Form Schedule M-3 (Form Schedule M-3 (Form U.S. Property and Casualty Insurance Company Income Tax

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
SCHEDULE M-3 (FORM 1120-PC), PAGE 1 of 4
MARGINS: TOP 13mm (1⁄ 2 ") CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 216mm (81⁄ 2 ") 3 279mm (11")
PERFORATE: (NONE)

Action

Revised proofs
requested

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

Check applicable box(es):

2007

Attach to Form 1120-PC.
See separate instructions.

(1)

Non-Consolidated return

(2)

Consolidated return (Form 1120-PC only)

(3)

Mixed 1120/L/PC group

(4)

Dormant subsidiaries schedule attached

Name of corporation (common parent, if consolidated return)

Part I

OMB No. 1545-1027

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Department of the Treasury
Internal Revenue Service

Signature

O.K. to print

PRINTS: HEAD TO HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

SCHEDULE M-3
(Form 1120-PC)

Date

Employer identification number

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. See instructions if multiple non-tax-basis income statements are prepared.
b Did the corporation prepare a certified audited non-tax-basis 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 a non-tax-basis 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
5a
b
6a
b

Worldwide consolidated net income (loss) from income statement source identified in Part I, line 1
Net income from nonincludible foreign entities (attach schedule)
Net loss from nonincludible foreign entities (attach schedule and enter as a positive amount)
Net income from nonincludible U.S. entities (attach schedule)
Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount)

9

Adjustment to eliminations of transactions between includible entities and nonincludible entities
(attach schedule)
Adjustment to reconcile income statement period to tax year (attach schedule)

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

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-PC.

)

Cat. No. 39664A

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9
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)
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7a
7b

7a Net income (loss) of other disregarded entities (attach schedule)
b Net income (loss) of other includible entities (attach schedule)
8

4
5a (
5b
6a (
6b

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Schedule M-3 (Form 1120-PC) 2007

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
SCHEDULE M-3 (FORM 1120-PC), PAGE 2 of 4
PRINTS: HEAD TO HEAD
MARGINS: TOP 13mm (1⁄ 2 ") CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄ 2 ") 3 279mm (11")
PERFORATE: (NONE)

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Page

Schedule M-3 (Form 1120-PC) 2007
Name of corporation (common parent, if consolidated return)

Check applicable box(es): (1)
Check if a sub-consolidated:

Consolidated group
(6)

1120-PC group

Name of subsidiary (if consolidated return)

Part II

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(2)

(7)

Parent corp (3)

Consolidated eliminations (4)

Subsidiary corp (5)

Mixed 1120/L/PC group

1120-PC 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

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 (attach Form 8916-A)
Hedging transactions
Mark-to-market income (loss)
Premium income (attach schedule)
Sale versus lease (for sellers and/or lessors)
Section 481(a) adjustments
Income from a special loss discount account
Income recognition from long-term contracts
Original issue discount and other imputed interest
Reserved for future use

12
13
14
15
16
17
18
19
20
21
22

2

Employer identification number

(a)
Income (Loss) per
Income Statement

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Income (Loss)
per Tax Return

23a Income statement gain/loss on sale, exchange,
abandonment, worthlessness, or other disposition of
assets other than pass-through entities
b Gross capital gains from Schedule D, excluding
amounts from pass-through entities
c Gross capital losses from Schedule D, excluding
amounts from pass-through entities, abandonment
losses, and worthless stock losses
d Net gain/loss reported on Form 4797, line 17,
excluding amounts from pass-through entities,
abandonment losses, and worthless stock losses
e Abandonment losses
f Worthless stock losses (attach details)
g Other gain/loss on disposition of assets
24 Capital loss limitation and carryforward used
25 Other income (loss) items with differences (attach schedule)
26 Total income (loss) items. Combine lines 1 through 25
27 Total expense/deduction items (from Part III, line 39)
28 Other items with no differences
29a Mixed groups, see instructions. All others, combine
lines 26 through 28
b 1120 subgroup reconciliation totals
c Life 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 Form 1120-PC, Schedule A, line 35.
Schedule M-3 (Form 1120-PC) 2007

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
SCHEDULE M-3 (FORM 1120-PC), PAGE 3 of 4 (Page 4 is Blank)
PRINTS: HEAD TO HEAD
MARGINS: TOP 13mm (1⁄ 2 ") CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄ 2 ") 3 279mm (11")
PERFORATE: (NONE)

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Page

Schedule M-3 (Form 1120-PC) 2007
Name of corporation (common parent, if consolidated return)

Check applicable box(es): (1)
Check if a sub-consolidated:

1120-PC group

Name of subsidiary (if consolidated return)

Part III

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39

(7)

Parent corp (3)

Consolidated eliminations (4)

Subsidiary corp (5)

Mixed 1120/L/PC group

1120-PC eliminations

Employer identification number

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

1
2
3
4
5

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Consolidated group (2)
(6)

3

Employer identification number

(a)
Expense per
Income Statement

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Deduction per
Tax Return

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
Foreign current income tax expense (other than
foreign withholding taxes)
Foreign deferred income tax expense
Foreign withholding taxes
Stock option expense
Other equity-based compensation
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
Charitable contribution of cash and tangible
property
Charitable contribution of intangible property
Charitable contribution limitation/carryforward
Write-off of premium receivables
Guarantee fund assessments
Current year acquisition or reorganization
investment banking fees
Current year acquisition or reorganization legal and
accounting fees
Current year acquisition/reorganization other costs
Amortization of acquisition, reorganization, and
start-up costs
Amortization/impairment of goodwill, insurance in
force, and ceding commissions
Other amortization or impairment write-offs
Discounting of unpaid losses (section 846) (attach schedule)
Reduction of loss deduction (section 832(b)(5)(B))
Depreciation
Bad debt expense and/or agency balances written off
Deduction from a special loss discount account
Corporate owned life insurance premiums
Purchase versus lease (for purchasers and/or
lessees)
Interest expense (attach Form 8916-A)
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-PC) 2007