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4           State of Rhode Island Division of Taxation                                                                                                                                              4
5           Form RI-1120F                                                                                                                                                                           5
6           Business Corporation Supplemental Schedule                                                22110299990101                                                                                6
7                                                                                                                                                                                                   7
8  Name                                                                                 Federal employer identification number                                                 For the year ending: 8
9                                                                                                                                                                                                   9
10 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                              999999999                                                                              06/03/2017           10
11                                                                                                                                                                                                  11
12                                                                                                                                                                                                  12
13 This form is to be used only by those corporations dealing in securities on their own behalf and which qualify as Investment Companies or which qualify                                          13
14 as Regulated Investment Companies, Non-Captive Real Estate Investment Trusts or Personal Holding Companies as provided in RI Gen. Laws 44-11-2. 14
15 Captive Real Estate Investment Trusts file a RI-1120C return and calculate the Rhode Island tax as a corporation using Form RI-1120C.                                                            15
16                                                                                                                                                                                                  16
17                             REGULATED INVESTMENT COMPANIES INCLUDING PERSONAL HOLDING COMPANIES                                                                                                  17
18                                   REGISTERED UNDER FEDERAL INVESTMENT COMPANY ACT OF 1940                                                                                                        18
19                                                                                                                                                                                                  19
20 1 Is this corporation registered and regulated under the Federal Investment Company Act of 1940? ...........................                                              1 YES NO               20
21                                                                                                                                                                                                  21
22 2 Registration Number with the Security and Exchange Commission............................................................................                               2 99999999999          22
23                                                                                                                                                                                                  23
24 3 Date of Registration with the Security and Exchange Commission.............................................................................                             3 06/10/2017           24
25                                                                                                                                                                                                  25
26 NOTE: If the certificate issued under the Act was not for the entire period, the taxpayer is not entitled to report as a Regulated Investment Company                                            26
27 Each company must submit with this return the annual report to stockholders for the period covered by the return along with such other reports as have                                           27
28 been issued during such period.  A Business Corporation Tax Return (Form RI-1120C) must be filed along with this Supplemental Schedule.                                                          28
29                                                                                                                                                                                                  29
30                                                                                                                                                                                                  30
31                                             NON-CAPTIVE REAL ESTATE INVESTMENT TRUSTS                                                                                                            31
32                         (CAPTIVE REAL ESTATE INVESTMENT TRUST SHOULD CALCULATE TAX USING FORM 1120C)                                                                                             32
33                                                                                                                                                                                                  33
34 1 Is this company a Real Estate Investment Trust within the meaning of Section 856 of the IRC of 1954? .........................                                          1 YES NO               34
35                                                                                                                                                                                                  35
36 2 Has the company met the requirements therein contained? ...............................................................................................                 2 YES NO               36
37                                                                                                                                                                                                  37
38 3 Does the company satisfy the conditions as to the determination of status contained in Section 856(b)? .................                                                3 YES NO               38
39 4 Has a return been filed with the Internal Revenue Service as a Real Estate Investment Trust for the fiscal period                                                       4 YES NO               39
40   covered by this return?  ..............................................................................................................................................                        40
41                                                                                                                                                                                                  41
42 NOTE: If the answers to the above questions areDRAFTall “Yes”, a return is required to be filed for the fiscal period as reported to the Internal Revenue Service.42
43 The annual report to shareholders for the period covered by this return must be submitted with this return.  A Business Corporation Tax Return (Form RI- 43
44 1120C) must be filed along with this Supplemental Schedule.                                                                                                                                      44
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4       State of Rhode Island Division of Taxation                                                                                                                                                               4
5       Form RI-1120F                                                                                                                                                                                            5
6       Business Corporation Supplemental Schedule                                          22110299990102                                                                                                       6
7                                                                                                                                                                                                                7
8  Name                                                   Federal employer identification number                                                                                                                 8
9                                                                                                                                                                                                                9
10 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                99-9999999                                                                                                                                             10
11                                                                                                                                                                                                               11
12                                                                                                                                                                                                               12
13    FOR USE OF REGULATED INVESTMENT COMPANIES, NON-CAPTIVE REAL ESTATE INVESTMENT TRUSTS AND                                                                                                                   13
14    PERSONAL HOLDING COMPANIES REGISTERED UNDER THE FEDERAL INVESTMENT COMPANY ACT OF 1940                                                                                                                     14
15                                                                                                                                                                                                               15
16 1  Total Income from Federal Form 1120, line 11 or Federal Form 1120-RIC or 1120-REIT, line 8.................................                                                             1  9999999999 99   16
17 2  Interest not included in Federal AGI from Federal Form 1120, Schedule M-1, line 7, Federal Form 1120-RIC,                                                                               2                  17
18    Schedule M-1, line 7 or Federal Form 1120-REIT, Schedule M-1, line 7.....................................................................                                                  9999999999 99   18
19                                                                                                                                                                                                               19
20 3  Total Adjusted Gross Income. Add lines 1 and 2 .........................................................................................................                                3  9999999999 99   20
21                                                                                                                                                                                                               21
22 4  Interest on Obligations of the United States or its possessions...................................................................................                                      4  9999999999 99   22
23                                                                                                                                                                                                               23
24 5  Interest exempt from taxation by Rhode Island ...........................................................................................................                               5  9999999999 99   24
25                                                                                                                                                                                                               25
26 6  Capital Gain Net Income from Federal Form 1120, line 8 or Federal Form 1120-RIC or 1120-REIT, page 1, line 5 ...                                                                        6  9999999999 99   26
27                                                                                                                                                                                                               27
28 7  Unused Capital Loss Carryover from Federal Form 1120, Schedule D, part 1, line 6.................................................                                                       7  9999999999 99   28
29                                                                                                                                                                                                               29
30 8  Total of lines 6 and 7....................................................................................................................................................              8  9999999999 99   30
31                                                                                                                                                                                                               31
32 9  50% of line 8.......................................................................................................................................................................... 9  9999999999 99   32
33                                                                                                                                                                                                               33
34 10 Total of lines 4, 5 and 9    ......................................................................................................................................................     10 9999999999 99   34
35                                                                                                                                                                                                               35
36 11 Net Adjusted Gross Income. Subtract line 10 from line 3............................................................................................                                     11 9999999999 99   36
37                                                                                                                                                                                                               37
38 12 Apportionment Ratio from RI-1120C, Schedule H, line 2.  Calculated to six (6) decimal places.................................                                                           12 1.000000        38
                                                                                                                                                                                                 _  .  __________
39                                                                                                                                                                                                               39
40 13 Rhode Island Adjusted Gross Income. Multiply line 11 times line 12...........................................................................                                           13 9999999999 99   40
41 14 Tax computed at ten cents ($0.10) per each One Hundred Dollars of amount on line 13.                                                                                                    14                 41
42    Calculate: (line 13/$100)*0.10  ....................................................................................................................................DRAFT                  999999999999    42
43                                                                                                                                                                                                               43
44 15 Minimum Tax - $400.00 ..............................................................................................................................................                    15 9999999999 99   44
45                                                                                                                                                                                                               45
      RI-1120F box on page 1 to the left of the header.........................................................................................................
46 16 Tax Due. Line 14 or line 15, whichever is greater. Enter on Form RI-1120C, page 2, line 13 and check the                                                                                16 9999999999 99   46
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4       State of Rhode Island Division of Taxation                                                                                                                                                                       4
5       Form RI-1120F                                                                                                                                                                                                    5
6       Business Corporation Supplemental Schedule                                      22110299990103                                                                                                                   6
7                                                                                                                                                                                                                        7
8  Name                                                                                 Federal employer identification number                                                                                           8
9                                                                                                                                                                                                                        9
10 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                              99-9999999                                                                                                                       10
11                                                                                                                                                                                                                       11
12                                                                                                                                                                                                                       12
13                                                                                                                                                                                                                       13
14                                                 INVESTMENT COMPANIES                                                                                                                                                  14
15 1  During the period covered by this return, did this corporation engage in buying, selling, dealing in or holding                                                                         1  YES NO                  15
16    securities on its own behalf and not as a broker, underwriter or distributor?                                                                                                                                      16
17 2  Were gross receipts derived from such activities during the taxable year at least 90% of total gross receipts                                                                           2  YES NO                  17
18    derived from all activities during the year?                                                                                                                                                                       18
19                                                                                                                                                                                                                       19
20 Note: If the answers to both of the above questions are “Yes”, the taxpayer is entitled to report as such an investment company and must complete the                                                                 20
21 information required in Form RI-1120C and the additional information required below.                                                                                                                                  21
22                                                                                                                                                                                                                       22
23                                                                                                                                                                                                                       23
24 3  Entire Net Income from Form RI-1120C, page 1, line 4...............................................................................................                                     3  9999999999 99           24
25                                                                                                                                                                                                                       25
26 4  Capital Gain Net Income from Federal Form 1120, page 1, line 8...............................................................................                                           4  9999999999 99           26
27                                                                                                                                                                                                                       27
28 5  Unused Capital Loss Carryover from Federal Form 1120, Schedule D, part 1, line 6................................................                                                        5  9999999999 99           28
29                                                                                                                                                                                                                       29
30 6  Total of lines 4 and 5....................................................................................................................................................              6  9999999999 99           30
31                                                                                                                                                                                                                       31
32 7  50% of line 6.......................................................................................................................................................................... 7  9999999999 99           32
33                                                                                                                                                                                                                       33
34 8  Net Adjusted Gross Income.  Subtract line 7 from line 3......................................................................................................                           8  9999999999 99           34
35                                                                                                                                                                                                                       35
   9  Apportionment Ratio from RI-1120C, Schedule H, line 2.  Calculated to six (6) decimal places.................................                                                           9
36                                                                                                                                                                                               _  .  __________1.00000036
37                                                                                                                                                                                                                       37
38 10 Rhode Island Adjusted Gross Income.  Multiply line 8 times line 9 .............................................................................                                         10 9999999999 99           38
39                                                                                                                                                                                                                       39
40 11 Seven percent (7%) of line 10 .....................................................................................................................................                     11 9999999999 99           40
41                                                                                                                                                                                                                       41
42 12 Minimum Tax - $400.00 ..............................................................................................................................................DRAFT               12 999999999999            42
43 13 Tax Due. Line 11 or line 12, whichever is greater. Enter on Form RI-1120C, page 2, line 13 and check the                                                                                13                         43
44    RI-1120F box on page 1 to the left of the header.........................................................................................................                                  9999999999 99           44
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