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                                                                  U.S. Information Return 
Form 1041-A
(Rev. September 2018)                             Trust Accumulation of Charitable Amounts                                      OMB No. 1545-0094
                                                      ▶ 
Department of the Treasury                              Go to www.irs.gov/Form1041A for the latest information.
Internal Revenue Service                                              For calendar year 20
Name of trust                                                                                                           Employer identification number 

Name of trustee 

Number, street, and room or suite no. (or P.O. box) 

City or town, state, and ZIP code 

Part I                   Income and Deductions (See the instructions for Form 1041 or Form 5227.) If total income is $25,000 or  
                         less, skip lines 1–8 and enter total income on line 9. 
                      1  Interest income  . .   . .     .     . . . . . . . .   .      . . . . .       . . .   . . .    1 
                      2  Dividends  . .  .  .   . .     .     . . . . . . . .   .      . . . . .       . . .   . . .    2 
                      3  Business income or (loss) (attach Schedule C or C-EZ (Form 1040)) .   .       . . .   . . .    3 
                      4  Capital gain or (loss) (attach Schedule D (Form 1041)) .      . . . . .       . . .   . . .    4 
                      5  Rents, royalties, partnerships, other estates and trusts, etc. (attach Schedule E (Form 1040)) 5 
           Income     6  Farm income or (loss) (attach Schedule F (Form 1040))  .      . . . . .       . . .   . . .    6 
                      7  Ordinary gain or (loss) (attach Form 4797)  .  . . .   .      . . . . .       . . .   . . .    7 
                      8  Other income (state type of income)                                                            8 
                      9  Total income (combine lines 1 through 8)     . . . .   .      . . . . .       . . .   . . .    9 
                      10 Interest . . .  .  .   . .     .     . . . . . . . .   .      . . . . .       . . .   . . .    10 
                      11 Taxes  .   . .  .  .   . .     .     . . . . . . . .   .      . . . . .       . . .   . . .    11 
                      12 Charitable deduction (itemize by charitable purpose; include payee’s name and address)         12 
                      13 Trustee fees  . .  .   . .     .     . . . . . . . .   .      . . . . .       . . .   . . .    13 
           Deductions 14 Attorney, accountant, and return preparer fees . . .   .      . . . . .       . . .   . . .    14 
                      15 Other deductions (attach schedule)       . . . . . .   .      . . . . .       . . .   . . .    15 
Part II                  Distributions of Income Set Aside for Charitable Purposes (see instructions) 
16                    Accumulated income set aside in prior tax years for which a deduction was claimed under section 
                      642(c)  . . . . .  .  .   . .     .     . . . . . . . .   .      . . . . .       . . .   . . .    16 
17                    Income set aside in prior tax years for which a deduction was claimed under section 642(c) 
                      and which was distributed during the current tax year (itemize by charitable purpose; include 
                      payee’s name and address):
a                                                                                          17a 
b                                                                                          17b 
c                                                                                          17c 
d                                                                                          17d 
e                                                                                          17e 
18                    Total (add lines 17a through 17e)  .    . . . . . . . .   .      . . . . .       . . .   . . .    18 
19                    Balance (subtract line 18 from line 16)   . . . . . . .   .      . . . . .       . . .   . . .    19 
20                    Income set aside during the current tax year for which a deduction was claimed under section 
                      642(c) (included in Part I, line 12)  . . . . . . . . .   .      . . . . .       . . .   . . .    20 
21                    Carryover (add lines 19 and 20)   .     . . . . . . . .   .      . . . . .       . . .   . . .    21 
Part III                 Distributions of Principal for Charitable Purposes (see instructions) 
22                    Principal distributed in prior tax years for charitable purposes . . . . .       . . .   . . .    22 
23                    Principal distributed during the current tax year for charitable purposes (itemize by charitable 
                      purpose; include payee’s name and address):
a                                                                                          23a 
b                                                                                          23b 
c                                                                                          23c 
d                                                                                          23d 
e                                                                                          23e 
24                    Total (add lines 23a through 23e)  .    . . . . . . . .   .      . . . . .       . . .   . . .    24 
For Paperwork Reduction Act Notice, see the instructions.                              Cat. No. 10615B                     Form 1041-A (Rev. 9-2018) 



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Form 1041-A (Rev. 9-2018)                                                                                              Page  2 
         Balance Sheets          (see instructions). If line 9, page 1, is $25,000 or less, complete only lines 38, 42, 
Part IV 
         and 45 (see instructions). 
                                                                                            (a) Beginning-of-      (b) End-of-Year 
                                         Assets                                             Year Book Value        Book Value 
25   Cash—non-interest bearing .     . . .  .    .   . .        . . . .   . . . . . . 25 
26   Savings and temporary cash investments  .       . .        . . . .   . . . . . . 26 
27a  Accounts receivable  .      . . . . .  .    .   . .        . .   27a 
b    Less: allowance for doubtful accounts  .    .   . .        . . 27b 
28a  Notes and loans receivable  .   . . .  .    .   . .        . .   28a 
b    Less: allowance for doubtful accounts  .    .   . .        . . 28b 
29   Inventories for sale or use   . . . .  .    .   . .        . . . .   . . . . . . 29 
30   Prepaid expenses and deferred charges       .   . .        . . . .   . . . . . . 30 
31   Investments—U.S. and state government obligations (attach schedule)        . . . 31 
32   Investments—corporate stock (attach schedule)  .           . . . .   . . . . . . 32 
33   Investments—corporate bonds (attach schedule) .            . . . .   . . . . . . 33 
34 a Investments—land, buildings, and equipment: basis .          .   34a 
b    Less: accumulated depreciation  .   .  .    .   . .        . . 34b 
35   Investments—other (attach schedule)    .    .   . .        . . . .   . . . . . . 35 
36a  Land, buildings, and equipment: basis  .    .   . .        . .   36a 
b    Less: accumulated depreciation  .   .  .    .   . .        . . 36b 
37   Other assets (describe ▶                                                       ) 37 
38   Total assets (add lines 25 through 37)  .   .   . .        . . . .   . . . . . . 38 
                                     Liabilities 
39   Accounts payable and accrued expenses  .        . .        . . . .   . . . . . . 39 
40   Mortgages and other notes payable (attach schedule)  .         . .   . . . . . . 40 
41   Other liabilities (describe ▶                                                  ) 41 
42   Total liabilities (add lines 39 through 41)  .  . .        . . . .   . . . . . . 42 
                                     Net Assets 
43   Trust principal or corpus .   . . . .  .    .   . .        . . . .   . . . . . . 43 
44   Undistributed income and profits  . .  .    .   . .        . . . .   . . . . . . 44 
45   Total net assets (add lines 43 and 44) .    .   . .        . . . .   . . . . . . 45 
46   Total liabilities and net assets (add lines 42 and 45)  .      . .   . . . . . . 46 
         Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge 
         and belief, it is true, correct, and complete. Declaration of preparer (other than trustee) is based on all information of which preparer has any knowledge.
Sign     ▲                                                                            ▲
Here 
           Signature of trustee or officer representing trustee                          Date 
         Print/Type preparer’s name                 Preparer’s signature               Date                        PTIN
Paid                                                                                            Check          if  
                                                                                                self-employed 
Preparer                                                                                                      ▶
         Firm’s name     ▶                                                                      Firm’s EIN 
         Firm’s address 
Use Only                  ▶                                                                     Phone no. 
                                                                                                Form 1041-A (Rev. 9-2018) 



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Form 1041-A (Rev. 9-2018)                                                                                                      Page  3 

Section references are to the Internal      To receive the automatic extension, the       Do not merely enter the category (that  
Revenue Code unless otherwise noted.        trustee must file Form 8868 on or before      is, religious, charitable, scientific, literary, 
                                            the original due date of Form 1041-A.         or educational), but also enter the  
Future Developments                                                                       purpose of the deduction. For example,  
                                            Amended Return 
For the latest information about                                                          “payments of $4,000 to indigent persons 
developments related to Form 1041-A         If you are filing an amended Form             for medical purposes,” or a “grant of  
and its instructions, such as legislation   1041-A, you must complete the entire          $25,000 to equip the chemistry lab at a  
enacted after they were published, go to    return, not just the new or corrected         university.” 
www.irs.gov/Form1041A.                      information. Enter “Amended Return”  
                                            across the top of the amended Form            Part III. Distributions of Principal 
What’s New                                  1041-A.                                       for Charitable Purposes 
The Tax Cuts and Jobs Act of 2017 (P.L.     The trustee may file an amended               Lines 23a–23e. Provide a listing in  
115-97) amended section 641(c)(2). As a     return at any time to change or add to        sufficient detail, similar to the examples  
result, electing small business trusts      the information reported on a previously      provided above, for each class of  
(ESBTs) are no longer subject to the        filed return for the same period.             activity for amounts paid out of principal  
                                                                                          for charitable purposes. 
charitable information reporting 
requirements under section 6034 and do      Where To File                                 See the Instructions for Form 1041,  
not file Form 1041-A.                       File Form 1041-A at the following             U.S. Income Tax Return for Estates and  
                                            address.                                      Trusts, for more information regarding  
Reminder                                                                                  the allowance of deductions for amounts 
                                            Department of the Treasury                    permanently set aside for a charitable  
Split-interest trusts as described in       Internal Revenue Service Center               purpose. 
section 4947(a)(2) don’t file Form          Ogden, UT 84201-0027 
1041-A. These types of trusts file Form                                                   Part IV. Balance Sheets 
5227, Split-Interest Trust Information      Penalties 
                                                                                          Complete the balance sheets using the  
Return, which meets the section 6034        Section 6652(c)(2) provides for separate      accounting method the trust uses in  
filing requirements.                        penalties of $10 a day, up to a maximum       keeping its books and records. All filers  
                                            of $5,000, against both the trust and the     must complete columns (a) and (b). 
General Instructions                        trustee for not filing Form 1041-A on  
                                            time, unless there is reasonable cause.       Assets 
Purpose of Form                             The law also provides penalties for filing    When space is provided to the left of  
                                            a false or fraudulent return. 
Use Form 1041-A to report the                                                             column (a) for reporting receivables and  
charitable information required by          Rounding Off to Whole Dollars                 the related allowance for doubtful  
section 6034 and the related regulations.                                                 accounts or depreciable assets and  
                                            You may show the money items on the           accumulated depreciation, enter the  
Who Must File                               return and accompanying schedules as          end-of-year figures. 
                                            whole-dollar amounts. To do so, drop  
The trustee must file Form 1041-A for a     amounts less than 50 cents and                Line 25. Cash—non-interest bearing.  
trust that claims a charitable or other     increase any amounts from 50 to 99            Enter the amount of cash on deposit in  
deduction under section 642(c) unless       cents to the next dollar.                     checking accounts, deposits in transit,  
an exception applies.                                                                     change funds, petty cash funds, or any  
                                            Attachments 
Exceptions. The trustee doesn’t file                                                      other non-interest bearing accounts. Do  
Form 1041-A for:                            If you need more space, attach separate       not include advances to employees or  
                                            sheets showing the same information in        officers or refundable deposits paid to  
• A trust that is required to distribute    the same order as on the printed forms.       suppliers or others. 
currently to the beneficiaries all the      Show the totals on the printed forms.         Line 26. Savings and temporary cash  
income for the tax year determined  
under section 643(b) and related            Enter the trust’s employer                    investments. Enter the total of cash in  
regulations;                                identification number (EIN) on each           savings or other interest-bearing  
                                            sheet. Also, use sheets that are the          accounts and temporary cash  
• A charitable trust described in section   same size as the forms and indicate           investments, such as money market  
4947(a)(1);                                 clearly the line of the printed form to       funds, commercial paper, certificates of  
• For tax years beginning after 2006, a     which the information relates.                deposit, and U.S. Treasury bills or other  
split-interest trust described in section                                                 governmental obligations that mature in  
4947(a)(2); or                              Public Inspection                             less than 1 year. 
• Electing small business trusts (ESBTs)    See Regulations section 301.6104(b)-          Line 27. Accounts receivable. Enter the 
described in section 641(c).                1(d) for the procedures to request public     total accounts receivable (reduced by  
                                            inspection of this form.                      the corresponding allowance for doubtful 
When To File                                                                              accounts) that arose from the sale of  
File Form 1041-A by April 15 following      Specific Instructions                         goods and/or the performance of  
                                                                                          services. Claims against vendors or  
the close of the calendar year. If the due  Part II. Distributions of Income Set          refundable deposits with suppliers or  
date falls on a Saturday, Sunday, or        Aside for Charitable Purposes                 others may be reported here if not  
legal holiday, file on the next business                                                  significant in amount. If significant in  
day.                                        Lines 17a–17e. Provide a listing in  
                                            sufficient detail for each class of activity  amount, report them (with any advances  
Extension of Time To File                   for which a disbursement was made,            to employees or officers) on line 37,  
The trustee may obtain an automatic         and a charitable deduction under section      Other assets. 
extension of time to file Form 1041-A by    642(c) was taken. 
filing Form 8868, Application for           Such amounts permanently set aside  
Automatic Extension of Time To File an      must be earned from amounts transferred 
Exempt Organization Return.                 to the trust before October 9, 1969. 



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Form 1041-A (Rev. 9-2018)                                                                                                     Page  4 

Line 28. Notes and loans receivable.         Line 35. Investments—other. Enter the        If you have questions about whether a  
Enter the combined total of notes            amount of all other investment holdings      preparer is required to sign the return,  
receivable and net loans receivable          not reported on lines 31 through 34.         please contact an IRS office. 
(including receivables due from officers,    Attach a schedule describing each of         The person signing the return as the 
directors, trustees, and other disqualified  these investments held at the end of the     preparer should complete the requested 
persons). In an attached schedule, show      year. List the cost, or other basis, and     preparer information and do the 
the following information (preferably in     the end-of-year book value.                  following.
columnar format).                            Line 36. Land, buildings, and                • Sign it in the space provided for the  
• Borrower’s name and title.                 equipment. Attach a schedule of all          preparer’s signature. (A facsimile  
• Original amount.                           land, buildings, and equipment that          signature is acceptable.) 
                                             aren’theld for investment purposes, 
• Balance due.                               such as the trust’s offices. List the cost   • Give the trustee a copy of the return in  
• Date of note.                              or other basis of these assets,              addition to the copy to be filed with the  
                                             accumulated  depreciation, and end-of-       IRS. 
• Maturity date.                             year bookvalue. 
• Repayment terms.                           Line 37. Other assets. Enter the book        Paperwork Reduction Act Notice. We  
• Interest rate.                             value of any trust assets that haven’t       ask for the information on this form to  
• Security provided by the borrower.         been reported on lines 25 through 36. If     carry out the Internal Revenue laws of  
                                             more space is needed, attach a separate      the United States. You are required to  
• Purpose of the loan.                       schedule with a description of the asset,    give us the information. We need it to  
• Description and fair market value of       date acquired, and end-of-year book          ensure that you are complying with  
the consideration furnished by the           value.                                       these laws and to allow us to figure and  
                                                                                          collect the right amount of tax. 
lender.                                      Liabilities                                  You aren’t required to provide the  
Line 29. Inventories for sale or use.        Line 39. Accounts payable and                information requested on a form that is  
Enter the amount of materials, goods,        accrued expenses. Enter the total            subject to the Paperwork Reduction Act  
and supplies purchased or manufactured       accounts payable to suppliers and            unless the form displays a valid OMB  
by the trust and held for sale or use in     others, and accrued expenses such as         control number. Books or records  
some future period.                          salaries payable, accrued payroll taxes,     relating to a form or its instructions must  
Line 30. Prepaid expenses and                and interest payable.                        be retained as long as their contents  
deferred charges. Enter the amount of        Line 40. Mortgages and other notes           may become material in the  
short-term and long-term prepayments         payable. Attach a schedule showing, as       administration of any Internal Revenue  
of future expenses attributable to one or    of the end of the year, the total amount     law. Generally, tax returns and return  
more future accounting periods.              of all mortgages payable, and for each       information are confidential, as required  
Examples include prepayments of rent,        nonmortgage note payable, the lender’s       by Code section 6103. 
insurance, and pension costs.                name and the other information specified     The time needed to complete and file  
Lines 31, 32, and 33. Investments—           in the line 28 instructions.                 this form will vary depending on  
government obligations, corporate            Line 41. Other liabilities. Enter the book   individual circumstances. The estimated  
stocks, and corporate bonds. Enter the       value of any trust liabilities that haven’t  average time is: 
book value (which may be market value)       been reported on line 39 or 40. If more      Recordkeeping    . .    .   24 hr., 52 min. 
of these investments. Attach a schedule      space is needed, attach a separate  
that lists each security held at the end of  schedule with a description of the           Learning about the                            
the year and shows whether the security      liability and amount.                        law or the form  . .    . . 2 hr., 37 min. 
is listed at cost (including the value  
recorded at the time of receipt in the       Signature                                    Preparing the form      . . 7 hr., 48 min.
case of donated securities) or               Form 1041-A must be signed by the            Copying, assembling,                       
end-of-year market value. Do not include     trustee or by an authorized                  and sending the                               
amounts on line 26. Government               representative.                              form to the IRS  . .    . . 1 hr., 20 min. 
obligations reported on line 31 are those  
that mature in 1 year or more. Debt          If you, as trustee (or an employee or        If you have comments concerning the  
securities of the U.S. government may        officer of the trust), fill in Form 1041-A,  accuracy of these time estimates or 
be reported as a single total rather than    the Paid Preparer space should be left       suggestions for making this form 
itemized. Obligations of state and           blank. If someone prepares this return       simpler, we would be happy to hear from 
municipal governments may also be            without charge, that person shouldn’t        you. You can send us comments 
reported as a lump-sum total. Do not         sign the return.                             through www.irs.gov/FormComments. 
                                                                                          Or you can write to: Internal Revenue 
combine U.S. government obligations          Generally, anyone who is paid to             Service, Tax Forms and Publications, 
with state and municipal obligations on      prepare a tax return must sign the return    1111 Constitution Ave. NW, IR-6526, 
the attached schedule.                       and fill in the other blanks in the Paid     Washington, DC 20224. Do not send the 
Line 34. Investments—land, buildings,        Preparer Use Only area of the return.        tax form to this address. Instead, see 
and equipment. Attach a schedule of all                                                   Where To File, earlier.
land, buildings, and equipment that are  
held for investment purposes, such as  
rental properties. List the cost or other  
basis of these assets, accumulated  
depreciation, and end-of-year book  
value. 






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