Form 1120-S U.S. Income Tax Return for an S Corporation
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2012 ending Signature of officer Date Title (: A) Unchecked (: B) Unchecked (: C) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: No) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (2) Amount (a) (b) (c) (d) (a) Accumulated (AMT) Items (b) Other adjustments (c) Shareholders undistributed (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (i) Name of Corporation (i) Name of Entity (if any) (ii) Employer Identification Number (ii) Total shares of stock outstanding if all instruments were executed (iii) Country of (iii) Type of Entity (iv) Country of (iv) Percentage of Stock (see instructions for limitations)7 Compensation of officers 7 (see instructions)? Yes No (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (v) If Percentage in (iv) is 100% Enter the (v) Maximum Percentage Owned in Profit 1 a Gross receipts or sales 1a 1 Balance at beginning of tax year 1 Cash 1 Net income (loss) per books 10 Bad debts 10 10 Does the corporation satisfy both of the following conditions? 10a Buildings and other depreciable assets 11 During the tax year did the corporation have any non shareholder debt that was canceled was forgiven or had the 11 Rents 11 11a Depletable assets 12 During the tax year was a qualified subchapter S subsidiary election terminated or revoked? If Yes see instructions 12 Land (net of any amortization) 12 Taxes and licenses 12 12c(2) 13 a Did the corporation make any payments in 2012 that would require it to file Form(s) 1099? 13 Interest 13 13a Intangible assets (amortizable only) 14 Depreciation not claimed on Form 1125 A or elsewhere on return (attach Form 4562) 14 14 Other assets (attach statement) 14l (itemize): 15 Depletion (Do not deduct oil and gas depletion ) 15 15 Total assets 16 Accounts payable 16 Advertising 16 17 Mortgages notes bonds payable in less than 1 year 17 Pension profit sharing etc plans 17 18 Employee benefit programs 18 18 Other current liabilities (attach statement) 19 Loans from shareholders 19 Other deductions (attach statement) 19 2 Cost of goods sold (attach Form 1125 A) 2 2 Income included on Schedule K lines 1 2 3c 4 2 Ordinary income from page 1 line 21 20 Mortgages notes bonds payable in 1 year or more 20 Total deductions Add lines 7 through 19 20 21 Ordinary business income (loss) Subtract line 20 from line 6 21 21 Other liabilities (attach statement) 22 a Excess net passive income or LIFO recapture tax (see instructions) 22a 22 Capital stock 23 a 2012 estimated tax payments and 2011 overpayment credited to 2012 23a 23 Additional paid in capital 24 Estimated tax penalty (see instructions) Check if Form 2220 is attached 24 24 Retained earnings 25 Adjustments to shareholders equity (attach statement) 25 Amount owed If line 23d is smaller than the total of lines 22c and 24 enter amount owed 25 26 Less cost of treasury stock 26 Overpayment If line 23d is larger than the total of lines 22c and 24 enter amount overpaid 26 27 Enter amount from line 26 Credited to 2013 estimated tax Refunded 27 27 Total liabilities and shareholders equity 2a Trade notes and accounts receivable 3 At any time during the tax year was any shareholder of the corporation a disregarded entity a trust an estate or a 3 Expenses recorded on books this year not 3 Gross profit Subtract line 2 from line 1c 3 3 Inventories 3 Other additions 4 Add lines 1 through 3 4 At the end of the tax year did the corporation: 4 Loss from page 1 line 21 ( 4 Net gain (loss) from Form 4797 line 17 (attach Form 4797) 4 4 U S government obligations 5 a At the end of the tax year did the corporation have any outstanding shares of restricted stock? 5 Income recorded on books this year not included 5 Other income (loss) (see instructions attach statement) 5 5 Other reductions ( 5 Tax exempt securities (see instructions) 5a 6 7 8a 9 and 10 not recorded on books this 6 Combine lines 1 through 5 6 Deductions included on Schedule K 6 Has this corporation filed or is it required to file Form 8918 Material Advisor Disclosure Statement to provide 6 Other current assets (attach statement) 6 Total income (loss) Add lines 3 through 5 6 7 Add lines 5 and 6 7 Check this box if the corporation issued publicly offered debt instruments with original issue discount 7 Distributions other than dividend distributions 7 Loans to shareholders 8 Balance at end of tax year Subtract line 7 from line 6 8 Income (loss) (Schedule K line 18) Line 4 less line 7 8 Mortgage and real estate loans 8 Salaries and wages (less employment credits) 8 9 Enter the accumulated earnings and profits of the corporation at the end of the tax year $ 9 Other investments (attach statement) 9 Repairs and maintenance 9 a Business activity a Depreciation $ a Own directly 20% or more or own directly or indirectly 50% or more of the total stock issued and outstanding of any A S election effective date a Tax exempt interest $ a The corporation s total receipts (see instructions) for the tax year were less than $250 000 account Accrual Accrued Address change (4) Adjusted gain or loss adjustments account against book income this year (itemize): Alcohol and cellulosic biofuel fuels credit (attach Form 6478) Alternative Amended return (5) asset with a bas is determined by reference to the ba sis of the asset (or the basis of any other property) in Assets At the end of the tax year did the corporation have any outstanding stock options warrants or similar instruments? attaching Form 2553 to elect to be an S corporation B Business activity code b If Yes did the corporation file or will it file required Forms 1099? b Investment expenses b Less accumulated amortization b Less accumulated depletion b Less accumulated depreciation b Less allowance for bad debts b Own directly an interest of 20% or more or own directly or indirectly an interest of 50% or more in the profit loss or b Product or service b Qualified dividends b Returns and allowances 1b b Tax deposited with Form 7004 23b b Tax from Schedule D (Form 1120S) 22b b The corporation s total assets at the end of the tax year were less than $250 000 b Travel and entertainment $ Basis below c Add lines 22a and 22b (see instructions for additional taxes) 22c c Balance Subtract line 1b from line 1a 1c C Check if Sch M 3 attached c Credit for federal tax paid on fuels (attach Form 4136) 23c c Dividend distributions paid from accumulated earnings and profits capital in any foreign or domestic partnership (including an entity treated as a partnership) or in the beneficial interest of a Cash b Caution Include only trade or business income and expenses on lines 1a through 21 See the instructions for more information Charitable contributions Check accounting method: a Check if Collectibles (28%) gain (loss) 8b column From the result subtract the sum of the amounts on lines 11 through 12d and 14l 18 correct and complete Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge Credits d Add lines 23a through 23c 23d D Employer identification number d Other items and amounts (attach statement) Date (if any) a Qualified Subchapter S Deductions Deductions allocated and apportioned at corporate level to foreign source income Deductions allocated and apportioned at shareholder level Department of the Treasury Depletion (other than oil and gas) Distributions (attach statement if required) (see instructions) Dividends: a Ordinary dividends Do not file this form unless the corporation has filed or is E Date incorporated Expenses from other rental activities (attach statement) F Total assets (see instructions) Final return (2) Firm s name Firm's EIN Firm's address Phone no For calendar year 2012 or tax year beginning For Paperwork Reduction Act Notice see separate instructions Cat No 11510H Form 1120S (2012) Foreign gross income sourced at corporate level foreign or domestic corporation? For rules of constructive ownership see instructions If Yes complete (i) through (v) Foreign Transactions Form 1120S Form 1120S (2012) Form 1120S (2012) Form 1120S (2012) Form 1120S (2012) Page 3 Form 1120S (2012) Page 4 Form 1120S (2012) Page 5 from prior years enter the net unrealized built in gain reduced by net recognized built in gain from prior years (see G Is the corporation electing to be an S corporation beginning with this tax year? General category Gross income from all sources Gross income sourced at shareholder level H Check if: (1) I Enter the number of shareholders who were shareholders during any part of the tax year If checked the corporation may have to file Form 8281 Information Return for Publicly Offered Original Issue Discount If the corporation: (a) was a C corporation before it elected to be an S corporation or the corporation acquired an If Yes complete lines (i) and (ii) below If Yes enter the amount of principal reduction $ If Yes the corporation is not required to complete Schedules L and M 1 included on Schedule K lines 1 through 12 and Income Income (Loss) Incorporation Information about Form 1120S and its separate instructions is at www irs gov/form1120s information on any reportable transaction? instructions) Instruments Interest expense Interest income Internal Revenue Service Investment interest expense Items Affecting Liabilities and Shareholders Equity lines 1 through 12 and 14l not charged Loss or Capital Low income housing credit (other) Low income housing credit (section 42(j)(5)) May the IRS discuss this return Minimum Tax n Other foreign tax information (attach statement) Name change (3) Name of country or U S possession Net long term capital gain (loss) (attach Schedule D (Form 1120S)) Net rental real estate income (loss) (attach Form 8825) Net section 1231 gain (loss) (attach Form 4797) Net short term capital gain (loss) (attach Schedule D (Form 1120S)) No If Yes attach Form 2553 if not already filed nominee or similar person? Nondeductible expenses Note Schedule M 3 required instead of Schedule M 1 if total assets are $10 million or more see instructions number (see instructions) OR Number street and room or suite no If a P O box see instructions Oil gas and geothermal properties deductions Oil gas and geothermal properties gross income OMB No 1545 0130 on Schedule K lines 1 through 10 (itemize): Ordinary business income (loss) (page 1 line 21) Organization Other Other (attach statement) Other (specify) Other AMT items (attach statement) Other credits (see instructions) Type Other deductions (see instructions) Type Other gross rental income (loss) Other income (loss) (see instructions) Type Other information Other Information (see instructions) Other net rental income (loss) Subtract line 3b from line 3a Other rental credits (see instructions) Type Other rental real estate credits (see instructions) Type Other tax exempt income OtherInformation17a Investment income Owned Page 2 Passive category Post 1986 depreciation adjustment Preparer PRINT City or town state and ZIP code Print/Type preparer s name Preparer's signature Date Qualified rehabilitation expenditures (rental real estate) (attach Form 3468) Recon ciliation18 Income/loss reconciliation Combine the amounts on lines 1 through 10 in the far right Reconciliation of Income (Loss) per Books With Income (Loss) per Return Reduction in taxes available for credit (attach statement) Repayment of loans from shareholders Royalties S election termination or revocation Schedule B Schedule K Schedule K Shareholders Pro Rata Share Items (continued) Total amount Schedule L Balance Sheets per Books Beginning of tax year End of tax year Schedule M 1 Schedule M 2 Analysis of Accumulated Adjustments Account Other Adjustments Account and Shareholders Section 179 deduction (attach Form 4562) Section 59(e)(2) expenditures (1) Type See the instructions and enter the: self employed Shareholder Shareholders Pro Rata Share Items Subsidiary Election Was Made Tax and Payments Tax exempt interest income taxable income previously taxed terms modified so as to reduce the principal amount of the debt? the hands of a C corporation and (b) has net unrealized built in gain in excess of the net recognized built in gain Total amount Total foreign taxes (check one): Total shares of non restricted stock Total shares of restricted stock Total shares of stock outstanding at the end of the tax year trust? For rules of constructive ownership see instructions If Yes complete (i) through (v) below U S Income Tax Return for an S Corporation 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 Undistributed Taxable Income Previously Taxed (see instructions) Unrecaptured section 1250 gain (attach statement) 8c Use Only with the preparer shown below year (itemize)