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04 Form IT-20S                                         Indiana Department of Revenue
   State Form 10814
05 (R21 / 8-22)                             Indiana S Corporation  Income  Tax  Return                                                     2022
06                                                for Calendar Year Ending December  31, 2022
07
                                                                                         AA                                                BB
08                     or  Other Tax Year Beginning                         99    99     2022 and Ending           99           99 9999
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10 Check box if amended. X               A1                                                                              Check box if name changed. X   B1
11 Name of Corporation                                                                                          B  Federal Employer Identification Number       A
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13 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                9999999999
14 Number and Street                                                           C  Principal Business Activity Code       D      Foreign Country 2-Character Code
15                                                                                                                                                E
16   XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                      99999999                                  XX
17 City                                              F                      State        G   2-Digit County Code                ZIP Code  I
18                                                                                                                       H
19       XXXXXXXXXXXXXXXXXXXX                                                     XX                            XX              999999999         M. Year of initial 
20 Telephone Number                      J     K. Date of incorporation           1   In the State of           2 L. State of commercial domicile Indiana return
21
22         9999999999                          99  99                       9999            XX                                  XX                 9999
23                                             1                            2           3
24 N. Accounting method:  Cash  X          Accrual           X                 Other  X  O. Date of election as S corporation      99      99          9999
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26 P. Check all boxes that apply to entity: 
27                     1                           2                                       3                                     4
28    Initial Return                   X Final Return                     X In Bankruptcy                    X Composite Return X
29                                                     1                                                                                 2
30 Q. Enter total number of shareholders:        9999         W. Enter number of nonresident shareholders:                       9999
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32 R. I have on file a valid extension of time to file my return (federal Form 7004  or an electronic extension of time).                X
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34 S. The corporation filed as a C corporation for the prior tax period.              X     
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36 T. This corporation is a member of a partnership.  X                           
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38 U. This entity reports income from disregarded entities.                 X                  V. Check box if reporting a credit on Schedule IT-20REC X
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40                                                                                                                                       Round all entries
41 Schedule A - S Corporation Adjusted Gross Income
42   1.  Total net income (loss) from U.S. S corporation return, Form 1120S Schedule K  
43       (see instructions); use minus sign for negative amounts                                                                   1     99999999999.     00
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45   2.  a. Enter name of addback or deduction (see instructions)                     XXXXXXXX                 Code. No. 999       2a    99999999999.00               
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47       b. Enter name of addback or deduction     XXXXXXXXXXXXXXXXXX                                          Code. No. 999       2b    99999999999.00 
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49       c. Enter name of addback or deduction     XXXXXXXXXXXXXXXXXX                                          Code. No. 999       2c    99999999999.00 
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51       d. Enter name of addback or deduction     XXXXXXXXXXXXXXXXXX                                          Code. No. 999       2d    99999999999.00 
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53       e. Enter name of addback or deduction     XXXXXXXXXXXXXXXXXX                                          Code. No. 999       2e    99999999999.00
54       f . Enter the total amount of addbacks and deductions from any additional sheets (use a 
55            minus sign for negative amount)                                                                                      2f    99999999999.00
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57   3.  Total S corporation income, as adjusted (add lines 1 through 2f)                                                          3     99999999999.00
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59   4.  Enter percentage for Indiana apportioned adjusted gross income from IT-20S Schedule E line 9                              4     999. 99                %
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04
05 Schedule B - Excess Net Passive Income & Built-In Gains
06
07 5.  LIFO recapture income (see instructions)                                                             5       99999999999.00 
08
09 6.  Excess net passive income from federal worksheet                                                     6       99999999999.00
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11 7.   Built-in gains from federal Schedule D (1120S)                                                      7       99999999999.00
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13 8.   Add the amounts on lines 5 through 7                                                                8       99999999999.00 
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15 9.  Taxable income apportioned to Indiana (multiply line 8 by line 4) (if applicable)                    9       99999999999.00
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17 10.  Pre-conversion Indiana Net Operating Loss (see instructions)                                        10      99999999999.00
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19 11.  Taxable income after loss. Line 9 minus line 10                                                     11      99999999999.00
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21 12.  Corporate adjusted gross income tax rate (*see instructions for line 12)                                    X tax rate
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23 13.  Total income tax from Schedule B (multiply line 11 by percent on line 12)                           13      99999999999.00
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25 Summary of Calculations
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27 14.  Sales/use tax on purchases subject to use tax from Sales/Use Tax Worksheet                          14      99999999999.00
28
29 15.  Total composite tax from completed Schedule Composite (15G). Enclose schedule                       15      99999999999.00
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31 16.  Total tax (add lines 13-15). If line 16 is zero, see line 25                                        16      99999999999.00
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33 17.  Total amount of pass-through withholding (enclose IN K-1 from the paying entity)                    17      99999999999.00
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35 18.  Total composite withholding IT-6WTH payments (see instructions)                                       18    99999999999.00
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37 19.  Other payments/credits (enclose supporting documentation)                                           19      99999999999.00
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39 20.  EDGE credit. Enter the total EDGE credit amount claimed (line 19 on Schedule IN-EDGE)               20      99999999999.00
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41 21.  EDGE-R credit. Enter the total EDGE-R credit amount claimed (line 19 on Schedule IN-EDGE-R)   21            99999999999.00
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43 22.  Other certified credits. Enter the total credit amount claimed (“Total” line from Schedule IN-OCC)  22      99999999999.00
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45 23.  Subtotal (line 16 minus lines 17-22). If total is greater than zero, proceed to lines 24-26         23      99999999999.00
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47 24.  Interest: Enter total interest due; see instructions (contact the department for current interest rate)  24 99999999999.00
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49 25.  Penalty: If paying late, enter 10% of line 23; see instructions. If line 16 is zero, enter $10 per  
50      day filed past due date                                                                             25      99999999999.00
51 26.  Penalty: If failing to include all nonresident shareholders on composite return, enter $500;  
52      see instructions                                                                                    26      99999999999.00
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54 27.  Total Amount Due: Add lines 23-26. If less than zero, enter on line 28. Make check payable to:  
55      Indiana Department of Revenue. Make payment in U.S. funds                                           27      99999999999.00
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57 28.  Overpayment and Refund Amount: Line 17 plus lines 18-22, minus lines 16 and 24-26.  
58      No carryforward allowed.                                                                            28      99999999999.00
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04
05
06 Certification of Signatures and Authorization Section
   Under penalties of perjury, I declare I have examined this return, including all accompanying schedules and statements, and to  
07                                                                                                                                 EE
   the best of my knowledge and belief it is true, correct, and complete.
08                                                                       Paid Preparer’s
09                                                                       Email Address    XXXXXXXXXXXXXXXXXXXXXX
10
11  I authorize the Department to discuss my return with my              Paid Preparer: Firm’s Name (or yours if self-employed)    FF
12  personal representative (see instructions).
13    1          2                                                       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
14  X     Y  X       N                                                   Paid Preparer’s Name                                      WW
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16  Personal Representative’s Name (please print)        QQ              XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
17                                                                                                 NN
18  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                  PTIN      999999999
19  Email                                                RR                                                                        PP
20  Address                                                              Telephone Number     9999999999
21          999999999999999999999999999999                                                                                           GG
22  Signature of                                                         Address XXXXXXXXXXXXXXXXXXXXXXXXXXXXX
23  Corporate Officer __________________________________                                                                             HH
24                                                                       City  XXXXXXXXXXXXXXXXXXXXXXXXXXXXX
25                                                                       II                        JJ
26  Date  99     99    9999                                              State        XX           ZIP Code+4 999999999
27
28  Print or Type Name of Corporate Officer              LL              Paid Preparer’s Signature ____________________________
29
30  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
31  Title                                               MM               Date  99       99    9999
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33  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
34
35  If you owe tax, please mail your return to IN Department of          If you do not owe any tax, mail it to IN Department of Revenue, 
36    Revenue, PO Box 7205, Indianapolis, IN 46207-7205.                           PO Box 7147, Indianapolis, IN 46207-7147.
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