Form 1120-PC U.S. Property and Casualty Insurance Company Income Tax

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Date

1120-PC

For calendar year 2005 or tax year beginning

Department of the Treasury
Internal Revenue Service

A Check applicable box if
an election has been
made under section(s):
1

953(c)(3)(C)

2

953(d)

E Check if:
1
2
3

(1)

Action

Date

Signature

O.K. to print
Revised proofs
requested

U.S. Property and Casualty Insurance Company
Income Tax Return
Please type or print

Form

I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 1 of 8
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 432 mm (17")
559 mm (22") FOLD TO
216 mm (8 1/2")
279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

, 2005, ending

OMB No. 1545-1027

2005

, 20

See separate instructions.

Name

B Employer identification number

Number, street, and room or suite no. If a P.O. box, see instructions.

C Date incorporated

City or town, state, and ZIP code

D Check if a consolidated return
(attach Form 851)

Final return

(2)

Name change

(3)

Address change

(4)

Amended return
1

Taxable income (Schedule A, line 37) (See instructions if Schedule C, line 10, was completed.)
Taxable investment income for electing small companies (Schedule B, line 21)

2

Check if a member of a controlled group (see sections 1561 and 1563)
Important: Members of a controlled group, see instructions.

a If the box on line 3 is checked, enter the corporation’s share of the $50,000, $25,000, and $9,925,000 taxable income
(2) $
(3) $
brackets (in that order): (1) $
$
b Enter the corporation’s share of: (1) additional 5% tax (not to exceed $11,750)
$

(2) additional 3% tax (not to exceed $100,000)
4

Income tax

4

5
6

Enter amount of tax that a reciprocal must include

5

Alternative minimum tax (attach Form 4626)

6

7

Total. Add lines 4 through 6

7
8a

Tax Computation and Payments

8a Foreign tax credit (attach Form 1118)

8b

b Specified credits (see instructions)
c General business credit. Check box(es) and indicate which forms are
attached:
Form(s) (specify)

Form 3800

8c

d Credit for prior year minimum tax (attach Form 8827)

8d

e Bond credits from:

8e

Form 8860

Form 8912

8f

f Total credits. Add lines 8a through 8e
Subtract line 8f from line 7

9

10

Foreign corporations—Tax on income not connected with U.S. business

10

11

Personal holding company tax (attach Schedule PH (Form 1120))

12
13

Other taxes. Check if from:
Total tax. Add lines 9 through 12

14

Payments: a 2004 overpayment credited to
2005

14a

b Prior year(s) special estimated tax payments
to be applied

14b

c 2005 estimated tax payments (see instructions)

14c

9

Form 4255

11

Form 8611

13

14d

d 2005 special estimated tax payments (Do not include on line 14f)
14e (
e Less 2005 refund applied for on Form 4466

)
14f
14g

f Enter the total of lines 14a through 14c less line 14e
g Tax deposited with Form 7004
h Credit by reciprocal for tax paid by attorney-in-fact under section 835(d)
i Other credits and payments

14h
14j

14i

15

Estimated tax penalty (see instructions). Check if Form 2220 is attached

16
17
18

Tax due. If line 14j is smaller than the total of lines 13 and 15, enter amount owed
Overpayment. If line 14j is larger than the total of lines 13 and 15, enter amount overpaid
Refunded
Enter amount of line 17 you want: Credited to 2006 estimated tax

Sign
Here

12

Other (attach schedule)

15
16
17

18

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
with the preparer shown below
Yes
No
(see instructions)?
Signature of officer
Date
Title

Paid
Preparer’s
Use Only

Preparer’s
signature

Firm’s name (or
yours if self-employed),
address, and ZIP code

Date

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Preparer’s SSN or PTIN

Check if
self-employed
EIN
Phone no.
Cat. No. 64270Q

(

)
Form

1120-PC

(2005)

4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 2 of 8
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
559 mm (22"), FOLD TO
216 mm (81⁄2 ")
279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2005)

Schedule A
1
2

Page

2

Taxable Income—Section 832 (see instructions)
1

Premiums earned (Schedule E, line 7)
Dividends (Schedule C, line 15)

2
(a) Interest received

(b) Amortization of
premium

3a Gross interest

Deductions (See instructions for limitations on deductions.)

Income

b Interest exempt under section 103
c Subtract line 3b from line 3a
3d

d Taxable interest. Subtract line 3c, column (b) from line 3c, column (a)
Gross rents

4

Gross royalties

5

6
7

Capital gain net income (attach Schedule D (Form 1120))

6

Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797)

7

8
9

Certain mutual fire or flood insurance company premiums (section 832(b)(1)(D))

8

4
5

Income on account of special income and deduction accounts

9

10

Income from protection against loss account (see instructions)

10

11

Mutual interinsurers or reciprocal underwriters—decrease in subscriber accounts

11

12

Income from a special loss discount account (attach Form 8816)

12

13
14

Other income (attach schedule)
Gross income. Add lines 1 through 13

14

15

Compensation of officers (attach schedule) (see instructions)

15

16

Salaries and wages (less employment credits)

16

17

Agency balances and bills receivable that became worthless during the tax year

17

18

Rents

18

19
20a

Taxes and licenses
Interest

13

19
c Bal.

b Less tax-exempt interest exp.

20c

21

Charitable contributions (see instructions for 10% limitation)

21

22

Depreciation (attach Form 4562)

22

23

Depletion

23

24

Pension, profit-sharing, etc., plans

24

25

Employee benefit programs

25

26

Losses incurred (Schedule F, line 14)

26

27

Additional deduction (attach Form 8816)

27

28

Other capital losses (Schedule G, line 12, column (g))

28

29

Dividends to policyholders

29

30

Mutual interinsurers or reciprocal underwriters—increase in subscriber accounts

30

31

Other deductions (see instructions) (attach schedule)

31

32

Total deductions. Add lines 15 through 31

32

33

Subtotal. Subtract line 32 from line 14

33

34a

Special deduction for section 833 organizations (Schedule H,
line 6)

b Deduction on account of special income and deduction accounts
35

34a
34b
34c

c Total. Add lines 34a and 34b
Subtotal. Subtract line 34c from line 33

36a

Dividends-received deduction (Schedule C, line 27)

b Net operating loss deduction

35
36a
36b

c Total. Add lines 36a and 36b
37

Taxable income (subtract line 36c from line 35). Enter here and on page 1, line 1

36c
37
Form

1120-PC

(2005)

4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 3 of 8
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
559 mm (22"), FOLDS TO
1
PERFORATE: ON FOLD
216 mm (8 ⁄2 ")
279 mm (11")
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2005)

Schedule B

3
Part I—Taxable Investment Income of Electing Small Companies—Section 834 (see instructions)
Page

(b) Amortization of
premium

(a) Interest received

1a

Gross interest

Deductions

Income

b Interest exempt under section 103
c Subtract line 1b from line 1a
1d

d Taxable interest. Subtract line 1c, column (b) from line 1c, column (a)
2

Dividends (Schedule C, line 15)

2

3

Gross rents

3

4

Gross royalties

4

5

Gross income from a trade or business, other than an insurance business, and from Form 4797

5

6
7
8

Income from leases described in sections 834(b)(1)(B) and 834(b)(1)(C)
Gain from Schedule D (Form 1120), line 14
Gross investment income. Add lines 1d through 7

6

9
10
11

Real estate taxes

9

Other real estate expenses
Depreciation (attach Form 4562)

10
11

12

Depletion

12

13

Trade or business deductions as provided in section 834(c)(8) (attach schedule)

13

14

Interest

14

15

Other capital losses (Schedule G, line 12, column (g))

15

16

Total. Add lines 9 through 15

16

17

Investment expenses (attach schedule)

17

18

Total deductions. Add lines 16 and 17

18

19

Subtract line 18 from line 8

19

20

Dividends-received deduction (Schedule C, line 27)

20

21

Taxable investment income. Subtract line 20 from line 19. Enter here and on page 1, line 2

21

7
8

Part II—Invested Assets Book Values
(Complete only if claiming a deduction for general expenses allocated to investment income.)
(a) Beginning of tax year

(b) End of tax year

22

Real estate

22

23

Mortgage loans

23

24
25

Collateral loans
Policy loans, including premium notes

24

26

Bonds of domestic corporations

26

27
28

Stock of domestic corporations
Government obligations, etc.

27

29
30

Bank deposits bearing interest
Other interest-bearing assets (attach schedule)

29

31
32

Total. Add lines 22 through 30
Add columns (a) and (b), line 31

31

33

Mean of invested assets for the tax year. Enter one-half of line 32

33

34

Multiply line 33 by .0025

34

35

Income base. Line 1b, column (a) plus line 8 less the sum of line 1b, column
(b) and line 16

35

36

Multiply line 33 by .0375

36

37

Subtract line 36 from line 35. Do not enter less than zero

37

38

Multiply line 37 by .25

38

39

Limitation on deduction for investment expenses. Add lines 34 and 38

39

25

28
30
32

Form

1120-PC

(2005)

4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 4 of 8
PRINTS: HEAD to HEAD
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
559 mm (22"), FOLDS TO
1
216 mm (8 ⁄2 ")
279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Page

Form 1120-PC (2005)

Schedule C

Dividends and Special Deductions
(see instructions)

Dividends-Received
(a) Subject to section
832(b)(5)(B)

Income
1

2

Dividends from less-than-20%-owned
debt-financed stock)

domestic

Dividends from 20%-or-more-owned
debt-financed stock)

domestic

corporations

(other

1
corporations

(other

than
2

Dividends on debt-financed stock of domestic and foreign corporations

3

4

Dividends on certain preferred stock of less-than-20%-owned public utilities

4

5

Dividends on certain preferred stock of 20%-or-more-owned public utilities

5

6

Dividends on stock of certain less-than-20%-owned foreign corporations and certain
FSCs

6

Dividends on stock of certain 20%-or-more-owned foreign corporations and certain
FSCs

7

8

Dividends from wholly owned foreign subsidiaries and certain FSCs

8

9

Dividends from affiliated companies

9

Dividends from controlled foreign corporations subject to the 85% deduction (attach
Form 8895)

10

11

Other dividends from foreign corporations not included on lines 3, 6, 7, 8, or 10

11

12

Income from controlled foreign corporations under subpart F (attach Forms 5471)

12

13

Foreign dividend gross-up (section 78)

13

14

Other dividends (attach schedule)

14

15

Total dividends. Add lines 1 through 14. Enter here and on Schedule A, line 2, or
Schedule B, line 2, whichever applies

15

10

(b) Total dividendsreceived

than

3

7

4

Dividends-Received Deduction
(a) Subject to section
832(b)(5)(B)

Deduction
16

Multiply line 1 by 70%

16

17

Multiply line 2 by 80%

17

18

Deduction for line 3 (see instructions)

18

19
20

Multiply line 4 by 42%
Multiply line 5 by 48%

19

21
22

Multiply line 6 by 70%
Multiply line 7 by 80%

21

23

Enter the amount from line 8

23

24

Multiply line 10 by 85%

24

25

Total. Add lines 16 through 24. (See instructions for limitation.)

25

26

Total. Add line 25, column (a), and line 9, column (a). Enter here and on Schedule F,
line 10

26

27

Total deductions. Add line 25, column (b), and line 9, column (b). Enter here and on Schedule A, line 36a,
or Schedule B, line 20, whichever applies

(b) Total dividendsreceived deduction

20
22

27
Form

1120-PC

(2005)

4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 5 of 8
PRINTS: HEAD to HEAD
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
559 mm (22"), FOLDS TO
216 mm (81⁄2 ")
279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2005)

Schedule E

Page

Premiums Earned—Section 832 (see instructions)
1

1

Net premiums written

2

Unearned premiums on outstanding business at the end of the preceding tax year:
a Enter 100% of life insurance reserves included in unearned premiums (section
832(b)(7)(A)) and all unearned premiums of section 833 organizations

2a

b Enter 90% of unearned premiums attributable to insuring certain securities

2b

c Discounted unearned premiums attributable to title insurance

2c

d Enter 80% of all other unearned premiums

2d
2e

e Total. Add lines 2a through 2d
3

Total. Add lines 1 and 2e

4

Unearned premiums on outstanding business at the end of the current tax year:
a Enter 100% of life insurance reserves included in unearned premiums (section
832(b)(7)(A)) and all unearned premiums of section 833 organizations
b Enter 90% of unearned premiums attributable to insuring certain securities

3

4a
4b

c Discounted unearned premiums attributable to title insurance

4c

d Enter 80% of all other unearned premiums

4d
4e

e Total. Add lines 4a through 4d
5
6
7

Losses paid during the tax year (attach schedule)

2

Balance outstanding at the end of the current tax year for:

4

6
7

Losses Incurred—Section 832 (see instructions)

1

3

5

Subtract line 4e from line 3
Transitional adjustments under section 832(b)(7)(D) (see instructions)
Premiums earned. Add lines 5 and 6. Enter here and on Schedule A, line 1

Schedule F

1

a Unpaid losses on life insurance contracts

2a

b Discounted unpaid losses

2b
2c

c Total. Add lines 2a and 2b
Add lines 1 and 2c

3

Balance outstanding at the end of the preceding tax year for:
a Unpaid losses on life insurance contracts

4a

b Discounted unpaid losses

4b

c Total. Add lines 4a and 4b

4c

5

Subtract line 4c from line 3

5

6

Estimated salvage and reinsurance recoverable at the end of the preceding tax year

6

7

Estimated salvage and reinsurance recoverable at the end of the current tax year

7

8

Losses incurred (line 5 plus line 6 less line 7)

9

Tax-exempt interest subject to section 832(b)(5)(B)

8
9

Dividends-received deduction subject to section 832(b)(5)(B) (Schedule C, line
26)

10

11

The increase in policy cash value of section 264(f) policies as defined in section
805(a)(4)(F)

11

12

Total. Add lines 9, 10, and 11

12

13
14

Reduction of deduction under section 832(b)(5)(B). Multiply line 12 by .15
Losses incurred deductible under section 832(c)(4). Subtract line 13 from line 8. Enter here and on
Schedule A, line 26

13

10

5

14
Form

1120-PC

(2005)

4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 6 of 8
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
559 mm (22"), FOLDS TO
PERFORATE: ON FOLD
216 mm (81⁄2 ")
279 mm (11")
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2005)

Schedule G

Page

6

Other Capital Losses (see instructions)
(Capital assets sold or exchanged to meet abnormal insurance losses and to pay dividends and similar
distributions to policyholders.)

Dividends and similar distributions paid to policyholders
Losses paid

1

2
3

Expenses paid

3

4

Total. Add lines 1, 2, and 3

4

1

2

Note. Adjust lines 5 through 8 to cash method if necessary.
5

Interest received

5

6

Dividends-received (Schedule C, line 15)

6

7

Gross rents, gross royalties, lease income, etc., and gross income from a trade
or business other than an insurance business including income from Form 4797
(include gains for invested assets only)

7

8

Net premiums received

8

9
10

Total. Add lines 5 through 8
Limitation on gross receipts from sales of capital assets. Line 4 less line 9. If zero or less, enter -0(a) Description of capital
asset

(b) Date
acquired

(c) Gross
sales price

(d) Cost or
other basis

(e) Expense
of sale

9
10

(f) Depreciation allowed
(or allowable)

(g) Loss
((d) plus (e) less
the sum of (c) and (f))

11

12

Totals—column (c) must not be more
than line 10. (Enter amount from
column (g) in Schedule A, line 28, or
Schedule B, line 15, whichever
applies)

Schedule H

Special Deduction And Ending Adjusted Surplus for Section 833 Organizations
(see instructions)

Health care claims incurred during the tax year and liabilities incurred during the tax year under cost-plus
contracts

1

2

Expenses incurred during the tax year in connection with the administration, adjustment, or settlement of
health care claims or in connection with the administration of cost-plus contracts

2

3

Total. Add lines 1 and 2

3

4

Multiply line 3 by .25

4

5

Beginning adjusted surplus

5

6

Special deduction. Subtract line 5 from line 4. If zero or less, enter -0-. Enter here and on Schedule A, line
34a. (See instructions for limitation.)

6

7

Net operating loss deduction (Schedule A, line 36b)

7

1

8

9
10

Net exempt income:
a Adjusted tax-exempt income

8a

b Adjusted dividends-received deduction

8b

Taxable income (Schedule A, line 37)
Ending adjusted surplus. Add lines 5 through 9

9
10
Form

1120-PC

(2005)

4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 7 of 8
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
559 mm (22"), FOLDS TO
1
PERFORATE: ON FOLD
216 mm (8 ⁄2 ")
279 mm (11")
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2005)

Schedule I

Page

Other Information (see instructions)
Yes No

1
a

Cash
Accrual

c

(c) The corporation may have to file Form 5472,
Information Return of a 25% Foreign-Owned U.S.
Corporation or a Foreign Corporation Engaged in
a U.S. Trade or Business. Enter number of Forms
5472 attached

Other (specify)

Check box for kind of company:

2

3

Yes No

Check method of accounting:
b

a

Mutual

b

Stock

7

At the end of the tax year, did the corporation own,
directly or indirectly, 50% or more of the voting
stock of a domestic corporation? (For rules of
attribution, see section 267(c).)

Is the corporation a subsidiary in an affiliated group
or a parent-subsidiary controlled group?
If “Yes,” enter name and EIN of the parent
corporation

5

Has the corporation elected to use its own payout
pattern for discounting unpaid losses and unpaid
loss adjustment expenses?

8a Enter the total unpaid losses shown on the
corporation’s annual statement:
(1) for the current tax year:

If “Yes,” attach a schedule showing:
(a) name and employer identification number (EIN);
(b) percentage owned; and (c) taxable income or
(loss) before NOL and special deductions of such
corporation for the tax year ending with or within
your tax year.
4

(2) for the previous tax year:

(1) for the current tax year:
(2) for the previous tax year:

(a) Percentage owned

$
$

9

Does the corporation discount any of the loss
reserves shown on its annual statement?

10

Enter the amount of tax-exempt interest received or
accrued during the tax year
$

11

If the corporation has an NOL for the tax year
and is electing to forgo the carryback period,


check here

At the end of the tax year, did any individual,
partnership, corporation, estate, or trust own, directly
or indirectly, 50% or more of the corporation’s voting
stock? (For rules of attribution, see section 267(c).)

Enter percentage owned

At any time during the tax year, did one foreign
person own, directly or indirectly, at least 25% of:
(a) the total voting power of all classes of stock of
the corporation entitled to vote, or (b) the total value
of all classes of stock of the corporation? If “Yes,”
enter:

$
$

b Enter the total unpaid loss adjustment expenses
shown on the corporation’s annual statement:

If the corporation is filing a consolidated return,
the statement required by Temporary
Regulations section 1.1502-21T(b)(3)(i) or (ii)
must be attached or the election will not be valid.

If “Yes,” attach a schedule showing name and
identifying number. (Do not include any information
already entered in 4 above.)
6

7

12

Enter the available NOL carryover from prior tax
years. (Do not reduce it by any deduction on

$
line 36b, Schedule A.)

and (b) Owner’s

country

Note: If the corporation, at any time during the tax year, had assets or operated a business in a foreign country or U.S. possession, it may be
required to attach Schedule N (Form 1120), Foreign Operations of U.S. Corporations, to this return. See Schedule N for details.
Form

1120-PC

(2005)

4
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 8 of 8
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 432 mm (17")
559 mm (22"), FOLD TO
216 mm (81⁄2 ")
279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2005)

Page

Schedule L

Balance Sheets per Books (All filers are required to complete this schedule.)
Beginning of tax year

Assets
1

8

(a)

End of tax year

(b)

(c)

(d)

Cash

2a Trade notes and accounts receivable
b Less allowance for bad debts
3

Inventories

4

U.S. government obligations

5

Tax-exempt securities (see instructions)

6

Other current assets (attach schedule)

7

Loans to shareholders

8

Mortgage and real estate loans

9

Other investments (attach schedule)

10a

14
15

(

)

(

)

(

)

(

)

(

)

(

)

(

)

Depletable assets

b Less accumulated depletion
12
13a

)

Buildings and other depreciable assets

b Less accumulated depreciation
11a

(

Land (net of any amortization)
Intangible assets (amortizable only)

b Less accumulated amortization
Other assets (attach schedule)
Total assets

Liabilities and Shareholders’ Equity
16

Accounts payable

17

Mortgages, notes, bonds payable in less than 1 year

18

Insurance liabilities (see instructions)

19

Other current liabilities (attach schedule)

20

Loans from shareholders

21
22

Mortgages, notes, bonds payable in 1 year or more
Other liabilities (attach schedule)

23

Capital stock:

24
25

Additional paid-in capital

26

Retained earnings—Unappropriated

27
28
29

Adjustments to shareholders’ equity (attach schedule)
Less cost of treasury stock
Total liabilities and shareholders’ equity

a Preferred stock
b Common stock

Retained earnings—Appropriated (attach schedule)

Schedule M-1

(

)

(

)

Reconciliation of Income (Loss) per Books with Income per Return (see instructions)

(The corporation is not required to complete Schedules M-1 and M-2 below if the total assets on line 15, column (d), of Schedule L are less than $25,000.)
1

Net income (loss) per books

2

Federal income tax per books

3

Excess of capital losses over capital gains

4

Income subject to tax not recorded on books
this year (itemize)

5

Expenses recorded on books this year not
deducted in this return (itemize)
a Depreciation

7

Income recorded on books this year not
included in this return (itemize)
a Tax-exempt interest $

8

Deductions in this tax return not charged
against book income this year (itemize)
a Depreciation

$

$

b Charitable contributions $

b Charitable contributions $
c Travel and entertainment $
6

Add lines 1 through 5

Schedule M-2

Add lines 7 and 8
Income (Schedule A, line 35)—line 6 less
line 9

Analysis of Unappropriated Retained Earnings per Books (line 26, Schedule L)

1

Balance at beginning of year

2

Net income (loss) per books

3

Other increases (itemize)

4

9
10

Add lines 1, 2, and 3

5

Distributions:

a Cash
b Stock
c Property

6

Other decreases (itemize)

7
8

Add lines 5 and 6
Balance at end of year (line 4 less line 7)

Printed on recycled paper

Form

1120-PC

(2005)