Form 63-20P "Premium Excise Return for Life Insurance Companies" - Massachusetts

What Is Form 63-20P?

This is a legal form that was released by the Massachusetts Department of Revenue - a government authority operating within Massachusetts. Check the official instructions before completing and submitting the form.

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Massachusetts Department of Revenue
Form 63-20P
Premium Excise Return for Life Insurance Companies
2020
For calendar year 2020.
Name of company
Federal Identification number
State of incorporation
Mailing address
City/Town
State
Zip
Phone number
Name of treasurer
Fill in if:
Amended return (see “Amended Return” in instructions)     
Federal amendment     
Federal audit
Enclosing Schedule TDS     
Final return     
Initial return     
Name change     
Address change
Fill in if federal government has changed your taxable income for any prior year which has not yet been reported to Massachusetts
Excise calculation
Domestic life insurers.
Enclose a copy of Schedule T of NAIC annual statement.
11 Taxable life premiums (from Part 1, line 10). . . . . . . . . . . . . . . . . . . . . . . . . . .
1
×
.0200
=
12 Net value of policies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
× .0025 =
2
13 Applicable measure (from line 1 or line 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14 Taxable accident and health premiums (from Part 1, line 11). . . . . . . . . . . . . .
.0200
=
4
×
15 Credit recapture (enclose Credit Recapture Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
16 Excise due before credits. Add lines 3 through 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Foreign life insurers.
Enclose a copy of Schedule T of NAIC annual statement.
17 Taxable life premiums (from Part 2, line 7). . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
×
.0200
=
18 Retaliatory computation (from Part 3, col. a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
19 Applicable measure (enter the larger of lines 7 or 8). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Taxable accident and health premiums (from Part 2, line 12). . . . . . . . . . . . .
= 10
×
.0200
11 Retaliatory computation (from Part 3, col. b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Applicable measure (enter the larger of lines 10 or 11). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Credit recapture (enclose Credit Recapture Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Excise due before credits. Add lines 9, 12 and 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Declaration
Under penalties of perjury, I declare that to the best of my knowledge and belief, this return and enclosures are true, correct and complete.
Signature of appropriate corporate officer (see instructions)
Date
Social Security number
Phone number
Signature of paid preparer
Date
Employer Identification number
Address
If you are signing as an authorized delegate of the appropriate corporate officer, fill in oval
and enclose Massachusetts Form M-2848, Power of
Attorney. The Privacy Act Notice is available upon request. Mail to Massachusetts Department of Revenue, PO Box 7052, Boston, MA 02204.
Massachusetts Department of Revenue
Form 63-20P
Premium Excise Return for Life Insurance Companies
2020
For calendar year 2020.
Name of company
Federal Identification number
State of incorporation
Mailing address
City/Town
State
Zip
Phone number
Name of treasurer
Fill in if:
Amended return (see “Amended Return” in instructions)     
Federal amendment     
Federal audit
Enclosing Schedule TDS     
Final return     
Initial return     
Name change     
Address change
Fill in if federal government has changed your taxable income for any prior year which has not yet been reported to Massachusetts
Excise calculation
Domestic life insurers.
Enclose a copy of Schedule T of NAIC annual statement.
11 Taxable life premiums (from Part 1, line 10). . . . . . . . . . . . . . . . . . . . . . . . . . .
1
×
.0200
=
12 Net value of policies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
× .0025 =
2
13 Applicable measure (from line 1 or line 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14 Taxable accident and health premiums (from Part 1, line 11). . . . . . . . . . . . . .
.0200
=
4
×
15 Credit recapture (enclose Credit Recapture Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
16 Excise due before credits. Add lines 3 through 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Foreign life insurers.
Enclose a copy of Schedule T of NAIC annual statement.
17 Taxable life premiums (from Part 2, line 7). . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
×
.0200
=
18 Retaliatory computation (from Part 3, col. a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
19 Applicable measure (enter the larger of lines 7 or 8). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Taxable accident and health premiums (from Part 2, line 12). . . . . . . . . . . . .
= 10
×
.0200
11 Retaliatory computation (from Part 3, col. b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Applicable measure (enter the larger of lines 10 or 11). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Credit recapture (enclose Credit Recapture Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Excise due before credits. Add lines 9, 12 and 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Declaration
Under penalties of perjury, I declare that to the best of my knowledge and belief, this return and enclosures are true, correct and complete.
Signature of appropriate corporate officer (see instructions)
Date
Social Security number
Phone number
Signature of paid preparer
Date
Employer Identification number
Address
If you are signing as an authorized delegate of the appropriate corporate officer, fill in oval
and enclose Massachusetts Form M-2848, Power of
Attorney. The Privacy Act Notice is available upon request. Mail to Massachusetts Department of Revenue, PO Box 7052, Boston, MA 02204.
2020 FORM 63-20P, PAGE 2
Name of company
Federal Identification number
State of incorporation
Excise calculation
(cont’d.)
Credits.
Do not claim any credit here if claimed on Form 63-23P.
15 Enter 1.5% of company’s capital contribution in excess of the full proportionate share in the Massachusetts life
insurance company community investment initiative. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Enter 1.5% of proportionate share of cost of equity securities and outstanding principal balance of debt securities
constituting of qualified investments of Massachusetts Capital Resource Company (enclose computation). . . . . . . . . . 16
17 Enter 10% of Massachusetts Life and Health Insurance Guaranty Association assessment paid in the prior years
(see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Other credits (from Credit Manager Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Total credits. Add lines 15 through 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Excise after credits
20 Excise due before voluntary contribution. Subtract line 19 from line 6 or line 14, whichever applies. Not less than 0. . . 20
21 Voluntary contribution for endangered wildlife conservation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Total excise plus voluntary contribution. Add lines 20 and 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Payments
23 2019 overpayment applied to 2020 estimated tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 2020 Massachusetts estimated tax payments (do not include amount from line 23). . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
25 Payments made with extension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Payment with original return. Use only if amending return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27 Pass-through entity withholding. . . . . . . . . . . . . . . . . . . . . Payer Identification number 3
27
28 Refundable credits (from Credit Manager Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
29 Total payments. Add lines 23 through 28. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Refund or balance due
30 Amount overpaid. If line 29 is greater than line 22, subtract line 22 from line 29. Otherwise, go to line 33. . . . . . . . . . . 30
31 Amount overpaid to be credited to 2021 estimated tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
32 Amount overpaid to be refunded. Subtract line 31 from line 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 Balance due. Subtract line 29 from line 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
34a M-2220 penalty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34a
34b Other penalties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34b
34 Total penalty. Add lines 34a and 34b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
35 Interest on unpaid balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 Total payment due at time of filing. Add lines 33, 34 and 35. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
2020 FORM 63-20P, PAGE 3
Name of company
Federal Identification number
State of incorporation
3
3
Part 1. Domestic life premium excise calculation
— Life insurance —
— Accident and health insurance —
b.
d.
Jurisdictions where
Jurisdictions where
a.
no insurance
c.
no insurance
Massachusetts
excise paid
Massachusetts
excise paid
11 All new and renewal (direct) premiums
for Massachusetts residents. . . . . . . . . 3 1
12 Dividends applied to:
a Purchase paid-up additions. . . . . . 3 2a
b Shorten premium paying period. . . 3 2b
13 Total add lines 1 through 2b. . . . . . . . . . . 3
Deductions.
Include only what has been returned as receipts on this return or on a previous return.
14 Returned premiums but not including
cash surrender values (enclose
schedule). . . . . . . . . . . . . . . . . . . . . . . . 3 4
15 Premiums for company employees’
group life and accident and health
plans if included in line 1*. . . . . . . . . . . 3 5
16 Gross premiums for authorized pre-
ferred provider arrangements. . . . . . . . 3 6
17 Dividends:
a Paid in cash. . . . . . . . . . . . . . . . . . 3 7a
b Applied in reduction of renewal
premiums. . . . . . . . . . . . . . . . . . . . 3 7b
c Left to accumulate at interest. . . . . 3 7c
d Applied to purchase paid-up
additions. . . . . . . . . . . . . . . . . . . . . 3 7d
e Applied to shorten premium paying
period. . . . . . . . . . . . . . . . . . . . . . . 3 7e
18 Total deductions. Add lines 4 through
7e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
19 Amount taxable. Subtract line 8 from
line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Total life amount taxable. Add line 9, columns a and b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Total accident and health amount taxable. Add line 9, columns c and d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
*Premiums under the company employees’ group plans for annuity consideration and retirement benefits shall not be deducted.
2020 FORM 63-20P, PAGE 4
Name of company
Federal Identification number
State of incorporation
3
3
Part 2. Foreign life premium excise calculation
Life premiums
11 All new and renewal direct premiums for all policies of life insurance allocable to Massachusetts. . . . . . . . . . . . . . . . . 3 1
12 Dividends applied to:
a Purchase paid-up additions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2a
b Shorten premium paying period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2b
13 Total gross direct premiums. Add lines 1, 2a and 2b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3
14 Returned premiums but not including cash surrender values. Enclose itemized supporting schedule. . . . . . . . . . . . . . 3 4
15 Dividends:
a Paid in cash. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5a
b Applied in reduction of renewal premiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5b
c Left to accumulate at interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5c
d Applied to purchase paid-up additions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5d
e Applied to shorten premium paying period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5e
16 Total deductions. Add lines 4 through 5e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6
17 Taxable premiums. Subtract line 6 from line 3. Enter result on page 1, line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7
Accident and health premiums
18 Total net direct premiums for insurance of property or interests in Massachusetts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 8
19 Dividend deduction. Premiums returned or credited to policyholders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9
10 Premium deduction. Gross premiums for authorized Preferred Provider arrangements. . . . . . . . . . . . . . . . . . . . . . . . 3 10
11 Total deductions. Add lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 11
12 Taxable amount. Subtract line 11 from line 8. Enter result on page 1, line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 12
13 Fill in if net direct premiums are reported in line 8 
14 Fill in if all dividends claimed as a deduction in line 9 have been included as taxable premiums in line 10 on this return or on a previous Massachusetts
return
2020 FORM 63-20P, PAGE 5
Name of company
Federal Identification number
State of incorporation
3
3
Part 3. Computation of retaliatory tax
Use the space below to calculate your excise using the identical method and the same rate used by the state in which you are incorporated in taxing a
like Massachusetts insurance company, or its agents, if doing business to the same extent. If the computation in the state of your incorporation is in every
respect the same as your Massachusetts computation, a statement to that effect should be made.
a. Life computation
b. Accident and health computation
Page of 5