Minnesota Fire Insurance Tax (Retaliatory Schedule)

Fire Insurance Tax (Retaliatory Schedule)
2023 M11AR, Fire Insurance Tax (Retaliatory Schedule)
M11AR

2023 Fire Insurance Tax (Retaliatory Schedule)
Due March 1, 2024

Check if: 	

Name of Insurance Company	

NAIC Number	

Amended Return 	

No Activity Return

Minnesota Tax ID (required)	 State/Country of Incorporation

Complete this form if your state of incorporation collects a fire insurance tax.
Note: Numbers in parentheses refer to line numbers
on NAIC Minnesota state page. Also include all finance
and service charges.

	A	
Total Direct	

B	
Dividends	

C	
Net Direct Premiums	
(A minus B)	

D	
% of Fire	

E
State of
Incorporation Basis
(C times D)

1	 Fire (1)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 1	
2	 Allied lines
a	Crop (2.1)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 2a	
b	Other than crop (2.1)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 2b	
	3	 Multi-peril
a	Farmowners (3)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
b	Homeowners (4)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .
c	 Commercial nonliability (5.1)  .  .  .  .  .  .  .  .  .  .
d	Commercial liability (5.2)  .  .  .  .  .  .  .  .  .  .  .  .  .  .

3a	
3b	
3c	
3d	

4	 Inland marine (9)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 4	
5	 Ocean marine (8)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 5	
6	 Earthquake (12)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 6	
7	 Auto physical damage (21.1-21.2)
(total commercial 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
miscellaneous with deductible
			 (exclude collision)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 7b	
c	 Fire and theft combined  .  .  .  .  .  .  .  .  .  .  .  .  .  . 7c	
d	Fire, theft and miscellaneous  .  .  .  .  .  .  .  .  .  . 7d	
e	Fire  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 7e	
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	 Percentage rate for fire in the state/country of incorporation  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 11	
	12	 Fire insurance tax liability (multiply line 10 by the percentage on line 11)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 12	
		Enter on Form M11, line 18, Column A.
Attach this form when you file your Form M11. Keep a copy for your records.

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2023 Form M11AR Instructions
Use this form to determine the correct amount of premiums collected for all fire, sprinkler and lightning damage. Use these instructions as a
guide. For further information, see M.S. 297I. The purpose of this form is to collect retaliatory tax on fire insurance premiums.
Be sure to include this form when you file your Form M11.

Filing Requirements

All insurers that write or are authorized to write fire insurance in Minnesota must file Form M11AR if their home state collects a fire insurance tax. This schedule is not required for companies domiciled in Minnesota, Arizona, Hawaii, Massachusetts, New York and Rhode
Island. (M.S. 297I.05, subd. 11)

File Electronically

This schedule (Form M11AR) may be filed electronically using TriTech Software.

Instructions
Check Boxes

At the top of the form, check if the return is:
•	an Amended Return: Check only if you are 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 sell any insurance that had fire, lightning or sprinkler leakage coverage for the year.

Line Instructions

Premiums include finance, service or other charges paid to the insurers.

Line 1

Enter all fire premiums written (line 1, 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).

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:
7a.	
7b.	
7c.	
7d.	
7e.	
7f. 	

all comprehensive fire, theft and miscellaneous premiums (excluding collision)
all comprehensive fire, theft and miscellaneous premiums with deductibles (excluding collision)
all fire and theft combined premiums
all fire, theft and miscellaneous premiums
all fire premiums
all collision and other premiums

The total auto physical damage premiums 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 your home state’s fire insurance tax if not already included. Provide a breakdown schedule showing
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.
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Continued

2023 Form M11AR Instructions (Continued)
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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