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

2
TLS, have you
transmitted all R
text files for this
cycle update?

Date

1120-PC

©

A Check if:
1 Consolidated return
(attach Form 851)
2 Life-nonlife
consolidated return
3 Schedule M-3 (Form
1120-PC) attached
E Check if:

(1)

Final return

Name

O.K. to print
Revised proofs
requested

OMB No. 1545-1027

, 2007, ending

2007

, 20

See separate instructions.

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

(2)

Name change (3)

Address change (4)

Amended return

953(c)(3)(C)

Taxable income (Schedule A, line 37)

4

Income tax

5
6

Enter amount of tax that a reciprocal must include

5

Alternative minimum tax (attach Form 4626)

6

7

Add lines 4 through 6

2

Taxable investment income for electing small companies (Schedule B, line 21)

©

Check if a member of a controlled group (attach Schedule O (Form 1120))

4

7

b Credits from Forms 5735 and 8834

8a

8b

Form 3800

c General business credit. Check applicable box(es):
Form 5884

Form 6478

Form 8844

Form 8846

Form 8835, Section B

8c

8d

d Credit for prior year minimum tax (attach Form 8827)
e Bond credits from:
Form 8860
Form 8912
f Total credits. Add lines 8a through 8e

8e
8f

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

Form 4255

14 a 2006 overpayment credited to 2007

11

Form 8611

12

Other (attach schedule)

13
14a

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

14b

c 2007 estimated tax payments (see instructions)

14c
14d

d 2007 special estimated tax payments (Do not include on line 14f)
14e (
e 2007 refund applied for on Form 4466

)

f Enter the total of lines 14a through 14c less line 14e
g Tax deposited with Form 7004

14f
14g

h Credit by reciprocal for tax paid by attorney-in-fact under section 835(d)
i Other credits and payments

14h
14j

14i

15

©

15

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

16
17
18

Amount owed. 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
Enter amount from line 17: Credited to 2008 estimated tax ©
Refunded

Sign
Here

953(d)

1

1
2
3

9

Signature

B Employer identification number

8a Foreign tax credit (attach Form 1118)

Tax Computation and Payments

Date

f
o
s
a
7
t
0
f
0
a
2
r
/
D /13
6
0

For calendar year 2007 or tax year beginning

Department of the Treasury
Internal Revenue Service

Action

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") 3 559 mm (22") FOLD TO
216 mm (8 1/2") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

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

(2007)

2
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") 3 559 mm (22"), FOLD TO
216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2007)

Page

Schedule A
1
2

Premiums earned (Schedule E, line 7)
Dividends (Schedule C, line 14)

f
o
s
a
7
t
0
f
0
a
2
r
/
D /13
6
0
1
2

(a) Interest received

3a Gross interest

Deductions (See instructions for limitations on deductions.)

Income

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

(b) Amortization of
premium

3d

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

4

4
5

Gross rents

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

5

Gross royalties

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

13

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

21

Charitable contributions

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
line 6)

19

Interest ©

deduction

14

c Bal. ©

b Less tax-exempt interest exp. ©

for

section

833

organizations

(Schedule

b Deduction on account of special income and deduction accounts
35

Dividends-received deduction (Schedule C, line 25)

b Net operating loss deduction

34a
34b
34c
35
36a
36b

c Total. Add lines 36a and 36b
37

20c

H,

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

36a

2

Taxable Income—Section 832 (see instructions)

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

36c
37
Form

1120-PC

(2007)

2
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") 3 559 mm (22"), FOLDS TO
216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2007)

Schedule B

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

f
o
s
a
7
t
0
f
0
a
2
r
/
D /13
6
0
(b) Amortization of
premium

(a) Interest received

1a

Gross interest

Income

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

2

3

Dividends (Schedule C, line 14)
Gross rents

4

Gross royalties

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

2

Deductions

1d

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

3
4

7
8
9

9
10
11

Real estate taxes

12

Depletion

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 25)

20

21

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

21

Other real estate expenses
Depreciation (attach Form 4562)

10
11
12

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

22

Real estate

22

23

Mortgage loans

23

24
25
26
27
28
29
30
31
32

Collateral loans
Policy loans, including premium notes
Bonds of domestic corporations
Stock of domestic corporations
Government obligations, etc.
Bank deposits bearing interest
Other interest-bearing assets (attach schedule)
Total. Add lines 22 through 30
Add columns (a) and (b), line 31

24

33
34

Mean of invested assets for the tax year. Enter one-half of line 32
Multiply line 33 by .0025

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
38

Subtract line 36 from line 35. Do not enter less than zero
Multiply line 37 by .25

37

39

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

(b) End of tax year

25
26
27
28
29
30
31
32
33
34

38
39
Form

1120-PC

(2007)

2
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 4 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") 3 559 mm (22"), FOLDS TO
216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Page

Form 1120-PC (2007)

Schedule C

Dividends and Special Deductions
(see instructions)

f
o
s
a
7
t
0
f
0
a
2
r
/
D /13
6
0
(a) Subject to section
832(b)(5)(B)

Income
1

2

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

domestic

corporations

(other

(b) Total dividendsreceived

than

1

domestic

corporations

(other

than

2

3

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

10

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

10

11

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

11

12

Foreign dividend gross-up (section 78)

12

13

Other dividends (attach schedule)

13

14

Total dividends. Add lines 1 through 13. Enter here and on Schedule A, line 2, or
Schedule B, line 2, whichever applies

14

7

4

Dividends-Received

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

Deduction
15

Multiply line 1 by 70%

15

16

Multiply line 2 by 80%

16

17

Deduction for line 3 (see instructions)

17

18
19

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

18

20
21
22

Multiply line 6 by 70%
Multiply line 7 by 80%
Enter the amount from line 8

20

23

Total. Add lines 15 through 22. (See instructions for limitation.)

23

24

Total. Add line 23, column (a), and line 9, column (a). Enter here and on Schedule F,
line 10

24

25

Total deductions. Add line 23, 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

19
21
22

25
Form

1120-PC

(2007)

2
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120-PC, PAGE 5 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") 3 559 mm (22"), FOLDS TO
216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2007)

Schedule E
1
2

Page

Net premiums written

4

f
o
s
a
7
t
0
f
0
a
2
r
/
D /13
6
0
1

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

e Total. Add lines 2a through 2d
3

Total. Add lines 1 and 2e

2e
3

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

4c

d Enter 80% of all other unearned premiums

4d

5
6
7

Losses Incurred—Section 832 (see instructions)

1

Losses paid during the tax year (attach schedule)

2

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

4

4e

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

3

4a

4b

c Discounted unearned premiums attributable to title insurance
e Total. Add lines 4a through 4d
5
6
7

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)

10

5

Premiums Earned—Section 832 (see instructions)

8
9

Dividends-received deduction subject to section 832(b)(5)(B) (Schedule C, line
24)

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
14
Form

1120-PC

(2007)

2
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") 3 559 mm (22"), FOLDS TO
216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2007)

Schedule G

Page

6

Other Capital Losses (see instructions)

f
o
s
a
7
t
0
f
0
a
2
r
/
D /13
6
0

(Capital assets sold or exchanged to meet abnormal insurance losses and to pay dividends and similar
distributions to policyholders.)
1

2

Dividends and similar distributions paid to policyholders
Losses paid

3

Expenses paid

3

4

Total. Add lines 1, 2, and 3

1

2
4

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

5

5

Interest received

6

Dividends-received (Schedule C, line 14)

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

Net premiums received

8

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

11

12

6

(c) Gross
sales price

(d) Cost or
other basis

(e) Expense
of sale

9
10

(f) Depreciation allowed
(or allowable)

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)

1

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

8

9
10

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

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

(2007)

2
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") 3 559 mm (22"), FOLDS TO
216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2007)

Schedule I

Page

Yes No
1

3

Yes No

Check method of accounting:
a

Cash

b

Accrual

c

Other (specify) ©

2

(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 ©

Check box for kind of company:
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).)

5

f
o
s
a
7
t
0
f
0
a
2
r
/
D /13
6
0

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

$
$

b Enter the total unpaid loss adjustment expenses
shown on the corporation’s annual statement:
(1) for the current tax year:
(2) for the previous tax year:

$
$

Is the corporation a subsidiary in an affiliated group
or a parent-subsidiary controlled group?

9

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

If “Yes,” enter name and EIN of the parent
corporation ©

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).)

If the corporation is filing a consolidated return,
the statement required by Regulations section
1.1502-21(b)(3) 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

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:

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

7

Other Information (see instructions)

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:
(a) Percentage owned
country ©

©

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
Form

1120-PC

(2007)

2
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") 3 559 mm (22"), FOLD TO
1
216 mm (8 ⁄ 2 ") 3 279 mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1120-PC (2007)

Page

Schedule L

Beginning of tax year

Assets
1

8

Balance Sheets per Books (All filers are required to complete this schedule.)
(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)

(

)

f
o
s
a
7
t
0
f
0
a
2
r
/
D /13
6
0
10a

(

)

(

)

(

)

(

)

(

)

(

)

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
14
Other assets (attach schedule)
15
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 (Loss) per Return
Note: Schedule M-3 required instead of Schedule M-1 if total assets are $10 million or more—See instructions.

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

(2007)