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)

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
Name of corporation (common parent, if consolidated return)

Check applicable box(es):

Part I

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

OMB No. 1545-0128

2010

Employer identification number

f
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(1)
(3)

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. 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.
Beginning
Ending
2a Enter the income statement period:
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 .
4a
b Indicate accounting standard used for line 4a (see instructions):
(1)
(3)
(4)
GAAP (2)
IFRS
Statutory
Other (specify)
5a Net income from nonincludible foreign entities (attach schedule) . . . . . . . . . . . . .
5a (
)
5b
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)
. . . . . . . . . . . . .
6a (
)
b Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount) . . . .
6b
7a
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)
. . . . . . .
7b
7c
c Net income (loss) of other includible corporations (attach schedule) . . . . . . . . . . . .
8
Adjustment to eliminations of transactions between includible entities and nonincludible entities
(attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
9
Adjustment to reconcile income statement period to tax year (attach schedule) . . . . . . . .
10a Intercompany dividend adjustments to reconcile to line 11 (attach schedule) . . . . . . . . .
10a
10b
b Other statutory accounting adjustments to reconcile to line 11 (attach schedule) . . . . . . .
c Other adjustments to reconcile to amount on line 11 (attach schedule) . . . . . . . . . . .
10c
11
Net income (loss) per income statement of includible corporations. Combine lines 4a through 10c 11
Note. Part I, line 11, must equal the amount on Part II, line 30, column (a).
12
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

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

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.

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Total Liabilities

▶
▶
▶
▶

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

Cat. No. 39668S

Schedule M-3 (Form 1120-L) 2010

Page 2
Employer identification number

Schedule M-3 (Form 1120-L) 2010
Name of corporation (common parent, if consolidated return)

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

(1)
(6)

Consolidated group
1120-L group

Name of subsidiary (if consolidated return)

Part II

(7)

(2)

Parent corp

b
c

d

e
f
g
24
25
26
27
28
29a

Consolidated eliminations

(4)

(5)

Subsidiary corp

Mixed 1120/L/PC group

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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
23a

(3)

1120-L eliminations

(a)
Income (Loss) per
Income Statement

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Income (Loss) per
Tax Return

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 . . . . . . .
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 41)
Other items with no differences
. . . . . . .
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) 2010

Page 3
Employer identification number

Schedule M-3 (Form 1120-L) 2010
Name of corporation (common parent, if consolidated return)

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

(1)
(6)

Consolidated group
1120-L group

Name of subsidiary (if consolidated return)

Part III

(2)

(7)

(3)

Parent corp

Consolidated eliminations

(4)

(5)

Subsidiary corp

Mixed 1120/L/PC group

1120-L eliminations

f
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Employer identification number

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

Expense/Deduction Items
1
2
3
4
5

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
foreign withholding taxes) . . . . . . .

. .
. .
. .
. .
than
. .

6

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

20
21
22
23

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 . . .

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.
.
.

.
.
.
.

24

Change in all other section 807(c) tax reserves

.

.

25

Section 807(f) adjustments for change in computing reserves .

26

Section 807(a)(2)(B) tax reserve amount with respect
to policyholder share of tax-exempt interest . . .

27

Current year acquisition/reorganization costs (attach schedule)

28
29

Amortization of acquisition, reorganization, and start-up costs
Amortization/impairment of goodwill, insurance in
force and ceding commissions . . . . . . . .

30

Other amortization or impairment write-offs

31
32
33
34
35
36

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) . . . . .

37

Domestic production activities deduction

38

Research and development costs (attach schedule) .

39

Section 118 exclusion (attach schedule) .

40
41

Other expense/deduction items with differences (attach schedule)
Total expense/deduction items. Combine lines 1 through
40. Enter here and on Part II, line 27, reporting positive
amounts as negative and negative amounts as positive .

.
.

.
.

.

.
.

(c)
Permanent
Difference

(d)
Deduction per
Tax Return

.

7
8
9
10
11
12
13
14
15
16
17
18
19

.

(b)
Temporary
Difference

.

.
.

Schedule M-3 (Form 1120-L) 2010