Form Schedule M-3 (Form Schedule M-3 (Form Net Income (Loss) Reconciliation for Life Insurance Comp

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SCHEDULE M-3
(Form 1120-L)

I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
SCHEDULE M-3 (FORM 1120-L), PAGE 1 OF 4
MARGINS; TOP 13mm (1/2"), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (8-1/2") x 279mm (11")
PERFORATE: None
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Action

Revised proofs
requested

OMB No. 1545-0128

2006

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© Attach to Form 1120-L.
© See separate instructions.

Name of corporation (common parent, if consolidated return)

Check applicable box(es):

(1)
(3)

Signature

O.K. to print

Net Income (Loss) Reconciliation for U.S. Life Insurance
Companies With Total Assets of $10 Million or More

Department of the Treasury
Internal Revenue Service

Part I

Date

Employer identification number

Non-Consolidated return
Mixed 1120/L/PC group

(2)
(4)

Consolidated return (Form 1120-L only)
Dormant subsidiaries schedule attached

Financial Information and Net Income (Loss) Reconciliation (see instructions)

1a Did the corporation file SEC Form 10-K for its income statement period ending with or within this tax year?
Yes. Skip lines 1b and 1c and complete lines 2a through 11 with respect to that SEC Form 10-K.
No. Go to line 1b.
b Did the corporation prepare a certified audited income statement for that period?
Yes. Skip line 1c and complete lines 2a through 11 with respect to that income statement.
No. Go to line 1c.
c Did the corporation prepare an income statement for that period?
Yes. Complete lines 2a through 11 with respect to that income statement.
No. Skip lines 2a through 3c and enter the corporation’s net income (loss) per its books and records on line 4.
/
/
/
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2a Enter the income statement period: Beginning
Ending
b Has the corporation’s income statement been restated for the income statement period on line 2a?
Yes. (If “Yes,” attach an explanation and the amount of each item restated.)
No.
c Has the corporation’s income statement been restated for any of the five income statement periods preceding the period on
line 2a?
Yes. (If “Yes,” attach an explanation and the amount of each item restated.)
No.
3a Is any of the corporation’s voting common stock publicly traded?
Yes.
No. If “No,” go to line 4.
b Enter the symbol of the corporation’s primary U.S. publicly traded voting common
stock
c Enter the nine-digit CUSIP number of the corporation’s primary publicly traded voting
common stock
4

Worldwide consolidated net income (loss) from income statement source identified in Part I, line 1

5a (

5a Net income from nonincludible foreign entities (attach schedule)

6a (

6a Net income from nonincludible U.S. entities (attach schedule)

7a

7a Net income of other includible entities (attach schedule)

7b (

b Net loss of other includible entities (attach schedule)
Adjustment to eliminations of transactions between includible entities and nonincludible entities
(attach schedule)

8

Adjustment to reconcile income statement period to tax year (attach schedule)

9

Net income (loss) per income statement of includible corporations. Combine lines 4 through 10

For Privacy Act and Paperwork Reduction Act Notice,
see the Instructions for Form 1120-L.

Cat. No. 39668S

)

10a
10b
10c

10a Intercompany dividend adjustments to reconcile to line 11 (attach schedule)
b Other statutory accounting adjustments to reconcile to line 11 (attach schedule)
c Other adjustments to reconcile to amount on line 11 (attach schedule)
11

)

6b

b Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount)

9

)

5b

b Net loss from nonincludible foreign entities (attach schedule and enter as a positive amount)

8

4

11

Schedule M-3 (Form 1120-L) 2006

14
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
SCHEDULE M-3 (FORM 1120-L), PAGE 2 OF 4
MARGINS; TOP 13mm (1/2"), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (8-1/2") x 279mm (11")
PERFORATE: None
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Page

Schedule M-3 (Form 1120-L) 2006
Name of corporation (common parent, if consolidated return)

Check applicable box(es):
Check if a sub-consolidated:

(1)

Consolidated group
(6)

1120-L group

(7)

Name of subsidiary (if consolidated return)

Part II

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(2)

Parent corp (3)

1
2
3
4
5
6
7
8
9
10

Income (loss) from equity method foreign corporations
Gross foreign dividends not previously taxed
Subpart F, QEF, and similar income inclusions
Section 78 gross-up
Gross foreign distributions previously taxed
Income (loss) from equity method U.S. corporations
U.S. dividends not eliminated in tax consolidation
Minority interest for includible corporations
Income (loss) from U.S. partnerships (attach schedule)
Income (loss) from foreign partnerships (attach schedule)

11

Income (loss) from other pass-through entities
(attach schedule)
Items relating to reportable transactions (attach details)
Interest income
Accrual of bond discount
Hedging transactions
Mark-to-market income (loss)
Deferred and uncollected premiums
Sale versus lease (for sellers and/or lessors)
Section 481(a) adjustments
Amortization of interest maintenance reserve
Original issue discount and other imputed interest
Market discount reclassification
Income statement gain/loss on sale, exchange,
abandonment, worthlessness, or other disposition of
assets other than pass-through entities
Gross capital gains from Schedule D, excluding
amounts from pass-through entities
Gross capital losses from Schedule D, excluding
amounts from pass-through entities, abandonment
losses, and worthless stock losses
Net gain/loss reported on Form 4797, line 17,
excluding amounts from pass-through entities,
abandonment losses, and worthless stock losses
Abandonment losses
Worthless stock losses (attach details)
Other gain/loss on disposition of assets
Capital loss limitation and carryforward used
Other income (loss) items with differences (attach schedule)
Total income (loss) items. Combine lines 1
through 25
Total expense/deduction items (from Part III,
line 39)
Other items with no differences

b
c

d

e
f
g
24
25
26
27
28

Consolidated eliminations (4)

Subsidiary corp

(5)

Mixed 1120/L/PC group

1120-L eliminations

Employer identification number

Reconciliation of Net Income (Loss) per Income Statement of Includible Corporations With
Taxable Income per Return (see instructions)
Income (Loss) Items

12
13
14
15
16
17
18
19
20
21
22
23a

2

Employer identification number

(a)
Income (Loss) per
Income Statement
(optional)

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Income (Loss) per
Tax Return
(optional)

29a Life insurance subgroup reconciliation totals. Add
lines 26 through 28
b 1120 subgroup reconciliation totals
c PC insurance subgroup reconciliation totals
30 Reconciliation totals. Combine lines 29a through 29c
Note. Line 30, column (a) must equal the amount on Part I, line 11, and column (d) must equal taxable income on Form 1120-L, page 1, line 20.
Schedule M-3 (Form 1120-L) 2006

14
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
SCHEDULE M-3 (FORM 1120-L), PAGE 3 OF 4 (Page 4 is Blank)
MARGINS; TOP 13mm (1/2"), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (8-1/2") x 279mm (11")
PERFORATE: None
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Schedule M-3 (Form 1120-L) 2006

Page

Name of corporation (common parent, if consolidated return)

Check applicable box(es):
Check if a sub-consolidated:

(1)

Consolidated group
(6)

1120-L group

Name of subsidiary (if consolidated return)

Part III

(7)

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(2)

Parent corp (3)

U.S. current income tax expense
U.S. deferred income tax expense
State and local current income tax expense
State and local deferred income tax expense

5

Foreign current income tax expense (other than
foreign withholding taxes)
Foreign deferred income tax expense
Foreign withholding taxes
Equity-based compensation
Capitalization of deferred acquisition costs
Amortization of deferred acquisition costs
Meals and entertainment
Fines and penalties
Judgments, damages, awards, and similar costs
Parachute payments
Compensation with section 162(m) limitation
Pension and profit-sharing
Other post-retirement benefits
Deferred compensation

20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39

Subsidiary corp

(5)

Mixed 1120/L/PC group

Employer identification number

Reconciliation of Net Income (Loss) per Income Statement of Includible Corporations With
Taxable Income per Return—Expense/Deduction Items (see instructions)

1
2
3
4

19

Consolidated eliminations (4)

1120-L eliminations

Expense/Deduction Items

6
7
8
9
10
11
12
13
14
15
16
17
18

3

Employer identification number

Charitable
property
Charitable
Charitable
Change in
Change in
Change in

(a)
Expense per
Income Statement
(optional)

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Deduction per
Tax Return
(optional)

contribution of cash and tangible
contribution of intangible property
contribution limitation/carryforward
section 807(c)(1) tax reserves
section 807(c)(2) tax reserves
all other section 807(c) tax reserves

Section 807(f) adjustments for change in computing
reserves
Section 807(a)(2)(B) tax reserve amount with respect to
policyholder share of tax-exempt interest
Current year acquisition/reorganization costs
(attach schedule)
Amortization of acquisition, reorganization, and
start-up costs
Amortization/impairment of goodwill, insurance in
force and ceding commissions
Other amortization or impairment write-offs
Section 846 amount
Depreciation
Bad debt expense/agency balances written off
Corporate owned life insurance premiums
Purchase versus lease (for purchasers and/or lessees)
Interest expense
Domestic production activities deduction
Other expense/deduction items with differences
(attach schedule)
Total expense/deduction items. Combine lines 1
through 38. Enter here and on Part II, line 27
Schedule M-3 (Form 1120-L) 2006