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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. December 2016)                                                                                                                 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. 12-2016)

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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. December 2016)         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. 12-2016)

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Instructions for Shareholder Line 5. If you are an individual, partnership, received a distribution with respect to that
S corporation, estate, or trust, line 5 shows stock, you may be able to treat part of that
Section references are to the Internal Revenue the amount of line 3 distributions taxable to distribution as a nontaxable distribution. See
Code. you as a dividend. section 996(d) for details.
Purpose of forms. Copy B of Schedule K For a tax-exempt entity, treat any deemed Part II—Nontaxable Distributions
(Form 1120-IC-DISC) reports an actual or distribution or actual distribution of previously
deemed distribution from an IC-DISC, former untaxed income as derived from the conduct Actual distributions from previously taxed
IC-DISC, or former DISC. It also reports of an unrelated trade or business. income and accumulated pre-1985 DISC
deferred DISC income from an IC-DISC. If you disposed income are generally not taxable to the extent
Keep it for your records; do not file it with Disposing of IC-DISC stock. of your basis in the stock for which the
your income tax return. of stock in an IC-DISC, former IC-DISC, or distribution was made. Except for
former DISC, you may need to include all or
Part I—Taxable Distributions part of the gain in your income. The gain, distributions of accumulated IC-DISC income
reported as a dividend under section 995(c), is and of earnings and profits from the time
Report as distributions from an IC-DISC: included to the extent of accumulated before the corporation became an IC-DISC,
1. Deemed and actual taxable distributions; IC-DISC income attributable to the stock actual distributions are not taxable to the
and while you held it (line 9). This dividend is not extent of your basis in the stock for which the
2. Gain, to the extent of accumulated eligible for the section 243 deduction. distribution was made. Treat distributions in
excess of your basis as a gain from the sale
IC-DISC income, on the sale of stock (see For a tax-exempt entity, treat the gain or exchange of property. See section 996(e).
Disposing of IC-DISC Stock below). under section 995(c) as derived from the
Line 1—Deemed distributions. You are conduct of an unrelated trade or business. Part III—Other Information
treated as having received deemed Foreign shareholders treat all gains on the Line 10—Deferred DISC income. Line 10
distributions (line 1c) as of the last day of the disposition of stock in an IC-DISC, former shows your share of the IC-DISC’s deferred
IC-DISC tax year. You must pay tax on the IC-DISC, or former DISC, and all distributions income for the year. Section 995(f) imposes
distributions in your tax year that includes that from accumulated IC-DISC income or an interest charge on the additional tax you
date. accumulated pre-1985 DISC income, would pay if you included this deferred
Line 2—Actual taxable distributions. You including deemed distributions, as effectively income in your income for your tax year that
must pay tax on actual taxable distributions in connected with the conduct of a trade or ends with or includes the IC-DISC’s tax year
the year of receipt. business through a permanent establishment end shown on Schedule K. Complete Form
within the United States. See section 996(g) 8404, Interest Charge on DISC-Related
Line 4. Line 4a shows the part of the total for details. Deferred Tax Liability, to figure the interest
taxable distribution on line 3 that qualifies for charge.
the 70% or 80% dividends-received Acquiring IC-DISC stock. If you acquired
deduction under section 243. Line 4b shows stock in an IC-DISC and subsequently Future developments. For the latest
the part that does not qualify for the information about developments related to
deduction. Schedule K (Form 1120-IC-DISC) and its
instructions, such as legislation enacted after
they were published, go to www.irs.gov/
form1120icdisc.

Schedule K (Form 1120-IC-DISC) (Rev. 12-2016)

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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. December 2016)                                                                                                         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. 12-2016)

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Instructions for IC-DISC Line 2. Enter the amount of actual (3) other earnings and profits. The total of this
distributions that are taxable to the line for all shareholders should equal the total
Section references are to the Internal Revenue shareholder. These distributions come from nontaxable income reported on
Code. accumulated IC-DISC income and other Form 1120-IC-DISC, Schedule J, Part IV, line
Future developments. For the latest earnings and profits. 4d.
information about developments related to Line 4a. Enter on line 4a each shareholder’s Part III—Other Information
Schedule K (Form 1120-IC-DISC) and its amount of dividends out of other earnings and
instructions, such as legislation enacted after profits that are eligible for the dividends- Line 9. If (1) a shareholder disposes of stock
they were published, go to www.irs.gov/ received deduction under section 243. No in an IC-DISC or former DISC, or (2) the stock
form1120icdisc. dividends-received deduction is allowed for a of an IC-DISC, former IC-DISC, or former
dividend from an IC-DISC, former IC-DISC, or DISC is disposed of in a transaction that
General Instructions former DISC if it is: terminates the separate corporate existence
Complete Schedule K (Form 1120-IC-DISC) 1. Paid out of accumulated IC-DISC income of an IC-DISC, former IC-DISC, or former
for each shareholder who had an actual or or accumulated pre-1985 DISC income, DISC (other than a mere change in the place
of organization), enter on line 9 the
deemed distribution during the tax year or to 2. Paid out of previously taxed income, or accumulated IC-DISC income attributable to
whom the corporation is reporting deferred
DISC income for the tax year. Attach Copy A 3. A deemed distribution under section the stock that was accumulated during the
to Form 1120-IC-DISC. Give Copy B to the 995(b)(1). period the shareholder held the stock.
shareholder by the last day of the second Line 5. Complete for shareholders that are Line 10. Enter the shareholder’s share of the
month after your tax year ends. Keep Copy C individuals, partnerships, S corporations, corporation’s deferred DISC income at tax
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’s pro pre-1985 DISC income. The total of line 6 for
rata share of the deemed distributions under 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,
Schedule J, Form 1120-IC-DISC. (2) accumulated IC-DISC income, and

Schedule K (Form 1120-IC-DISC) (Rev. 12-2016)

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