldeductionforinsurersrequiredtodiscountunpaidlosses . . . . . . . . . . . . . . . . . . . . 4 5 Total(enteronForm4I,page1,line2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
.00 .00 .00 .00 .00 .00 .00 .00
(b) Total Company
Schedule 2 Subtractions From Federal Taxable Income 1 SubtractionsfromScheduleW,line16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Incomerealizedfromthepurchaseandsubsequentsaleorredemptionoflotteryprizesifthe winningticketswereoriginallyboughtinWisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Total(enteronForm4I,page1,line4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Schedule 3 Wisconsin Apportionment Percentage 1 Directpremiumswrittenforinsuranceonpropertyand risks,otherthanlifeinsurance . . . . . . . . . . . . . . . . . . . . . . 1
(a) Wisconsin
2 Assumedpremiumsfromdomesticinsurance companieswrittenforreinsuranceonpropertyand risks,otherthanlifeinsurance . . . . . . . . . . . . . . . . . . . . . . 2 3 Addlines1and2.Thisisthetotalpremiums. . . . . . . . . . . 3 4 Divideline3,columna,byline3,columnb,andmultiply by100(carry to 4 decimal places). ThisistheWisconsin apportionmentpercentage . . . . . . . . . . . . . . . . . . . . . . . . . 4
.
%