SCHEDULE I-1  
(Form 5471)                     Information for Global Intangible Low-Taxed Income
(Rev. December 2021)                                                                                                          OMB No. 1545-0123
                                                        ▶
Department of the Treasury                                 Attach to Form 5471.
Internal Revenue Service              ▶ Go to www.irs.gov/Form5471 for instructions and the latest information.
Name of person filing Form 5471                                                                                  Identifying number

Name of foreign corporation                                           EIN (if any)                               Reference ID number (see instructions)

    Separate Category (Enter code–see instructions.)       .      . . . .         . .  . . . . .      .        . . . .  ▶
                                                                                           Functional              Conversion       U.S. Dollars
                                                                                           Currency                Rate
1   Gross income (see instructions if cost of goods sold exceed gross 
    receipts) .            . .  . . . . . .   . . .   .  . .      . . . .           1
2   Exclusions (see instructions if cost of goods sold exceed gross receipts)
a   Effectively connected income .        .   . .     2a 
b   Subpart F income  .           . . . . .   . .     2b 
c   High-tax  exception  income  per  section 
    954(b)(4)  .           . .  . . . . . .   . .     2c
d   Related party dividends  .        . . .   . .     2d
e   Foreign oil and gas extraction income       .     2e
3   Total exclusions (combine lines 2a through 2e)       . .      . . . .           3
4   Gross  income  less  total  exclusions  (line  1  minus  line  3)  (see 
    instructions)  .         .  . . . . . .   . . .   .  . .      . . . .           4
5   Deductions properly allocable to amount on line 4  .          . . . .           5
6   Tested income (loss) (line 4 minus line 5) (see instructions) .   . .           6
7   Tested foreign income taxes         . .   . . .   .  . .      . . . .           7
8   Qualified business asset investment (QBAI) .      .  . .      . . . .           8
9a  Interest expense included on line 5       . .     9a 
b   Qualified interest expense        . . .   . .     9b 
c   Tested loss QBAI amount           . . .   . .     9c 
d   Tested interest expense (line 9a minus the sum of line 9b and line 
    9c). If zero or less, enter -0-  .  . .   . . .   .  . .      . . . .           9d
10a Interest income included in line 4 .      . .     10a 
b   Qualified interest income .       . . .   . .     10b 
c   Tested  interest  income  (line  10a  minus  line  10b).  If  zero  or  less, 
    enter -0- .            . .  . . . . . .   . . .   .  . .      . . . .           10c
For Paperwork Reduction Act Notice, see instructions.                 Cat. No. 71400M                            Schedule I-1 (Form 5471) (Rev. 12-2021)