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

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2008

© 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

Non-consolidated return
Mixed 1120/L/PC group

Employer identification number

(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. 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 4a.
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/
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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 4a.
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
4a Worldwide consolidated net income (loss) from income statement source identified in Part I, line 1
4b Indicate accounting standard used for line 4a (see instructions):
(1)
GAAP (2)
IFRS (3)
Statutory (4)
Other (specify)
5a Net income from nonincludible foreign entities (attach schedule)
b Net loss from nonincludible foreign entities (attach schedule and enter as a positive amount)
6a Net income from nonincludible U.S. entities (attach schedule)
b Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount)
7a Net income (loss) of other includible foreign disregarded entities (attach schedule)
b Net income (loss) of other includible U.S. disregarded entities (attach schedule)
c Net income (loss) of other includible corporations (attach schedule)
Adjustment to eliminations of transactions between includible entities and nonincludible entities
(attach schedule)
9 Adjustment to reconcile income statement period to tax year (attach schedule)
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 Net income (loss) per income statement of includible corporations. Combine lines 4a through 10c
Note. Part I, line 11, must equal the amount on Part II, line 30, column (a).
8

12

4a

5a (
5b
6a (
6b
7a
7b
7c

)
)

8
9
10a
10b
10c
11

Enter the total amount (not just the corporation’s share) of the assets and liabilities of all entities
included or removed on the following lines.

Total Assets
a
b
c
d

Total Liabilities

Included on Part I, line 4
Removed on Part I, line 5
Removed on Part I, line 6
Included on Part I, line 7

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

Cat. No. 39668S

Schedule M-3 (Form 1120-L) 2008

2
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) 2008
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 II

(7)

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(2)

Parent corp (3)

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
(Attach schedules for lines 1 through 11)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22

2

Employer identification number

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
Income (loss) from foreign partnerships
Income (loss) from other pass-through entities
Items relating to reportable transactions (attach details)
Interest income (attach Form 8916-A)
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

(a)
Income (Loss) per
Income Statement

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Income (Loss) per
Tax Return

D

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 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 Form 1120-L, page 1, line 20.
Schedule M-3 (Form 1120-L) 2008

2
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) 2008

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

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

25

Consolidated eliminations (4)

1120-L eliminations

Expense/Deduction Items

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

3

Employer identification number

(a)
Expense per
Income Statement

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Deduction per
Tax Return

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 (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, reporting positive
amounts as negative and negative amounts as positive
Schedule M-3 (Form 1120-L) 2008