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SCHEDULE K                      Shareholder's Statement of IC-DISC Distributions                                                        OMB No. 1545-0123
(Form 1120-IC-DISC)                            For calendar year 20                             or tax year
(Rev. November 2018)                                                                                                                   COPY A—Attach to 
                             beginning                                          , 20   , ending                            , 20
Department of the Treasury                                                                                                             Form 1120-IC-DISC
Internal Revenue Service        (Complete for each shareholder. See instructions on back of Copy C.)
Part I   Taxable Distributions
1  Deemed distributions:     a Under section 995(b)(1)  .                            . . . .    . .        . . . . .       .   . .   . 1a
                             b Annual installment under section 995(b)(2)  .                               . . . . .       .   . .   . 1b
                             c Total. Add lines 1a and 1b .                            . . .    . .        . . . . .       .   . .   . 1c
2  Actual taxable distributions  .     . . . . . .                              . .  . . . .    . .        . . . . .       .   . .   . 2
3  Total taxable distributions. Add line 1c and line 2. Enter here and in Section A or B below .                                 .   . 3
Section A—C Corporations
4a Part of line 3 above entitled to section 243 dividends-received deduction .                               . . . .       .   . .   . 4a
b  Part of line 3 above not entitled to section 243 dividends-received deduction  .                              . .       .   . .   . 4b
Section B—Shareholders Other Than C Corporations
5  Amount of taxable dividends included on line 3  .                              .  . . . .    . .        . . . . .       .   . .   . 5
Part II  Nontaxable Distributions
6  Actual distributions from previously taxed income and accumulated pre-1985 DISC income                                        .   . 6
7  Other actual nontaxable distributions .   . . .                              . .  . . . .    . .        . . . . .       .   . .   . 7
8  Total nontaxable distributions. Add lines 6 and 7  .                              . . . .    . .        . . . . .       .   . .   . 8
Part III Other Information
9  Accumulated IC-DISC income attributable to stock sold during the year  .                                  . . . .       .   . .   . 9
10 Deferred DISC income. See instructions .    . .                              . .  . . . .    . .        . . . . .       .   . .   . 10
                                                                                         Name, employer identification number, and address (including ZIP code)  
Shareholder’s name, identifying number, and address (including ZIP code)                 of IC-DISC, former DISC, or former IC-DISC

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-IC-DISC. www.irs.gov/Form1120icdisc Cat. No. 11474A Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

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SCHEDULE K                      Shareholder's Statement of IC-DISC Distributions                                            OMB No. 1545-0123
(Form 1120-IC-DISC)                            For calendar year 20                   or tax year                            COPY B— 
(Rev. November 2018)         beginning             , 20                      , ending                     , 20             For Shareholder's 
Department of the Treasury                                                                                                   records
Internal Revenue Service   
Part I   Taxable Distributions
1  Deemed distributions:     a Under section 995(b)(1)  .                  . . . .    . . .       . . . . . .   .        . 1a
                             b Annual installment under section 995(b)(2)  .              .       . . . . . .   .        . 1b
                             c Total. Add lines 1a and 1b .                  . . .    . . .       . . . . . .   .        . 1c
2  Actual taxable distributions  .     . . . . . . .                     . . . . .    . . .       . . . . . .   .        . 2
3  Total taxable distributions. Add line 1c and line 2. Enter here and in Section A or B below .                .        . 3
Section A—C Corporations
4a Part of line 3 above entitled to section 243 dividends-received deduction .                    . . . . . .   .        . 4a
b  Part of line 3 above not entitled to section 243 dividends-received deduction  .                   . . . .   .        . 4b
Section B—Shareholders Other Than C Corporations
5  Amount of taxable dividends included on line 3  .                     . . . . .    . . .       . . . . . .   .        . 5
Part II  Nontaxable Distributions
6  Actual distributions from previously taxed income and accumulated pre-1985 DISC income                       .        . 6
7  Other actual nontaxable distributions .   . . . .                     . . . . .    . . .       . . . . . .   .        . 7
8  Total nontaxable distributions. Add lines 6 and 7  .                    . . . .    . . .       . . . . . .   .        . 8
Part III Other Information
9  Accumulated IC-DISC income attributable to stock sold during the year  .                       . . . . . .   .        . 9
10 Deferred DISC income. See instructions .    . . .                     . . . . .    . . .       . . . . . .   .        . 10
                                                                               Name, employer identification number, and address (including ZIP code)  
Shareholder’s name, identifying number, and address (including ZIP code)       of IC-DISC, former DISC, or former IC-DISC

www.irs.gov/Form1120icdisc                   Cat. No. 11474A                                          Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

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Instructions for Shareholder Line 5. If you are an individual, partnership, Part II—Nontaxable Distributions
S corporation, estate, or trust, line 5 shows
Section references are to the Internal Revenue the amount of line 3 distributions taxable to Actual distributions from previously taxed
Code. you as a dividend. income and accumulated pre-1985 DISC
income are generally not taxable to the extent
Purpose of forms. Copy B of Schedule K For a tax-exempt entity, treat any deemed of your basis in the stock for which the
(Form 1120-IC-DISC) reports an actual or distribution or actual distribution of previously distribution was made. Except for
deemed distribution from an IC-DISC, former untaxed income as derived from the conduct distributions of accumulated IC-DISC income
IC-DISC, or former DISC. It also reports of an unrelated trade or business. and of earnings and profits from the time
deferred DISC income from an IC-DISC. If you disposed before the corporation became an IC-DISC,
Keep it for your records; do not file it with Disposing of IC-DISC stock.
your income tax return. of stock in an IC-DISC, former IC-DISC, or actual distributions are not taxable to the
former DISC, you may need to include all or extent of your basis in the stock for which the
Part I—Taxable Distributions part of the gain in your income. The gain, distribution was made. Treat distributions in
reported as a dividend under section 995(c),is excess of your basis as a gain from the sale
Report as distributions from an IC-DISC: included to the extent of accumulated or exchange of property. See section 996(e).
1. Deemed and actual taxable distributions; IC-DISC income attributable to the stock
and while you held it (line 9). This dividend is not Part III—Other Information
2. Gain, to the extent of accumulated eligible for the section 243 deduction. Line 10—Deferred DISC income. Line 10
IC-DISC income, on the sale of stock (see For a tax-exempt entity, treat the gain shows your share of the IC-DISC’s deferred
Disposing of IC-DISC Stock below). under section 995(c) as derived from the income for the year. Section 995(f) imposes
Line 1—Deemed distributions. You are conduct of an unrelated trade or business. an interest charge on the additional tax you
would pay if you included this deferred
treated as having received deemed Foreign shareholders treat all gains on the
income in your income for your tax year that
distributions (line 1c) as of the last day of the disposition of stock in an IC-DISC, former
ends with or includes the IC-DISC’s tax year
IC-DISC tax year. You must pay tax on the IC-DISC, or former DISC, and all distributions
end shown on Schedule K. Complete Form
distributions in your tax year that includesthat from accumulated IC-DISC income or
8404, Interest Charge on DISC-Related
date. accumulated pre-1985 DISC income,
Deferred Tax Liability, to figure the interest
Line 2—Actual taxable distributions. You including deemed distributions, as effectively
charge.
must pay tax on actual taxable distributionsin connected with the conduct of a trade or
the year of receipt. business through a permanent establishment Future developments. For the latest
within the United States. See section 996(g) information about developments related to
Line 4. Line 4a shows the part of the total for details. Schedule K (Form 1120-IC-DISC) and its
taxable distribution on line 3 that qualifies for instructions, such as legislation enacted after
the 50% or 65% dividends-received Acquiring IC-DISC stock. If you acquired they were published, go to www.irs.gov/
deduction under section 243. Line 4b shows stock in an IC-DISC and subsequently Form1120icdisc.
the part that does not qualify for the received a distribution with respect to that
deduction. stock, you may be able to treat part of that
distribution as a nontaxable distribution. See
section 996(d) for details.
Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

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SCHEDULE K                      Shareholder's Statement of IC-DISC Distributions                                            OMB No. 1545-0123
(Form 1120-IC-DISC)                            For calendar year 20                   or tax year
(Rev. November 2018)                                                                                                         COPY C— 
                             beginning             , 20                      , ending                    , 20
Department of the Treasury                                                                                                 For IC-DISC's records
Internal Revenue Service        (Complete for each shareholder. See instructions on back of Copy C.)
Part I   Taxable Distributions
1  Deemed distributions:     a Under section 995(b)(1)  .                  . . . .    . . .      . . . . .   . .         . 1a
                             b Annual installment under section 995(b)(2)  .              .      . . . . .   . .         . 1b
                             c Total. Add lines 1a and 1b .                  . . .    . . .      . . . . .   . .         . 1c
2  Actual taxable distributions  .     . . . . . . .                     . . . . .    . . .      . . . . .   . .         . 2
3  Total taxable distributions. Add line 1c and line 2. Enter here and in Section A or B below .               .         . 3
Section A—C Corporations
4a Part of line 3 above entitled to section 243 dividends-received deduction .                   . . . . .   . .         . 4a
b  Part of line 3 above not entitled to section 243 dividends-received deduction  .                  . . .   . .         . 4b
Section B—Shareholders Other Than C Corporations
5  Amount of taxable dividends included on line 3  .                     . . . . .    . . .      . . . . .   . .         . 5
Part II  Nontaxable Distributions
6  Actual distributions from previously taxed income and accumulated pre-1985 DISC income                      .         . 6
7  Other actual nontaxable distributions .   . . . .                     . . . . .    . . .      . . . . .   . .         . 7
8  Total nontaxable distributions. Add lines 6 and 7  .                    . . . .    . . .      . . . . .   . .         . 8
Part III Other Information
9  Accumulated IC-DISC income attributable to stock sold during the year  .                      . . . . .   . .         . 9
10 Deferred DISC income. See instructions .    . . .                     . . . . .    . . .      . . . . .   . .         . 10
                                                                               Name, employer identification number, and address (including ZIP code)  
Shareholder’s name, identifying number, and address (including ZIP code)       of IC-DISC, former DISC, or former IC-DISC

www.irs.gov/Form1120icdisc                   Cat. No. 11474A                                         Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

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Instructions for IC-DISC Line 2.Enter the amount of actualdistributions earnings and profits. The total of this line for
that are taxable to theshareholder. These all shareholders should equal the total
Section references are to the Internal Revenue distributions come fromaccumulated IC-DISC nontaxable income reported on Form 1120-
Code. income and otherearnings and profits. IC-DISC, Schedule J, Part IV, line 4d.
Future developments. For the latest Line 4a. Enter on line 4a each shareholder’s Part III—Other Information
information about developments related to amount of dividends out of other earningsand
Schedule K (Form 1120-IC-DISC) and its profits that are eligible for thedividends- Line 9. If (1) a shareholder disposes of stock
instructions, such as legislation enacted after received deduction under section243. No in an IC-DISC or former DISC, or (2) the stock
they were published, go to www.irs.gov/ dividends-received deduction isallowed for a of an IC-DISC, former IC-DISC, or former
Form1120icdisc. dividend from an IC-DISC,former IC-DISC, or DISC is disposed of in a transaction that
former DISC if it is: terminates the separate corporate existence
General Instructions 1. Paid out of accumulated IC-DISC income of an IC-DISC, former IC-DISC, or former
Complete Schedule K (Form 1120-IC-DISC) for or accumulated pre-1985 DISC income, DISC (other than a mere change in the place
of organization), enter on line 9 the
each shareholder who had an actual or deemed 2. Paid out of previously taxed income, or accumulated IC-DISC income attributable to
distribution during the tax year or to whom the
corporation is reporting deferred DISC income 3. A deemed distribution under section the stock that was accumulated during the
for the tax year. Attach Copy A to Form 1120- 995(b)(1). period the shareholder held the stock.
IC-DISC. Give Copy B to the shareholder by the Line 5. Complete for shareholders that are Line 10. Enter the shareholder’s share of the
last day of the second month after your tax year individuals, partnerships, S corporations, corporation’s deferred DISC income at tax
ends. Keep Copy C for your records. estates, or trusts. Enter on line 5 each year end. See section 995(f) and the
Note: Do not report on Form 1099-DIV actual shareholder’s pro rata share of taxable instructions for Schedule J, Part V, in the
and deemed distributions or deferred DISC dividends included on line 3. Instructions for Form 1120-IC-DISC for
income. information on figuring deferred DISC income.
Part II—Nontaxable Distributions The total of this line for all shareholders
Specific Instructions Line 6. Enter the shareholder’s pro rata share should equal the total amount reported on
of actual distributions from previously taxed Form 1120-IC-DISC, Schedule J, Part V,
Part I—Taxable Distributions income and distributions from accumulated line 3.
Line 1. On line 1a, enter the shareholder’spro pre-1985 DISC income. The total of line 6 for
rata share of the deemed distributionsunder all shareholders should equal the total the
section 995(b)(1). On line 1b, enter the corporation reports on Form 1120-IC-DISC,
shareholder’s pro rata share of the annual Schedule J, Part IV, line 4a.
installment under section 995(b)(2). The sum Line 7. Enter the shareholder’s pro rata share
of the amounts on these lines for all of actual nontaxable distributions out of other
shareholders should equal the total the than (1) previously taxed income or
corporation reports in Part I and Part III, accumulated pre-1985 DISC income,(2)
Schedule J, Form 1120-IC-DISC. accumulated IC-DISC income, and (3) other
Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

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