Note: This problem is for the 2021 tax year.
John Parsons (123-45-6781) and George Smith (123-45-6782) are 70% and 30% owners, respectively, of Premium, Inc. (11-1111120), a candy company located at 1005 16th Street, Cut and Shoot, TX 77303. Premium's S election was made on January 15, 2012, its date of incorporation. The following information was taken from the company's 2021 income statement.
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Interest income
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$ 100,000
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Gross sales receipts
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2,410,000
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Beginning inventory
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9,607
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Direct labor
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(203,102)
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Direct materials purchased
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(278,143)
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Direct other costs
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(249,356)
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Ending inventory
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3,467
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Salaries and wages
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(442,103)
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Officers' salaries ($75,000 each to Parsons and Smith)
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(150,000)
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Repairs
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(206,106)
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Depreciation expense, tax and book
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(15,254)
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Interest expense
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(35,222)
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Rent expense (operating)
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(40,000)
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Taxes
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(65,101)
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Charitable contributions (cash)
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(20,000)
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Advertising expenses
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(20,000)
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Payroll penalties
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(15,000)
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Other deductions
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(59,899)
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Book income
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704,574
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A comparative balance sheet appears below.
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January 1, 2021
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December 31, 2021
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Cash
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$ 47,840
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$ ?
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Accounts receivable
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93,100
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123,104
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Inventories
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9,607
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3,467
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Prepaid expenses
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8,333
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17,582
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Building and equipment
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138,203
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185,348
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Accumulated depreciation
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(84,235)
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(?)
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Land
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2,000
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2,000
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Total assets
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$214,848
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$844,422
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Accounts payable
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$ 42,500
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$ 72,300
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Notes payable (less than 1 year)
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4,500
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2,100
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Notes payable (more than 1 year)
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26,700
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24,300
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Capital stock (100 shares outstanding)
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30,000
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30,000
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Retained earnings
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$111,148
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?
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Total liabilities and capital
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$214,848
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$844,422
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Premium's accounting firm provides the following additional information.
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Distributions to shareholders (not reported on Form 1099-DIV andmade based on percentage of ownership):
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$100,000
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Beginning balance, Accumulated adjustments account:
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111,148
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Ordinary business income for QBI:
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639,574
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W-2 wages for QBI:
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795,205
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UBIA of qualified property
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125,000
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Required:
Prepare Premium's Form 1120S, Additional Information – Continuation Statement, and Schedule K-1s for John Parsons and George Smith, 5607 20th Street, Cut and Shoot, TX 77303.
· If an amount box does not require an entry or the answer is zero, enter "0".
· Enter all amounts as positive numbers, unless otherwise instructed.
· If required, round amounts to the nearest dollar.
· Make realistic assumptions about any missing data.
Complete the Form 1120-S for Premium, Inc.
Note: You are not required to complete Form 1125-A Cost of goods sold.
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Form 1120-SDepartment of the Treasury Internal Revenue Service
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U.S. Income Tax Return for an S Corporation ► Do not file this form unless the corporation has filed oris attaching Form 2553 to elect to be an S corporation. ► Go to for instructions and the latest information.
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OMB No. 1545-0123
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2021
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For calendar year 2021 or tax year beginning
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, 2021, ending
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,
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A
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S election effective date 1/15/2012
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TYPEORPRINT
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Premium, Inc.1005 16th StreetCut and Shoot, TX 77303
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D
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Employer identification number11-1111120
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B
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Business activity codenumber (see instructions) 311300
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E
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Date incorporated 1/15/2012
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C
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Check if ScheduleM-3 attached ☐
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F
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Total assets (see instructions)$fill in the blank f9a553ffbf8c05b_1
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G
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Is the corporation electing to be an S corporation beginning with this tax year? See instructions. ☐ Yes ☒ No
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H
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Check if: (1) ☐ Final return (2) ☐ Name change (3) ☐ Address change (4) ☐ Amended return (5) ☐ S election termination
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I
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Enter the number of shareholders who were shareholders during any part of the tax year . . . . . . . . . . . . . . . . . . . . . . . . . . .
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►
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2
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J
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Check if corporation: (1) ☐ Aggregated activities for section 465 at-risk purposes (2) ☐ Grouped activities for section 469 passive activity purposes
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Caution: Include only trade or business income and expenses on lines 1a through 21. See the instructions for more information.
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![]()
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1a
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Gross receipts or sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1a
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fill in the blank f9a553ffbf8c05b_2
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b
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Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1b
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c
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Balance. Subtract line 1b from line 1a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1c
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fill in the blank f9a553ffbf8c05b_3
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2
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Cost of goods sold (attach Form 1125-A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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2
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fill in the blank f9a553ffbf8c05b_4
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3
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Gross profit. Subtract line 2 from line 1c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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3
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fill in the blank f9a553ffbf8c05b_5
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4
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Net gain (loss) from Form 4797, line 17 (attach Form 4797) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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4
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5
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Other income (loss) (see instrs — att statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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5
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6
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Total income (loss). Add lines 3 through 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ►
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6
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fill in the blank f9a553ffbf8c05b_6
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![]()
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7
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Compensation of officers (see instructions – attach Form 1125-E) . . . . . . . . . . . . . . . . . . . . . . . . . .
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7
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fill in the blank f9a553ffbf8c05b_7
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8
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Salaries and wages (less employment credits) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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8
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fill in the blank f9a553ffbf8c05b_8
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9
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Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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9
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fill in the blank f9a553ffbf8c05b_9
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10
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Bad debts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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10
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11
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Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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11
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fill in the blank f9a553ffbf8c05b_10
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12
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Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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12
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fill in the blank f9a553ffbf8c05b_11
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13
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Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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13
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fill in the blank f9a553ffbf8c05b_12
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14
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Depreciation not claimed on Form 1125-A or elsewhere on return (attach Form 4562) . . . . . . . . . . .
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14
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fill in the blank f9a553ffbf8c05b_13
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15
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Depletion (Do not deduct oil and gas depletion.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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15
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16
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Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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16
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fill in the blank f9a553ffbf8c05b_14
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17
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Pension, profit-sharing, etc., plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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17
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18
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Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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18
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19
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Other deductions (attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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19
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fill in the blank f9a553ffbf8c05b_15
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20
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Total deductions. Add lines 7 through 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ►
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20
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fill in the blank f9a553ffbf8c05b_16
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21
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Ordinary business income (loss). Subtract line 20 from line 6 . . . . . . . . . . . . . . . . . . . . . . . . .
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21
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fill in the blank f9a553ffbf8c05b_17
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22a
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Excess net passive income or LIFO recapture tax (see instructions) . . . . . .
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22a
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b
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Tax from Schedule D (Form 1120-S) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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22b
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c
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Add lines 22a and 22b (see instructions for additional taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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22c
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23a
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2021 estimated tax payments and 2020 overpayment credited to 2021 . . .
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23a
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b
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Tax deposited with Form 7004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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23b
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c
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Credit for federal tax paid on fuels (attach Form 4136) . . . . . . . . . . . . . . .
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23c
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d
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Add lines 23a through 23c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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23d
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24
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Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . . . . . . . . . . . . . . ► ☐
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24
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25
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Amount owed. If line 23e is smaller than the total of lines 22c and 24, enter amount owed . . . . . .
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25
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fill in the blank f9a553ffbf8c05b_18
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26
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Overpayment. If line 23e is larger than the total of lines 22c and 24, enter amount overpaid . . . . .
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26
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27
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Enter amount from line 26: Credited to 2022 estimated tax ►
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Refunded ►
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27
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SignHere
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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, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
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►
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►
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May the IRS discuss this return with the preparer shown below? See instructions. ☐ Yes ☐ No
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Signature of officer
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Date
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Title
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Paid Preparer Use Only
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Print/Type preparer's name
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Preparer's signature Self-Prepared
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Date
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Check ☐ if self-employed
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PTIN
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Firm's name ►
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Firm's EIN ►
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Firm's address ►
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Phone no.
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BAA For Paperwork Reduction Act Notice, see separate instructions.
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Form 1120-S (2021)
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Form 1120-S (2021)
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Premium, Inc.
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11-1111120
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Page 2
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Schedule B
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Other Information (see instructions)
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Yes
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No
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1
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Check accounting method:
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a ☐
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Cash
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b ☒
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Accrual
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c ☐
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Other (specify) ►
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2
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See the instructions and enter the:
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a Business activity ►
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Food Processing
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b Product or service ►
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Candy
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3
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At any time during the tax year, was any shareholder of the corporation a disregarded entity, a trust, an estate, or a nominee or similar person? If "Yes," attach Schedule B-1, Information on Certain Shareholders of an S Corporation . . .
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X
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4
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At the end of the tax year, did the corporation:
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a
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Own directly 20% or more, or own, directly or indirectly, 50% or more of the total stock issued and outstanding of any foreign or domestic corporation? For rules of constructive ownership, see instructions. If "Yes," complete (i) through (v) below . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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X
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(i) Name of Corporation
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(ii) Employer Identification Number (if any)
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(iii) Country of Incorporation
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(iv) Percentage of Stock Owned
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(v) If Percentage in (iv) is 100%, Enter the Date (if applicable) a Qualified Subchapter S Subsidiary Election Was Made
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b
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Own directly an interest of 20% or more, or own, directly or indirectly, an interest of 50% or more in the profit, loss, or capital in any foreign or domestic partnership (including an entity treated as a partnership) or in the beneficial interest of a trust? For rules of constructive ownership, see instructions. If "Yes," complete (i) through (v) below . . . . . . . . . . .
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X
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(i) Name of Entity
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(ii) Employer Identification Number (if any)
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(iii) Type of Entity
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(iv) Country of Organization
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(v) Maximum Percentage Owned in Profit, Loss, or Capital
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5 a
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At the end of the tax year, did the corporation have any outstanding shares of restricted stock? . . . . . . . . . . . . . . . . .
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X
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If "Yes," complete lines (i) and (ii) below.
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(i)
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Total shares of restricted stock . . . . . . . . . . . . . . . . . . . . . . . . . . .
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►
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(ii)
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Total shares of non-restricted stock . . . . . . . . . . . . . . . . . . . . . . . .
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►
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b
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At the end of the tax year, did the corporation have any outstanding stock options, warrants, or similar instruments? . . . .
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X
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If "Yes," complete lines (i) and (ii) below.
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(i)
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Total shares of stock outstanding at the end of the tax year
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►
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(ii)
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Total shares of stock outstanding if all instruments were executed
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►
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6
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Has this corporation filed, or is it required to file, Form 8918, Material Advisor Disclosure Statement, to provide information on any reportable transaction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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X
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7
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Check this box if the corporation issued publicly offered debt instruments with original issue discount . . . . . . . . ► ☐
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If checked, the corporation may have to file Form 8281, Information Return for Publicly Offered Original Issue Discount Instruments.
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8
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If the corporation (a) was a C corporation before it elected to be an S corporation or the corporation acquired an asset with a basis determined by reference to the basis of the asset (or the basis of any other property) in the hands of a C corporation and (b) has net unrealized built-in gain in excess of the net recognized built-in gain from prior years, enter the net unrealized built-in gain reduced by net recognized built-in gain from prior years.See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► $
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9
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Did the corporation have an election under section 163(j) for any real property trade or business or any farming business in effect during the tax year? See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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X
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10
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Does the corporation satisfy one or more of the following? See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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X
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a
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The corporation owns a pass-through entity with current, or prior year carryover, excess business interest expense.
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b
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The corporation's aggregate average annual gross receipts (determined under section 448(c)) for the 3 tax years preceding the current tax year are more than $26 million and the corporation has business interest expense.
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c
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The corporation is a tax shelter and the corporation has business interest expense.If "Yes," complete and attach Form 8990.
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11
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Does the corporation satisfy both of the following conditions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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X
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a
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The corporation's total receipts (see instructions) for the tax year were less than $250,000.
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b
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The corporation's total assets at the end of the tax year were less than $250,000.
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If "Yes," the corporation is not required to complete Schedules L and M-1.
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Form 1120-S (2021)
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Premium, Inc.
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11-1111120
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Page 3
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Schedule B
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Other Information (see instructions) (continued)
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Yes
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No
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12
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During the tax year, did the corporation have any non-shareholder debt that was canceled, was forgiven, or had the terms modified so as to reduce the principal amount of the debt? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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X
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If "Yes," enter the amount of principal reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ►
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$
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13
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During the tax year, was a qualified subchapter S subsidiary election terminated or revoked? If "Yes," see instructions . . .
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X
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14 a
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Did the corporation make any payments in 2021 that would require it to file Form(s) 1099? . . . . . . . . . . . . . . . . . . . . .
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X
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b
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If "Yes," did the corporation file or will it file required Form(s) 1099? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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15
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Is the corporation attaching Form 8996 to certify as a Qualified Opportunity Fund? . . . . . . . . . . . . . . . . . . . . . . . . . . .
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X
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If "Yes," enter the amount from Form 8996, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ►
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$
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Schedule K
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Shareholders' Pro Rata Share Items
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Total amount
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![]()
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1
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Ordinary business income (loss) (page 1, line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1
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fill in the blank f9a553ffbf8c05b_19
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2
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Net rental real estate income (loss) (attach Form 8825) . . . . . . . . . . . . . . . . . . . . . . . . . . .
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2
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3 a
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Other gross rental income (loss) . . . . . . . . . . . . . . . . . . . . . . .
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3a
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b
|
Expenses from other rental activities (attach statement) . . . .
|
3b
|
|
|
|
|
|
c
|
Other net rental income (loss). Subtract line 3b from line 3a . . . . . . . . . . . . . . . . . . . . . . . .
|
3c
|
|
|
|
4
|
Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
4
|
fill in the blank f9a553ffbf8c05b_20
|
|
|
5
|
Dividends:
|
a
|
Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
5a
|
|
|
|
|
|
b
|
Qualified dividends . . . . . . . . . . . . . . . . . . . . . .
|
5b
|
|
|
|
|
|
6
|
Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
6
|
|
|
|
7
|
Net short-term capital gain (loss) (attach Schedule D (Form 1120-S)) . . . . . . . . . . . . . . . . . .
|
7
|
|
|
|
8 a
|
Net long-term capital gain (loss) (attach Schedule D (Form 1120-S)) . . . . . . . . . . . . . . . . . .
|
8a
|
|
|
|
b
|
Collectibles (28%) gain (loss) . . . . . . . . . . . . . . . . . . . . . . . . .
|
8b
|
|
|
|
|
|
c
|
Unrecaptured section 1250 gain (attach statement) . . . . . . . .
|
8c
|
|
|
|
|
|
9
|
Net section 1231 gain (loss) (attach Form 4797) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
9
|
|
|
|
10
|
Other income (loss) (see instructions) . . . . . . Type ►
|
10
|
|
|
![]()
|
11
|
Section 179 deduction (attach Form 4562) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
11
|
|
|
|
12a
|
Charitable contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
12a
|
fill in the blank f9a553ffbf8c05b_21
|
|
|
b
|
Investment interest expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
12b
|
|
|
|
c
|
Section 59(e)(2) expenditures . . . . . . . . . . . . Type ► _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
|
12c
|
|
|
|
d
|
Other deductions (see instructions) . . . . . . . . . Type ►
|
12d
|
|
|
![]()
|
13a
|
Low-income housing credit (section 42(j)(5)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
13a
|
|
|
|
b
|
Low-income housing credit (other) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
13b
|
|
|
|
c
|
Qualified rehabilitation expenditures (rental real estate) (attach Form 3468, if applicable) . . .
|
13c
|
|
|
|
d
|
Other rental real estate credits (see instrs) . . Type ► _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
|
13d
|
|
|
|
e
|
Other rental credits (see instructions) . . . . . Type ► _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
|
13e
|
|
|
|
f
|
Biofuel producer credit (attach Form 6478) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
13f
|
|
|
|
g
|
Other credits (see instructions) . . . . . . . . . . Type ►
|
13g
|
|
|
![A picture containing text, font, screenshot, graphic design Description automatically generated]()
|
14
|
Attach Schedule K-2 (Form 1120-S), Shareholders' Pro Rata Share Items—International, and check this box to indicate you are reporting items of international tax relevance . . . . . . . . . . ► ◻
|
|
|
|
![]()
|
15a
|
Post-1986 depreciation adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
15a
|
|
|
|
b
|
Adjusted gain or loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
15b
|
|
|
|
c
|
Depletion (other than oil and gas) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
15c
|
|
|
|
d
|
Oil, gas, and geothermal properties — gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
15d
|
|
|
|
e
|
Oil, gas, and geothermal properties — deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
15e
|
|
|
|
f
|
Other AMT items (attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
15f
|
|
|
![]()
|
16a
|
Tax-exempt interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
16a
|
|
|
|
b
|
Other tax-exempt income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
16b
|
|
|
|
c
|
Nondeductible expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
16c
|
fill in the blank f9a553ffbf8c05b_22
|
|
|
d
|
Distributions (attach stmt if required) (see instrs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
16d
|
fill in the blank f9a553ffbf8c05b_23
|
|
|
e
|
Repayment of loans from shareholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
16e
|
|
|
|
f
|
Other AMT items (attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
16f
|
|
|
|
Form 1120-S (2021)
|
Premium, Inc.
|
11-1111120
|
Page 4
|
|
Schedule K
|
Shareholders' Pro Rata Share Items (continued)
|
Total amount
|
|
![]()
|
17a
|
Investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
17a
|
fill in the blank f9a553ffbf8c05b_24
|
|
|
b
|
Investment expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
17b
|
|
|
|
c
|
Dividend distributions paid from accumulated earnings and profits . . . . . . . . . . . . . . . . . . . . . .
|
17c
|
|
|
|
d
|
Other items and amounts(attach statement)
|
|
|
|
|
![]()
|
18
|
Income (loss) reconciliation. Combine the amounts on lines 1 through 10 in the far right column. From the result, subtract the sum of the amounts on lines 11 through 12d and 16f . . . . .
|
18
|
fill in the blank f9a553ffbf8c05b_25
|
|
Schedule L
|
Balance Sheets per Books
|
Beginning of tax year
|
End of tax year
|
|
|
Assets
|
(a)
|
(b)
|
(c)
|
(d)
|
|
1
|
Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
|
fill in the blank f9a553ffbf8c05b_26
|
|
fill in the blank f9a553ffbf8c05b_27
|
|
2a
|
Trade notes and accounts receivable . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_28
|
|
fill in the blank f9a553ffbf8c05b_29
|
|
|
b
|
Less allowance for bad debts . . . . . . . . . . . . . . .
|
()
|
fill in the blank f9a553ffbf8c05b_30
|
()
|
fill in the blank f9a553ffbf8c05b_31
|
|
3
|
Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
|
fill in the blank f9a553ffbf8c05b_32
|
|
fill in the blank f9a553ffbf8c05b_33
|
|
4
|
U.S. government obligations . . . . . . . . . . . . . . . .
|
|
|
|
|
|
5
|
Tax-exempt securities (see instructions) . . . . . . .
|
|
|
|
|
|
6
|
Other current assets (attach stmt)
|
|
fill in the blank f9a553ffbf8c05b_34
|
|
fill in the blank f9a553ffbf8c05b_35
|
|
7
|
Loans to shareholders . . . . . . . . . . . . . . . . . . . .
|
|
|
|
|
|
8
|
Mortgage and real estate loans . . . . . . . . . . . . . .
|
|
|
|
|
|
9
|
Other investments (attach statement) . . . . . . . .
|
|
|
|
|
|
10a
|
Buildings and other depreciable assets . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_36
|
|
fill in the blank f9a553ffbf8c05b_37
|
|
|
b
|
Less accumulated depreciation . . . . . . . . . . . . . .
|
(fill in the blank f9a553ffbf8c05b_38)
|
fill in the blank f9a553ffbf8c05b_39
|
(fill in the blank f9a553ffbf8c05b_40)
|
fill in the blank f9a553ffbf8c05b_41
|
|
11a
|
Depletable assets . . . . . . . . . . . . . . . . . . . . . . .
|
|
|
|
|
|
b
|
Less accumulated depletion. . . . . . . . . . . . . . . . .
|
()
|
|
()
|
|
|
12
|
Land (net of any amortization) . . . . . . . . . . . . . .
|
|
fill in the blank f9a553ffbf8c05b_42
|
|
fill in the blank f9a553ffbf8c05b_43
|
|
13a
|
Intangible assets (amortizable only) . . . . . . . . . .
|
|
|
|
|
|
b
|
Less accumulated amortization . . . . . . . . . . . . . .
|
()
|
|
()
|
|
|
14
|
Other assets (attach stmt) . . . . . . . . . . . . . . . . .
|
|
|
|
|
|
15
|
Total assets . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
|
fill in the blank f9a553ffbf8c05b_44
|
|
fill in the blank f9a553ffbf8c05b_45
|
|
|
Liabilities and Shareholders' Equity
|
|
|
|
|
|
16
|
Accounts payable . . . . . . . . . . . . . . . . . . . . . . . .
|
|
fill in the blank f9a553ffbf8c05b_46
|
|
fill in the blank f9a553ffbf8c05b_47
|
|
17
|
Mortgages, notes, bonds payable in less than 1 year
|
|
fill in the blank f9a553ffbf8c05b_48
|
|
fill in the blank f9a553ffbf8c05b_49
|
|
18
|
Other current liabilities (attach stmt) . . . . . . . . .
|
|
|
|
|
|
19
|
Loans from shareholders . . . . . . . . . . . . . . . . . .
|
|
|
|
|
|
20
|
Mortgages, notes, bonds payable in 1 year or more
|
|
fill in the blank f9a553ffbf8c05b_50
|
|
fill in the blank f9a553ffbf8c05b_51
|
|
21
|
Other liabilities (attach statement) . . . . . . . . . . .
|
|
|
|
|
|
22
|
Capital stock . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
|
fill in the blank f9a553ffbf8c05b_52
|
|
fill in the blank f9a553ffbf8c05b_53
|
|
23
|
Additional paid-in capital . . . . . . . . . . . . . . . . . .
|
|
|
|
|
|
24
|
Retained earnings . . . . . . . . . . . . . . . . . . . . . . .
|
|
fill in the blank f9a553ffbf8c05b_54
|
|
fill in the blank f9a553ffbf8c05b_55
|
|
25
|
Adjustments to shareholders' equity (attach stmt) . . .
|
|
|
|
|
|
26
|
Less cost of treasury stock . . . . . . . . . . . . . . . . .
|
|
()
|
|
()
|
|
27
|
Total liabilities and shareholders' equity . . . . . . .
|
|
fill in the blank f9a553ffbf8c05b_56
|
|
fill in the blank f9a553ffbf8c05b_57
|
|
|
Form 1120-S (2021)
|
Premium, Inc.
|
11-1111120
|
Page 5
|
|
Schedule M-1
|
Reconciliation of Income (Loss) per Books With Income (Loss) per Return
|
|
|
Note: The corporation may be required to file Schedule M-3. See instructions.
|
|
1
|
Net income (loss) per books . . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_58
|
|
2
|
Income included on Schedule K, lines 1, 2, 3c, 4, 5a, 6, 7, 8a, 9, and 10, not recorded on books this year (itemize): _ _ _ _ _ _ _ _
|
|
|
3
|
Expenses recorded on books this year not included on Schedule K, lines 1 through 12 and 16f (itemize):
|
|
|
a
|
Depreciation $_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
|
|
|
b
|
Travel and entertainment $ _ _ _ _ _ _ _ _
|
|
|
|
|
fill in the blank f9a553ffbf8c05b_60
|
|
4
|
Add lines 1 through 3 . . . . . . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_61
|
|
|
5
|
Income recorded on books this year not included on Schedule K, lines 1 through 10 (itemize):
|
|
|
a
|
Tax-exempt interest $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
|
fill in the blank f9a553ffbf8c05b_62
|
|
6
|
Deductions included on Schedule K, lines 1 through 12 and 16f, not charged against book income this year (itemize):
|
|
|
a
|
Depreciation $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
|
fill in the blank f9a553ffbf8c05b_63
|
|
7
|
Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_64
|
|
8
|
Income (loss) (Schedule K, line 18). Subtract line 7 from line 4 . . . . . . . . . . . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_65
|
|
|
Schedule M–2
|
Analysis of Accumulated Adjustments Account, Shareholders' Undistributed Taxable Income Previously Taxed, Accumulated Earnings and Profits, and Other Adjustments Account(see instructions)
|
|
|
|
|
|
|
(a) Accumulated adjustments account
|
(b) Shareholders' undistributed taxable income previously taxed
|
(c) Accumulated earnings and profits
|
(d) Other adjustments account
|
|
1
|
Balance at beginning of tax year . . . . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_66
|
|
|
|
|
2
|
Ordinary income from page 1, line 21 . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_67
|
|
|
|
|
3
|
Other additions . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_68
|
|
|
|
|
4
|
Loss from page 1, line 21 . . . . . . . . . . . . . . . . . . . .
|
()
|
|
|
|
|
5
|
Other reductions . . . . . . . . . . . . . . . . . . . . . . . . .
|
(fill in the blank f9a553ffbf8c05b_69)
|
|
|
()
|
|
6
|
Combine lines 1 through 5 . . . . . . . . . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_70
|
|
|
|
|
7
|
Distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
fill in the blank f9a553ffbf8c05b_71
|
|
|
|
|
8
|
Balance at end of tax year. Subtract line 7 from line 6.
|
fill in the blank f9a553ffbf8c05b_72
|
|
|
|
|
Form 1120-S (2021)
|
|
Complete Form 1125-A for Premium, Inc.
|
Form 1125-A(Rev. November 2018)Department of the TreasuryInternal Revenue Service
|
Cost of Goods Sold ► Attach to Form 1120, 1120-C, 1120-F, 1120S, or 1065. ► Go to for the latest information.
|
OMB No. 1545-0123
|
|
|
|
|
|
NamePremium, Inc.
|
Employer identification number11-1111120
|
|
1
|
Inventory at beginning of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
1
|
fill in the blank cfdd07065052047_1
|
|
2
|
Purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
2
|
fill in the blank cfdd07065052047_2
|
|
3
|
Cost of labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
3
|
fill in the blank cfdd07065052047_3
|
|
4
|
Additional section 263A costs (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
4
|
|
|
5
|
Other costs (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
5
|
fill in the blank cfdd07065052047_4
|
|
6
|
Total. add lines 1 through 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
6
|
fill in the blank cfdd07065052047_5
|
|
7
|
Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
7
|
fill in the blank cfdd07065052047_6
|
|
8
|
Cost of goods sold. Subtract line 7 from line 6. Enter here and on Form 1120, page 1, line 2 or the appropriate line of your tax return. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
8
|
fill in the blank cfdd07065052047_7
|
|
9 a
|
Check all methods used for valuing closing inventory:
|
|
|
(i) ☐ Cost
|
|
|
(ii) ☐ Lower of cost or market
|
|
|
(iii) ☐ Other (Specify method used and attach explanation.) ►
|
|
b
|
Check if there was a writedown of subnormal goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► ☐
|
|
c
|
Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) . . . . . . . . . . . . . . . . . ► ☐
|
|
d
|
If the LIFO inventory method was used for this tax year, enter amount of closing inventory computed under LIFO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
9d
|
|
|
e
|
|
If property is produced or acquired for resale, do the rules of section 263A apply to the entity? See instructions . . . .
|
☐ Yes ☐ No
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f
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Was there any change in determining quantities, cost, or valuations between opening and closing inventory? If"Yes," attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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☐ Yes ☐ No
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Prepare the Schedule K–1 for John Parsons.
If required, round amounts to the nearest dollar.
Note:Box 12: Code A is is to report cash charitable contributions.Box 16: Code C is used to report nondeductible expenses, and Code D is used to report distributions not reported on Form 1099-DIV.Box 17: Code A is used to report Investment income, Code AC is used to report gross receipts for Section 448(c) purposes.
Box 17: Code V is used to report information required for the QBI deduction. You are not required to provide a statement of the QBI items.
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671120
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◻ Final K-1
|
◻ Amended K-1
|
OMB No. 1545-0123
|
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Schedule K-1 (Form 1120-S)
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2021
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Part III
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Shareholder's Share of Current Year Income,
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|
|
|
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Deductions, Credits, and Other Items
|
|
Department of the Treasury Internal Revenue Service
|
For calendar year 2021, or tax
|
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1
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Ordinary business income (loss)
fill in the blank c53596078fd2006_1
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13
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Credits
|
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2
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Net rental real estate income (loss)
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3
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Other net rental income (loss)
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4
|
Interest income
fill in the blank c53596078fd2006_2
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5a
|
Ordinary dividends
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5b
|
Qualified dividends
|
14
|
Schedule K-3 is attached if checked . . . . . . . . . ► ◻
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6
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Royalties
|
15
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Alternative minimum tax (AMT) items
|
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7
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Net short-term capital gain (loss)
|
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8a
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Net long-term capital gain (loss)
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8b
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Collectibles (28%) gain (loss)
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8c
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Unrecaptured section 1250 gain
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9
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Net section 1231 gain(loss)
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16C
|
Items affecting shareholder basis
fill in the blank c53596078fd2006_3
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10
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Other income (loss)
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D
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fill in the blank c53596078fd2006_4
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17A
|
Other information
fill in the blank c53596078fd2006_5
|
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11
|
Section 179 deduction
|
AC
|
fill in the blank c53596078fd2006_6
|
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12A
|
Other deductions
fill in the blank c53596078fd2006_7
|
V*
|
STMT
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18 ☐ More than one activity for at-risk purposes* 19 ☐ More than one activity for passive activity purposes*
|
|
*See attached statement for additional information.
|
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Shareholder's Share of Income, Deductions,Credits, etc. ► See separate instructions.
|
|
|
Part I Information About the Corporation
|
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A
|
Corporation's employer identification number 11-1111120
|
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B
|
Corporation's name, address, city, state, and ZIP code Premium, Inc.1005 16th StreetCut and Shoot, TX 77303
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C
|
IRS Center where corporation filed return e-file
|
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D
|
Corporation's total number of shares
|
|
|
Beginning of tax year . . . . . . . . . . . .
|
fill in the blank c53596078fd2006_8
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|
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End of tax year . . . . . . . . . . . . . . . .
|
fill in the blank c53596078fd2006_9
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Part II Information About the Shareholder
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E
|
Shareholder's identifying number 123-45-6781
|
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F
|
Shareholder's name, address, city, state, and ZIP code John Parsons5607 20th StreetCut and Shoot, TX 77303
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G
|
Current year allocation percentage . . .
|
fill in the blank c53596078fd2006_10 %
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|
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H
|
Shareholder's number of shares
|
|
|
Beginning of tax year . . . . . . . . . . . .
|
fill in the blank c53596078fd2006_11
|
|
|
End of tax year . . . . . . . . . . . . . . . .
|
fill in the blank c53596078fd2006_12
|
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I
|
Loans from shareholder
|
|
|
Beginning of tax year . . . . . . . . . . . .
|
$
|
|
|
End of tax year . . . . . . . . . . . . . . . .
|
$
|
|
|
|
![]()
|
|
|
Complete Statement A—QBI Pass-through Entity Reporting (Schedule K-1, Box 17, Code V) for Premium, Inc.
|
Statement A—QBI Pass-through Entity Reporting (Schedule K-1, Box 17, Code V)
|
|
Partnership's name:
|
Premium, Inc.
|
Partnership's EIN:
|
11-1111120
|
|
Partner's name:
|
John Parsons
|
Partner's identifying number:
|
123-45-6781
|
|
|
|
Partner's share of:
|
Premium, Inc.
|
|
|
|
|
☐ PTP☐ Aggregated☐ SSTB
|
☐ PTP☐ Aggregated☐ SSTB
|
☐ PTP☐ Aggregated☐ SSTB
|
|
QBI or qualified PTP items subject to partner-specific determinations:
|
|
|
Ordinary business income (loss)
|
fill in the blank e1493a03e07efb0_1
|
|
|
|
|
Rental income (loss) . . . . . . . . .
|
|
|
|
|
|
Royalty income (loss) . . . . . . . .
|
|
|
|
|
|
Section 1231 gain (loss) . . . . . .
|
|
|
|
|
|
Other income (loss). . . . . . . . . .
|
|
|
|
|
|
Section 179 deduction. . . . . . . .
|
|
|
|
|
|
Other deductions. . . . . . . . . . . .
|
|
|
|
|
W-2 wages . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
fill in the blank e1493a03e07efb0_2
|
|
|
|
UBIA of qualified property. . . . . . . . . . . . . . . .
|
fill in the blank e1493a03e07efb0_3
|
|
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|
Section 199A dividends
|
|
|
|
|
|
Partner's share of:
|
|
|
|
|
|
☐ PTP☐ Aggregated☐ SSTB
|
☐ PTP☐ Aggregated☐ SSTB
|
☐ PTP☐ Aggregated☐ SSTB
|
|
QBI or qualified PTP items subject to partner-specific determinations:
|
|
|
Ordinary business income (loss)
|
|
|
|
|
|
Rental income (loss) . . . . . . . . .
|
|
|
|
|
|
Royalty income (loss) . . . . . . . .
|
|
|
|
|
|
Section 1231 gain (loss) . . . . . .
|
|
|
|
|
|
Other income (loss). . . . . . . . . .
|
|
|
|
|
|
Section 179 deduction. . . . . . . .
|
|
|
|
|
|
Other deductions. . . . . . . . . . . .
|
|
|
|
|
W-2 wages . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
|
|
|
|
UBIA of qualified property. . . . . . . . . . . . . . . .
|
|
|
|
|
Prepare the Schedule K-1 for George Smith.
If required, round amounts to the nearest dollar.
Note:Box 12: Code A is is to report cash charitable contributions.Box 16: Code C is used to report nondeductible expenses, and Code D is used to report distributions not reported on Form 1099-DIV.Box 17: Code A is used to report Investment income, Code AC is used to report gross receipts for Section 448(c) purposes.
Box 17: Code V is used to report information required for the QBI deduction. You are not required to provide a statement of the QBI items.
|
|
671120
|
|
|
◻ Final K-1
|
◻ Amended K-1
|
OMB No. 1545-0123
|
|
Schedule K-1 (Form 1120-S)
|
2021
|
Part III
|
Shareholder's Share of Current Year Income,
|
|
|
|
|
Deductions, Credits, and Other Items
|
|
Department of the Treasury Internal Revenue Service
|
For calendar year 2021, or tax
|
|
1
|
Ordinary business income (loss)
fill in the blank 727906f9500af87_1
|
13
|
Credits
|
|
2
|
Net rental real estate income (loss)
|
|
|
|
3
|
Other net rental income (loss)
|
|
|
|
4
|
Interest income
fill in the blank 727906f9500af87_2
|
|
|
|
5a
|
Ordinary dividends
|
|
|
|
5b
|
Qualified dividends
|
14
|
Schedule K-3 is attached if checked . . . . . . . . . ► ◻
|
|
6
|
Royalties
|
15
|
Alternative minimum tax (AMT) items
|
|
7
|
Net short-term capital gain (loss)
|
|
|
|
8a
|
Net long-term capital gain (loss)
|
|
|
|
8b
|
Collectibles (28%) gain (loss)
|
|
|
|
8c
|
Unrecaptured section 1250 gain
|
|
|
|
9
|
Net section 1231 gain(loss)
|
16C
|
Items affecting shareholder basis
fill in the blank 727906f9500af87_3
|
|
10
|
Other income (loss)
|
D
|
fill in the blank 727906f9500af87_4
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17A
|
Other information
fill in the blank 727906f9500af87_5
|
|
11
|
Section 179 deduction
|
AC
|
fill in the blank 727906f9500af87_6
|
|
12A
|
Other deductions
fill in the blank 727906f9500af87_7
|
V*
|
STMT
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
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|
|
|
|
|
|
|
18 ☐ More than one activity for at-risk purposes* 19 ☐ More than one activity for passive activity purposes*
|
|
*See attached statement for additional information.
|
|
|
|
|
|
Shareholder's Share of Income, Deductions,Credits, etc. ► See separate instructions.
|
|
|
Part I Information About the Corporation
|
|
|
A
|
Corporation's employer identification number 11-1111120
|
|
|
|
B
|
Corporation's name, address, city, state, and ZIP code Premium, Inc.1005 16th StreetCut and Shoot, TX 77303
|
|
|
|
C
|
IRS Center where corporation filed return e-file
|
|
|
|
D
|
Corporation's total number of shares
|
|
|
Beginning of tax year . . . . . . . . . . . .
|
fill in the blank 727906f9500af87_8
|
|
|
End of tax year . . . . . . . . . . . . . . . .
|
fill in the blank 727906f9500af87_9
|
|
|
|
Part II Information About the Shareholder
|
|
|
E
|
Shareholder's identifying number 123-45-6782
|
|
|
|
F
|
Shareholder's name, address, city, state, and ZIP code George Smith5607 20th StreetCut and Shoot, TX 77303
|
|
|
|
G
|
Current year allocation percentage . . .
|
fill in the blank 727906f9500af87_10 %
|
|
|
|
H
|
Shareholder's number of shares
|
|
|
Beginning of tax year . . . . . . . . . . . .
|
fill in the blank 727906f9500af87_11
|
|
|
End of tax year . . . . . . . . . . . . . . . .
|
fill in the blank 727906f9500af87_12
|
|
|
|
I
|
Loans from shareholder
|
|
|
Beginning of tax year . . . . . . . . . . . .
|
$
|
|
|
End of tax year . . . . . . . . . . . . . . . .
|
$
|
|
|
|
![]()
|
|
|
Complete Statement A—QBI Pass-through Entity Reporting (Schedule K-1, Box 17, Code V) for Premium, Inc.
|
Statement A—QBI Pass-through Entity Reporting (Schedule K-1, Box 17, Code V)
|
|
Partnership's name:
|
Premium, Inc.
|
Partnership's EIN:
|
11-1111120
|
|
Partner's name:
|
George Smith
|
Partner's identifying number:
|
123-45-6782
|
|
|
|
Partner's share of:
|
Premium, Inc.
|
|
|
|
|
☐ PTP☐ Aggregated☐ SSTB
|
☐ PTP☐ Aggregated☐ SSTB
|
☐ PTP☐ Aggregated☐ SSTB
|
|
QBI or qualified PTP items subject to partner-specific determinations:
|
|
|
Ordinary business income (loss)
|
fill in the blank 1f335707ef87009_1
|
|
|
|
|
Rental income (loss) . . . . . . . . .
|
|
|
|
|
|
Royalty income (loss) . . . . . . . .
|
|
|
|
|
|
Section 1231 gain (loss) . . . . . .
|
|
|
|
|
|
Other income (loss). . . . . . . . . .
|
|
|
|
|
|
Section 179 deduction. . . . . . . .
|
|
|
|
|
|
Other deductions. . . . . . . . . . . .
|
|
|
|
|
W-2 wages . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
fill in the blank 1f335707ef87009_2
|
|
|
|
UBIA of qualified property. . . . . . . . . . . . . . . .
|
fill in the blank 1f335707ef87009_3
|
|
|
|
Section 199A dividends
|
|
|
|
|
|
Partner's share of:
|
|
|
|
|
|
☐ PTP☐ Aggregated☐ SSTB
|
☐ PTP☐ Aggregated☐ SSTB
|
☐ PTP☐ Aggregated☐ SSTB
|
|
QBI or qualified PTP items subject to partner-specific determinations:
|
|
|
Ordinary business income (loss)
|
|
|
|
|
|
Rental income (loss) . . . . . . . . .
|
|
|
|
|
|
Royalty income (loss) . . . . . . . .
|
|
|
|
|
|
Section 1231 gain (loss) . . . . . .
|
|
|
|
|
|
Other income (loss). . . . . . . . . .
|
|
|
|
|
|
Section 179 deduction. . . . . . . .
|
|
|
|
|
|
Other deductions. . . . . . . . . . . .
|
|
|
|
|
W-2 wages . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
|
|
|
|
UBIA of qualified property. . . . . . . . . . . . . . . .
|
|
|
|
|
|
Form 1125-E(Rev October 2016)Department of the TreasuryInternal Revenue Service
|
Compensation of Officers ► Attach to Form 1120, 1120-C, 1120-F, 1120-REIT, 1120-RIC, or 1120S► Information about Form 1125-E and its separate instructions is at .
|
OMB No. 1545-0123
|
|
NamePremium, Inc.
|
Employer identification number11-1111120
|
|
Note: Complete Form 1125-E only if total receipts are $500,000 or more. See instructions for definition of total receipts.
|
|
1 (a) Name of officer
|
(b) Social security number(see instructions)
|
(c) Percent of time devoted to business
|
Percent of stock owned
|
(f) Amount of compensation
|
|
|
|
|
(d) Common
|
(e) Preferred
|
|
|
John Parsons
|
123-45-6781
|
fill in the blank c9270e044044026_1%
|
fill in the blank c9270e044044026_2%
|
%
|
fill in the blank c9270e044044026_3
|
|
George Smith
|
123-45-6782
|
fill in the blank c9270e044044026_4%
|
fill in the blank c9270e044044026_5%
|
%
|
fill in the blank c9270e044044026_6
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
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|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
|
|
%
|
%
|
%
|
|
|
2
|
Total compensation of officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
2
|
fill in the blank c9270e044044026_7
|
|
3
|
Compensation of officers claimed on Form 1125-A or elsewhere on return . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
3
|
|
|
4
|
Subtract line 3 from line 2. Enter the result here and on Form 1120, page 1, line 12 or the appropriate line of your tax return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
4
|
fill in the blank c9270e044044026_8
|
Complete Federal Statements for Premium, Inc.
|
2021
|
Federal Statements
|
Page 1
|
|
|
Premium, Inc.
|
11-1111120
|
|
|
Statement 1Form 1120S, Line 19Other Deductions
|
|
|
Other Deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
$fill in the blank d3cf1f0a1028fa8_1
|
|
Total
|
$fill in the blank d3cf1f0a1028fa8_2
|
|
|
|
|
Statement 2Form 1120S, Schedule K, Line 12aCharitable Contributions
|
|
|
Cash Contributions – 60% Limitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
$fill in the blank d3cf1f0a1028fa8_3
|
|
Total
|
$fill in the blank d3cf1f0a1028fa8_4
|
|
|
|
|
Statement 3Form 1120S, Schedule K, Line 17dOther Items and Amounts
|
|
|
Gross Receipts for Section 448(c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
$fill in the blank d3cf1f0a1028fa8_5
|
|
|
|
|
Statement 4Form 1120S, Schedule L, Line 6Other Current Assets
|
|
|
|
|
Beginning
|
|
Ending
|
|
|
Prepaid Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
$fill in the blank d3cf1f0a1028fa8_6
|
|
$fill in the blank d3cf1f0a1028fa8_7
|
|
|
Total
|
$fill in the blank d3cf1f0a1028fa8_8
|
|
$fill in the blank d3cf1f0a1028fa8_9
|
|
|
|
|
|
|
Statement 5Form 1120S, Schedule M-1, Line 3Expenses On Books Not On Schedule K
|
|
|
Penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
|
$fill in the blank d3cf1f0a1028fa8_10
|
|
Total
|
$fill in the blank d3cf1f0a1028fa8_11
|
|
|
|
|
Statement 6Form 1120S, Schedule M-2, Column A, Line 3Other Additions
|
|
|
Interest Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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$fill in the blank d3cf1f0a1028fa8_12
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Total
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$fill in the blank d3cf1f0a1028fa8_13
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2021
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Federal Statements
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Page 2
|
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Premium, Inc.
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11-1111120
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|
|
`
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Statement 7Form 1120S, Schedule M-2, Column A, Line 5Other Reductions
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|
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Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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$fill in the blank d3cf1f0a1028fa8_14
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Penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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$fill in the blank d3cf1f0a1028fa8_15
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Total
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$fill in the blank d3cf1f0a1028fa8_16
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Statement 8Form 1125-A, Line 5Other Costs
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Direct other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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$fill in the blank d3cf1f0a1028fa8_17
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Total
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$fill in the blank d3cf1f0a1028fa8_18
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|
|
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|
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