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1350

STATE OF SOUTH CAROLINA
ANNUAL REPORT OF ELECTRIC COOPERATIVE CL-4
CORPORATION PROPERTY AND GROSS RECEIPTS (Rev. 08/4/20)
dor.sc.gov Due by the 15th day of the fourth month following the close of the taxable year. 3135

SC file #
Return for period ending - -
License Fee period ending - -

FEIN
Name
Mailing address
City State ZIP
Change of Address Initial Return Final Amended
Check if you filed a federal or state extension
PART I COMPUTATION OF LICENSE FEE - ELECTRIC COOPERATIVES
1. Fair market value of property owned and used to conduct business in SC as determined by the
SCDOR for Property Tax purposes for the preceding tax year ....................................................... 1. $ 00
2. License Fee: fair market value component (multiply line 1 by .001)................................................. 2. 00
(A) Total System (B) In South Carolina
Operating revenues (list below):
$ 00 00
00 00
00 00
00 00
3. Total operating revenues .................................................................. 3. 00 3. 00
Other receipts (list below):
00 00
00 00
00 00
00 00
4. Total other receipts.......................................................................... 4. 00 4. 00
5. Total gross receipts (add line 3 and line 4) ........................................... 5. 00 5. 00
6. License Fee: gross receipts component (multiply line 5, column B by .003) .............................. 6. 00
7. Total License Fee (add line 2 and line 6, cannot be less than $25) ......................................... 7. 00
8. Section 12-20-105 Credit (see Part II and instructions)......................................................... 8. 00
9. Balance of License Fee (subtract line 8 from line 7, cannot be less than zero) .......................... 9. 00
10. Interest 00 Penalty 00.................... 10. 00
11. Total License Fee, Interest, and Penalty (add line 9 and line 10)..................... BALANCE DUE 11. 00
PART II INFRASTRUCTURE CREDIT INFORMATION
Unused Infrastructure Credit Infrastructure Credit Infrastructure Credit Infrastructure Credit Carried
Carried Forward from Last Year Earned This Year Taken This Year Forward for One Year Only
$ $$ $

Describe the types of infrastructure provided by the taxpayer to eligible projects. Types of infrastructure are listed in SC Code Section
12-20-105(C). Eligible projects are described in SC Code Section 12-20-105(B).

31351034

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CL-4
PART III                       ANNUAL REPORT TO BE COMPLETED BY ALL ELECTRIC COOPERATIVES
 1.   Name  
 2.   Organized under the laws of the state of  
 3.   Location of the registered office of the Cooperative in South Carolina  
       In the city of                                        Registered agent at this address  
 4.   Principal office address 
 5.   Total number of authorized shares of capital stock, itemized by class and series, if any, within each class: 
                  Number of shares                                      Class                                                                     Series 
  
 6.   Total number of issued and outstanding shares of capital stock itemized by class and series, if any, within each class: 
                  Number of shares                                      Class                                                                     Series 
  
 7.   Names and business addresses of the directors (or individuals functioning as directors) and principal officers in the Cooperative: 
       Attach separate schedules if you need more space. 
 Name          Title                Business address 

  8.   Date organized                                                Date commenced business in South Carolina   
  9.   Date of this report                                                                                                      FEIN 
10.   If foreign entity, the date qualified to do business in South Carolina 
11.   Was the name of the Cooperative changed during the year?                          Previous name 
12.   The Cooperative's books are in the care of 
        Located at (street address) 

          Under penalty of law, I certify that I have examined this return, including accompanying annual report, statements, and schedules, 
          and it is true and complete to the best of my knowledge.
Sign 
Here
          Signature of officer                                               Officer's title                                              Email

          Print officer's name                                               Date                                   Phone number
          I authorize the Director of the SCDOR or delegate to discuss this return,                                                     Preparer's printed name
          attachments, and related tax matters with the preparer.                               Yes  No
Paid      Preparer's                                                         Date                    Check if                             Preparer's phone number
          signature
Preparer's                                                                                           self-employed
          Firm's name (or                                                                                                            PTIN or FEIN
Use Only  yours if self-employed) 
          and address                                                                                                                ZIP
If this is an Electric Cooperative's final return, signing here authorizes the SCDOR to disclose that information with the South Carolina Secretary of 
State (SCSOS). You must close with the SCSOS and the SCDOR.

Signature                                                                                                                                 Date
                                         Attach a complete copy of your federal return.
Payments: Pay online using our free tax portal, MyDORWAY, at dor.sc.gov/pay. Select Business Income Tax Payment to get 
started. If you pay by check, make your check payable to SCDOR and include your name, FEIN, tax year, and CL-4 in the memo.

            Mail Balance Due returns to:                                                             Mail Refund or Zero Tax returns to: 
                               SCDOR                                                                                                     SCDOR 
                      Corporate Taxable                                                                                               Corporate Refund 
                      PO Box 100151                                                                                                     PO Box 125 
                      Columbia, SC 29202                                                                                             Columbia, SC 29214-0032

          31352032

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INSTRUCTIONS
Electric Cooperatives are subject to an annual License Fee according to SC Code Section 12-20-100. The License Fee
equals 0.1% (rounded up) of the fair market value of property owned and used in South Carolina to conduct business, as
determined by the SCDOR for the prior year's Property Tax. Distribution Electric Cooperatives must add 0.3% (rounded
up) of gross receipts from services rendered from regulated business in South Carolina during the prior tax year. The
minimum License Fee is $25.

Line 1: The fair market value of property owned and used in the conduct of business in South Carolina is the tax
assessment value divided by 10.5%. This amount is shown on the PT-422, South Carolina Property Tax Proposed
Assessment.

Line 5: Gross receipts, as used in SC Code Section 12-20-100, include all receipts from operations in South Carolina,
and other profit and loss items located in South Carolina. Income from intangibles used to conduct business in South
Carolina is also included in gross receipts. For more information, see SC Regulation 117-1075.1 at dor.sc.gov/policy.

Line 8: If the company paid cash to provide infrastructure for a qualifying project, enter the amount of credit applied on
line 8 and complete Part II. Attach a schedule to the return that includes the following:
• the name of the person completing the project
• a description of the project
• the sections of the statute the project qualifies under
• the amounts paid in cash
• recipient and date of payment
• a description of the infrastructure provided
• the date the infrastructure was completed or is expected to be completed

If the infrastructure has not been completed as of the date the return is filed, include a waiver of the statute of limitations.
The maximum credit for a single tax year may not exceed $400,000. If the credit is more than the tax liability, the excess
may be carried forward and deducted in the following tax year. For more information see SC Code Section 12-20-105 and
SC Revenue Ruling #18-8 at dor.sc.gov/policy.

Line 10: See the SC1120 Instructions for information on calculating interest and penalties. Forms are available at dor.sc.
gov/forms. A Penalty and Interest Calculator is available on our free tax portal, MyDORWAY, at dor.sc.gov/calculator.

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