Form   1125-E                                  Compensation of Officers
(Rev. December 2013)                                                                                                            OMB No. 1545-2225
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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. 12-2013)