Minnesota Fire Safety Surcharge Return for Mutual Companies

Fire Safety Surcharge Return for Mutual Companies
2023 IG262, Fire Safety Surcharge Return for Mutual Companies
2023 IG262, Fire Safety Surcharge Return
for Mutual Companies
For the period of (check one):
Jan. 1 – March 31, 2023	
(Due May 15, 2023) 	

April 1 – June 30, 2023	
(Due Aug. 15, 2023)	

*226361*

July 1 – Sept. 30, 2023	
(Due Nov. 15, 2023)	
Check if: 	

Print or Type

Name of Insurance Company				

Amended Return 	

Minnesota Tax ID (required)
State/Country of Incorporation

Check if New Address

NAIC Number	

City	

State		

Contact Person

Email Address	

Website Address	

Daytime Phone 	

Note: Numbers in parentheses refer to line num- 	A	
Total Direct	
bers on NAIC Minnesota state page. Also include
	
Premiums
all finance and service charges.

B	

Dividends	

Fax Number

C	

D	

	1	Fire (1)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 1	
	2	Allied lines
		
a	 Crop (2.1)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 2a	

100% 	

		
b	 Other than crop (2.1)  .  .  .  .  .  .  .  .  .  .  .  . 2b	
3	 Multi-peril
		
a	Farmowners (3)  .  .  .  .  .  .  .  .  .  .  .  .  .  . 3a	

30% 	

1% 	
35% 	
35% 	
55% 	
35% 	
15% 	
15% 	
15% 	

		
c	 Commercial nonliability (5.1)  .  .  .  .  .  .  . 3c	
		d	 Commercial liability (5.2)  .  .  .  .  .  .  .  .  . 3d	
	4 	 Inland marine (9)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 4	
5	 Ocean marine (8)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 5	
6	Earthquake (12)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 6	
	 7	 Auto physical damage (21.1-21.2) (total com		
mercial and private) or itemize combined auto
		
comprehensive fire premiums (lines 7a-7f)  .  . 7	
		
a	 Comprehensive fire, theft and
miscellaneous (exclude collision)  .  .  .  .  . 7a	
		
b	 Comprehensive fire, theft and miscellane	 	 	 ous with deductible (exclude collision)  .  . 7b	

7% 	
19% 	
35% 	
75% 	
50% 	
100% 	

		
c	 Fire and theft combined  .  .  .  .  .  .  .  .  .  . 7c	
		
d	 Fire, theft and miscellaneous  .  .  .  .  .  .  . 7d	
		
e	Fire  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .

E

Net Direct 	
% of	
Minnesota
Premiums	
Fire	
Basis
(C times D)
(A minus B)	

		
b	Homeowners (4)  .  .  .  .  .  .  .  .  .  .  .  .  .  . 3b	

Calculate the Surcharge

No Activity Return

FEIN		

Mailing Address	

ZIP Code	

Oct. 1 – Dec. 31, 2023
(Due Feb. 15, 2024)

7e	

%	
10% 	
%	

		
f	 Collision and others  .  .  .  .  .  .  .  .  .  .  .  . 7f	
	8	 Aircraft physical damage (22)  .  .  .  .  .  .  .  .  . 8	
	9	Other fire (itemize on a separate schedule)  .  . 9	

	10	 Taxable fire premiums (add lines 1 through 9, column E)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 10	
11	 Surcharge rate (0.5%) .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 11	

.005

12	 Fire insurance surcharge liability (multiply line 10 by the rate on line 11)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 12	
	13	Penalty (see instructions)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 13	
	14	Interest (see instructions)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 14	
	15	 TOTAL AMOUNT DUE (or overpaid) (add lines 12 through 14)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 15	
If you owe additional tax (make separate payments for each period):
		
Payment method:

Electronic payment

Enter amount paid

Check (payable to Minnesota Department of Revenue; write MN tax ID number on check; attach voucher)
Date paid

(If amount paid is different from line 15, attach an explanation.)

		
If you overpaid: Overpayments will be refunded.
Sign Here

I declare that this return is correct and complete to the best of my knowledge and belief.
Authorized signature	

Title	

Date	

Daytime phone

Signature of preparer	

Print name of preparer	

Date	

Daytime phone

Mail to: Minnesota Department of Revenue, Mail Station 1780, 600 N. Robert St., St. Paul, MN 55145-1780

I authorize the
Minnesota Department
of Revenue to discuss
this tax return with the
preparer.

2023 Form IG262 Instructions

For insurance tax laws, see Minnesota Statutes, Chapter 297I at www.leg.state.mn.us.

Filing Requirements

All insurers that write or are authorized to write homeowners, fire and commercial nonliability insurance subject to Minnesota premium tax,
must file a return even if no business is conducted during the tax year.
This surcharge does not apply to Minnesota township mutual fire insurance companies organized under Chapter 67A.
Mutual property and casualty companies (described in M.S. 297I.05, subd. 3 and 4) shall elect to collect and remit the fire safety surcharge
(Form IG261) or (Form IG262).
The election must be made by Dec. 31 of each year for insurance for policies written or renewed in the succeeding calendar year. (M.S.
297I.06).

Due Dates

File Form IG262 and pay any surcharge due by May 15, Aug. 15 and Nov. 15 of the current year and Feb. 15 of the following year. Make
separate electronic payments or write separate checks for each return.
The U.S. postmark date, or date recorded or marked by a designated delivery service, is considered the filing date (private postage meter
marks are not valid). When the due date falls on a Saturday, Sunday or legal holiday, returns and payments electronically made or postmarked
on the next business day are considered timely. When a return or payment is late, the date it is received at the Department of Revenue is
treated as the date filed or paid.
Extension for Filing Return. If good cause exists, you may request a filing extension.

Before You File

Enter your federal ID number and NAIC number on your return, but not in place of your Minnesota tax ID number.

Payments

Electronic Payments

If your total insurance taxes and surcharges for the last 12-month period ending June 30 is $10,000 or more, you’re required to pay your tax
electronically in all subsequent years.
You must also pay electronically if you’re required to pay any Minnesota business tax electronically, such as sales or withholding tax.
To pay electronically, go to the department’s website at www.revenue.state.mn.us and log in to e-Services. You’ll need your user name,
password and bank routing and account numbers. When paying electronically, you must use an account not associated with any foreign
banks.
If you use other electronic payment methods, such as ACH credit method or Fed Wire, instructions are available on our website or by calling
Business Registration Office at 651-282-5225 or 1-800-657-3605.
Submit separate payments for each return.

Check Payments

If you are not required to pay electronically and you choose to pay by check, you must mail a personalized payment voucher along with your
estimated tax payment to help ensure the payment is credited correctly. Go to www.revenue.state.mn.us and select Make a Payment. Select
Check or Money Order. Use the Payment Voucher System to create a voucher.
When you pay by check, your check authorizes us to make a one-time electronic fund transfer from your account. You will not receive your
canceled check.
Note: If no amount is due or if you pay electronically, do not send in a voucher.

Instructions
Check Boxes

At the top of the form, check if the return is:
•	 an Amended Return: Check only if you’re amending a previously filed return for the same period. Include all original and corrected
premiums on the amended return.
•	 a No Activity Return: Check only if you did not have any applicable surcharge activity during the period.

Continued

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2023 Form IG262 Instructions (Continued)
Line Instructions
Column D

If you wish to use different percentages than the ones listed on the form, you must receive prior approval. For written approval, send a letter
or email to the department (see Information and Assistance) requesting to use percentages that were computed prior to collecting premiums
during this period. Attach documentation including detailed supporting schedules.
Premiums must include finance, service or other charges paid to the insurers.

Line 1

Enter fire premiums written (line 1 of your NAIC Minnesota state page).

Lines 2a and 2b

Enter all crop premiums written for allied lines on line 2a and other than crop premiums on line 2b (line 2.1, Minnesota state page).
If the allied lines premiums reported on the NAIC line 2.1 do not contain fire coverage, those premiums are not subject to the fire safety
surcharge. Include documentation demonstrating that no fire coverage is included on the NAIC line 2.1.

Lines 3a and 3b

Enter all farmowners and homeowners multi-peril premiums written (lines 3 and 4, Minnesota state page).

Line 3c

Enter the nonliability portion of all commercial premiums written (line 5.1, Minnesota state page).

Line 3d

Enter the liability portion of all commercial premiums written (line 5.2, Minnesota state page).

Line 4

Enter all inland marine premiums (line 9, Minnesota state page).

Line 5

Enter all ocean marine premiums (line 8, Minnesota state page).

Line 6

Enter all earthquake premiums (line 12, Minnesota state page).

Line 7

Enter all total auto physical damage premiums (lines 21.1 - 21.2, Minnesota state page) OR the appropriate type of premiums on lines 7a
through 7f.
The total auto physical damage premiums, if listed by breakdown (lines 7a through 7f), should equal total auto physical damage premiums on
the state page of your annual statement.

Line 8

Enter all aircraft physical damage premiums (line 22, Minnesota state page).

Line 9

Include all other premiums collected for fire, sprinkler and lightning damage if not already included. Provide a breakdown schedule showing
the fire portion. For package policies, the fire insurance portion may be broken out to more accurately reflect the correct portion of fire
premiums. Include a schedule detailing the breakdown.

Line 13

Penalties

Late Payment. If you do not pay the entire surcharge by the due date, a late payment penalty is due. The penalty is 5% of the unpaid
surcharge for any part of the first 30 days the payment is late, and 5% for each additional 30-day period, up to a maximum of 15%.
Late Filing. Add a late filing penalty to the late payment penalty if your return is not filed by the due date. The penalty is 5% of the unpaid
surcharge. When added to the late payment penalty, the maximum combined penalty is 20%.
Payment Method. If you’re required to pay electronically and do not, an additional 5% penalty applies to payments not made electronically,
even if a paper check is sent on time.

Line 14

Interest

You must pay interest on the unpaid surcharge plus penalty from the due date until the total is paid. The interest rate for calendar year 2023 is
5%. The interest rate may change for future years.
To figure how much interest you owe, use the following formula with the appropriate interest rate:
Continued

2

2023 Form IG262 Instructions (Continued)
Interest = (surcharge + penalty) × # of days late × interest rate ÷ 365

Mailing Your Return

Mail your return and all required attachments to:
Minnesota Department of Revenue
Mail Station 1780
600 N. Robert St.
St. Paul, MN 55145-1780
For express deliveries, use our street address:
Minnesota Department of Revenue
600 N. Robert St.
St. Paul, MN 55101

Business Information Changes

Be sure to let us know within 30 days if you change mailing addresses, phone numbers or any other business information. To do so, go to
our website, log in to e-Services and update your profile information. By notifying us, we will be able to let you know of any changes in
Minnesota tax laws and filing requirements.

Information and Assistance
Website:	www.revenue.state.mn.us
Email: 	 [email protected]
Phone:	 651-556‑3024

This material is available in alternate formats.
For questions about licensing and regulations, contact the Minnesota Department of Commerce:
Website:	www.mn.gov/commerce
Email: 	 [email protected]
Phone:	 651-539-1599 or 1-800-657-3978
Fax:	
651-539-0107

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