Form   1125-E                                  Compensation of Officers
(Rev. October 2016)                                                                                                            OMB No. 1545-0123
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Department of the Treasury                Attach to Form 1120, 1120-C, 1120-F, 1120-REIT, 1120-RIC, or 1120S.  
Internal Revenue Service    ▶ Information about Form 1125-E and its separate instructions is at www.irs.gov/form1125e.
Name                                                                                                                      Employer identification number

Note: Complete Form 1125-E only if total receipts are $500,000 or more. See instructions for definition of total receipts.
                    (a) Name of officer          (b) Social security number   (c) Percent of         Percent of stock owned       (f) Amount of 
                                                     (see instructions)            time devoted to (d) Common (e) Preferred       compensation
                                                                                   business

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2      Total compensation of officers  .  .  . . .   . .  .    . .      .   . .    .    . .     .  .    . . . .   .       2 

3      Compensation of officers claimed on Form 1125-A or elsewhere on return  .                .  .    . . . .   .       3 

4      Subtract  line  3  from  line  2.  Enter  the  result  here  and  on  Form  1120,  page  1,  line  12  or  the
       appropriate line of your tax return . . . .   . .  .    . .      .   . .    .    . .     .  .    . . . .   .       4 
For Paperwork Reduction Act Notice, see separate instructions.                          Cat. No. 55989C                   Form 1125-E (Rev. 10-2016)