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Michigan Department of Treasury                                                                                                                            Attachment 4 
4895 (Rev. 05-22), Page 1 of 2 

2022 MICHIGAN Corporate Income Tax Loss Adjustment 
for the Small Business Alternative Credit 
Issued under authority of Public Act 38 of 2011. 

Taxpayer Name                                                                         Federal Employer Identification Number (FEIN) 

Use this form to qualify for an otherwise disallowed or reduced Small Business Alternative Credit by adjusting current year adjusted 
business income (ABI) and/or allocated income. This is available only if a taxpayer had a negative adjusted business income in any of the 
five tax years (“loss year”) immediately preceding this tax year and received a Michigan Business Tax Small Business Alternative Credit or 
Corporate Income Tax Small Business Alternative Credit in the loss year. Unitary Business Groups (UBGs), see instructions. 

PART 1:   CURRENT YEAR AMOUNTS FOR ABI DISQUALIFIER 
Use this section to determine amount of loss adjustment to business income needed to qualify for the Small Business Alternative Credit. 

Adjusted Business Income Disqualifier 

1.  Adjusted Business Income from Form 4893, line 9 .....................................................................................               1.           00 

2. Business Income Disqualifier  ...................................................................................................................... 2. 1,521,000 00 

3.  Loss adjustment needed. Subtract line 2 from line 1. If less than zero, enter zero .....................................                            3.           00 

PART 2:   AVAILABLE LOSS FOR ABI DISQUALIFIER 
Read instructions before completing Part 2.   Use Part 2 to determine the loss available from the five preceding periods. Do not enter 
a negative sign in front of the loss amounts in lines 5 through 10. 
Complete line 4 with the end dates of the five preceding tax periods (oldest to the left). Then complete lines 5 through 10, one column at 
a time beginning with the oldest, but completing only those columns representing periods that reported a loss (either generated or used) 
AND received a Small Business Alternative Credit. UBGs, see instructions. 

4.  Tax year end date  
   (MM-DD-YYYY) ........................... 

5.  Adjusted business income ........... 

6.  Loss used on prior returns ........... 
7.  Loss available  
   for current return .......................... 
8.  Loss adjustment needed  
   for current return .......................... 
9.  Additional loss adjustment 
   needed......................................... 

10.  Loss adjustment carryforward  ..... 

+  0000 2022 20 01 27 2                                                                                                                                    Continue on Page 2 



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2022 Form 4895, Page 2 of 2                                                              Taxpayer FEIN 

PART 3: CURRENT YEAR AMOUNTS FOR SHAREHOLDER ALLOCATED INCOME DISQUALIFIER 
UBGs, see special instructions on using member data to complete Part 3 and the “Loss Adjustment for a Shareholder with Multiple Allocations” worksheet. 

Shareholder Allocated Income Disqualifier:  $180,000 

 11.  Enter the amount from Form 4893, line 6 (see instructions)  .......................................................................                             11. 00 

 12. Shareholder Allocated Income Disqualifier (See chart in instructions) ........................................................                                   12. 00 
 13.  Enter compensation and director fees from Form 4894, line 3, column L, of the shareholder creating the 
     disqualifier or reduction*  ..............................................................................................................................       13. 00 

 14.  Subtract line 13 from line 12. If less than zero, see instructions  .................................................................                           14. 00 
 15.  Divide line 14 by the percent of ownership from Form 4894, line 3, column G, for the shareholder  
     on line 13 ..................................................................................................................................................... 15. 00 

 16.  Loss adjustment needed. Subtract line 15 from line 11 ...............................................................................                           16. 00 
*Note:If compensation exceeds $180,000 for any shareholder or officer,  a Small Business Alternative Credit cannot be claimed nor can a loss adjustment 
be used to reduce compensation from Form 4894, line 3, column L. A shareholder of a UBG member must combine all items paid or allocable by all 
members of the UBG. 

PART 4:   AVAILABLE LOSS FOR SHAREHOLDER ALLOCATED INCOME DISQUALIFIER 
Read instructions before completing Part 4.   Use Part 4 to determine the loss available from the five preceding periods. Do not enter a  
negative sign in front of the loss amounts in lines 18 through 23. UBGs, see special instructions on using member data to complete Part 4  
and the “Loss Adjustment for a Shareholder with Multiple Allocations” worksheet. 
Complete line 17 with the end dates of the five preceding tax periods (oldest to the left). Then complete lines 18 through 23, one column 
at a time beginning with the oldest, but completing only those columns representing periods that reported a loss (either generated or used) 
AND received a Small Business Alternative Credit. 
 17.  Tax year end date  
     (MM-DD-YYYY) ........................... 

 18.  Adjusted business income ........... 

 19.  Loss used on prior returns ........... 
 20.  Loss available  
     for current return .......................... 
 21.  Loss adjustment needed  
     for current return .......................... 
 22.  Additional loss adjustment 
     needed......................................... 

 23.  Loss adjustment carryforward  ..... 

+  0000 2022 20 02 27 0 



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          Instructions for Form 4895, Corporate Income Tax (CIT) Loss Adjustment 
                                                        for the Small Business Alternative Credit 
                                                                                                                 or   extinguished.        For  the purposes          of     completing          Part                        2, if a
Purpose 
                                                                                                                 member’s      separate  year does             not  share                a common  year end                
To  reduce  the adjusted            business        income       (ABI)                or shareholder             with the     UBG,      use       a separate column            for  that     member.               If some  
allocated income               to qualify for        the    Small      Business       Alternative                members’      separate  years  share                    a common         year  end, total         the     
Credit (SBAC)              or minimize the           reduction     percentage             required.              amount      of  those  members’ available                   loss             in a single      column.  
   If the  ABI    was  less than            zero    in  any  of the       five    years                          Arrange all           of the columns           in chronological order.                   If additional  
immediately   preceding  the tax                    year   for   which     the  credit                        is columns  are  needed               to accommodate             the     five   preceding  years,            
being   claimed,  and the             taxpayer       received     an SBAC            under                       create   and  attach            a table  comparable      to that             found      in lines   4   
the   Michigan  Business Tax                (MBT),         or    an   SBAC      under       the                  through 10.    Apply            to that custom      table     the  calculations         described         
Corporate  Income  Tax (CIT)                   for   that     same    year,     the   taxpayer                   in the  form   text    and    instructions         for    lines   4   through      10.  
may   adjust  for the       loss      before      figuring       eligibility    for the                          Loss adjustment            used    for  the  ABI      disqualifier           from   a   member’s          
current   year  SBAC.  Business income                           for  credit    purposes                      is separately      filed  years should           be   tracked      in the      taxpayer’s                    
adjusted   by    using  available loss               from     prior    years    on                a first-       records. Any          ABI   loss    adjustment           remaining         from           a member’s  
in,   first-out  basis until        those      losses      are   consumed         (by use)                       separately  filed  years will           be  available                 to that   member      in the  
or   extinguished  (by age).                      A loss  adjustment will            not   affect                event  the  member leaves             the  UBG          prior           to complete           usage   of   
   a reduction       to  or  elimination of             the   SBAC        based   on  gross                      the available      loss    adjustment        by     the      UBG,           or expiration due             to   
receipts  that  exceed $19,000,000.                     Also,          it will  not   change  the                age. See     the  “Supplemental           Instructions           for     Standard       Members           
amount      of compensation      in column      L on                   the   CIT Schedule of                     in UBGs”      section           in Form 4890       for     details.    
Shareholders and Officers  (Form  4894).   
                                                                                                                 Line-by-Line Instructions 
Instructions for Unitary Business Groups 
                                                                                                                 Lines not listed are explained on the form. 
(UBGs)  
                                                                                                                 Dates  must      beentered in   MM-DD-YYYY                          format.        
The ABI     threshold        must           be calculated      by the UBG               by combining  
the ABIs             of its members. Likewise,                to reduce      an ABI disqualifier                 Taxpayer Name and Account Number:                                          Enter  name and                
of the   UBG,    loss     adjustment         must             be calculated  on   a   group        level         account      number  as reported           on     page      1 of      the           CIT Annual 
and used    against      the   group’s       ABI.        Loss     used       at the group     level        is    Return (Form  4891).  Also,  the taxpayer                       FEIN       from     the     top   of      
independent      of the  loss  available      at the  member  level.                                             page       1 must      repeatedbe  in   the       proper     location       on   page      2.   
NOTE: The  usage                  of loss   adjustment           for  one    disqualifier  does                  UBGs:                                                                                                    
                                                                                                                             Enter the DM’s         name       in   the Taxpayer            Name       field    and       
                                                                                                                 FEIN   the   in  FEIN       field.  
not  affect  the  available  loss  adjustment  for  the  other  disqualifier.  
This   form  will accommodate                  the      separate      maintenance           of                   Part 1: Current Year Amounts for ABI Disqualifier                                                
loss   adjustment  available  for the                   UBG      for  both   the    ABI      and                 Use   Part      1 and Part   3 to      determine          the amount         of loss                      
allocated  income  disqualifiers.                                                                                adjustment  necessary   qualify   to               for     the  SBAC.        
For   years  in which                a member  was not            part    of  the  UBG,                             If the   taxpayer      is not   eligible        for  the  credit because              its  ABI         
the   UBG  will use         that    member’s            available     loss   from        those                   exceeds $1,521,000,           complete        lines   through   1          10.   
separate  years  on      a first-in,  first-out  basis  until  those  losses  are                                Tax Year Less Than 12 Months:                                   Business  income and                      
consumed      or extinguished.                                                                                   shareholder  disqualifiers  must be                  calculated         on   an   annualized              
                                                                                                                 basis. Enter     annualized         numbers         on      lines   11,   1,  and    13.   
Adjusted Business Income Disqualifier 
                                                                                                                 Annualizing 
This   disqualifier      is calculated      at the               group  level.          If the    UBG          
                                                                                                                 To   annualize, multiply           each    applicable          amount,         ABI,  or                   
has      a group  wide      ABI  that  exceeds  $1,458,600  then the                         entire            
                                                                                                                 shareholder      compensation,  by  12  and divide                        the   result    by    the       
UBG      is disqualified. 
                                                                                                                 number      ofmonths in   the       tax   year.     
In   the   Taxpayer  Name field                      at the  top       of the   page,  enter  the              
Designated       Member’s  (DM’s)  name followed                            by    the    DM’s                    UBGs:                                                                                                    
                                                                                                                             For UBG members reporting                       a   period of   less than          12        
                                                                                                                 months      with  the group        return,       annualization           is done      using               
Federal  Employer  Identification Number                          (FEIN).        
                                                                                                                 the  member’s  number      of months in      the group’s                     tax    year.     Sum         
To   reduce  the  UBG’s  ABI disqualifier,                       the  group       will   use      its            the   annualized  member  amounts (when                         applicable)         to      get the       
available   loss     from           a prior    tax  year when         the    UBG         received                group’s total     annualized        amount.         
the   SBAC,     as  well as               a member’s         available  loss from                    a tax  
year when         it received the         SBAC        and      was     not  part        of the UBG               Part 2: Available Loss for ABI Disqualifier                                      
(member’s    separate  year). However,                       the  group      may      not   use                  Use  Part          2 to determine       the   loss   available          from    the five                  
   a member’s        separately        calculated          available      loss    for      a tax    year         preceding years.          Report    the   loss      amount          as a positive number.               
when the    member           was     part         of the UBG       under      MBT              to reduce         Line 4:  Enter  each  tax year             end     date      for  the     five   preceding                 
the group’s   ABI        disqualifier.                                                                           tax   years.  Begin with           the  earliest     year    in the       left  column.                   
To   reduce  the  UBG’s ABI                 disqualifier,        available      loss             is used         Each    short  period return                  is treated  as          a separate  year  when              
on      a first-in,  first-out  basis until             those    losses   are   consumed                         determining the           available     loss.     

                                                                                                                                                                                                                        41 



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Complete lines               5 through 10,              one column                   at a time. Complete                disqualifier,        there  is no         calculated         figure      from     this form                     
only   columns  for  years that                reported                 a loss      (either      generated              that   feeds to      another        form.     Simply          ignore       the apparent                         
or used)      and received an               SBAC.             If the taxpayer             did   not     report          disqualification          on  Form 4893,                 line               9 and proceed          with         
   a loss   or    did  not   receive        an  SBAC for                      a tax   year,  leave  that                calculating the          SBAC        on    the  remainder                   of Form 4893.      
column, lines             5 through 10,        blank.                                                                      If loss     adjustment      is successfully                applied      to fully      or partially  
Line 5: Enter (as               a positive number)               the     negative         ABI        from      the      cure   an  owner’s allocated                  income         disqualifier,          this  will     be           
CIT Small Business Alternative Credit                                (Form 4893),               line            9, for  demonstrated by             the   final     column                 of line      9 being zero.              In that  
tax years       where        an SBAC was               received.                                                        event,   carry  the number                from        line   12   of  this     form       to Form               
                                                                                                                        4893, line           9, and proceed        with        the  calculation           there.     
For MBT         years,  enter       the     ABI        from    the     Michigan Business Tax 
Common Credits for Small Businesses (Form 4571),                                             line      8.               Part 3: Current Year Amounts for Shareholder 
UBGs: When completing                       this       line  for        a UBG, enter           the     sum         of   Allocated Income Disqualifier 
the following:            1) UBG’s negative                 ABI      for    tax      years          it received         UBGs, see “Special Instructions for UBGs” on the following 
the   SBAC,       plus,             2) a member’s           negative          ABI        for        a tax   year        page for guidance on completing Part 3. 
when      it received the          SBAC        and       was    not part      of the UBG.               These          
                                                                                                                           If the taxpayer            is not eligible     because                a shareholder’s allocated              
member         amounts  are  calculated initially                                at the  member  level               
but  used  and maintained                for   use            in future         years  on  the  Group                   income                                                                                                         
                                                                                                                                  exceeds $180,000, complete lines   11 through 23 for the 
Copy for        ABI.                                                                                                    shareholder(s)                                                                                                      
                                                                                                                                               creating the disqualifier.                     The      loss    adjustment              
                                                                                                                        required      is the largest         amount            needed            to eliminate all       allocated       
Line 6:  Enter         the  amount                  of loss   entered  on  line                     5 that    was       income disqualifiers.              
used          as an adjustment          in a prior year          (including            loss    adjustment            
used      in SBT years        and     MBT       years).                                                                 Reduced SBAC:   A  reduction of                              the  SBAC           is required                     if   
                                                                                                                           a shareholder          or  an  officer  has allocated                    income        after    loss         
UBGs:        If a member’s               negative          ABI     was  included on                  Line          5    adjustment      of more             than   $160,000.             This  reduction                is based      on  
(the  member  received an                SBAC           and     was     not     part              of the    UBG         the   officer   or  shareholder with                    the   largest      allocated        income.             
in   the  tax year     the     credit      was        received),        include       any loss                          This      is determined          at a group level.             
adjustment        used      by  that member                          in a prior     year      to offset         an  
ABI  disqualifier  (including loss                      adjustment            used              in MBT          and     Any    UBG  that has                   a shareholder  whose income                        creates                a   
CIT   years).     Also  enter any             groupwide             loss   used         against       the               partial      or complete disqualification,                        and     that    has      loss  available      
UBG’s ABI          disqualifier                    in a prior year.                                                     to   resolve   that  disqualification                         in whole      or         in part,  must  file     
                                                                                                                        Form  4895.             A shareholder         or  officer  must combine                      all   items        
Line 7: Subtract  line                   6 from        line          5 to arrive      at loss        available                      or allocable      to the      shareholder      or officer               by    all    members        
                                                                                                                        paid
on  the  current return.                   If less     than  zero,  enter zero;               no      loss         is      the  group      when        calculating             the  allocated        income        disqualifier.         
                                                                                                                        of
available. 
                                                                                                                        Complete       lines  11 through              16        for  the shareholder              whose                 
UBGs:   If        the group’s       membership               has     not    changed,            that       is,   no    
                                                                                                                        allocated income            needs                  to be reduced. 
member has         joined            or left the       group   since        the   filing            of the prior     
year’s return,       the   amounts           calculated          on      line         7 should equal           the      NOTE:   A         shareholder that                  is paid      or allocated items                of income  
amounts on         line    10         of the prior       year’s     corresponding                  columns.             from     more  than one          member               of  the  UBG         must  calculate                      
   If membership for          this       year       is different, these           amounts             may      not      Part      3 using amounts              from   the       “Loss      Adjustment             for                    a   
be  the  same. See        the     “Supplemental               Instructions              for   Standard                  Shareholder with            Multiple        Allocations”               worksheet           later       in these  
Members      in UBGs” section                       in Form 4890            for  details.                               instructions. 
Line 8: Enter the            amount         from        line            3, in the first   column        where           Line  11:  When  calculating this                         line,   the    shareholder         must               
   a loss      is available  on line                 7. In  subsequent columns,                        enter            calculate      a pro      forma          CIT Small Business Alternative Credit 
amount from        line               9 of the previous      applicable           column.                               (Form      4893),       lines          3 through              9, using  only  the information                   
Line 9:   If      line          8 is larger than        line        7, subtract line              7 from line           from the      member        creating           the     disqualifier.         Enter      the   calculated        
    8. Enter here  and       on    line              8 of the next    column           where              a loss   is   pro-forma amounts                 from     the  4893        line         6 here on   line     11.     
available on       line    7.                                                                                           Line 12:        Form          4895  should be              calculated          initially     using              
Line 10:   If     line          7 is larger than         line       8, subtract line                8 from line         $160,000       as  the disqualifier.             This       calculation          will     establish             
   7. This amount           is available      to use      in subsequent years.                                          taxpayer       eligibility  without the                 need      to  reduce        the SBAC.                   
                                                                                                                        However,      if the total        loss     available           for   the     current       year     on      line   
NOTE:  To  benefit from                           a loss  adjustment, the                 total      loss                     does  not  equal or           exceed     the       loss     adjustment        required           on       
                                                                                                                        20
available for      the     current        year,        line       7, must equal                or exceed the                   16,  the  taxpayer         may      still        calculate   a   lesser       loss    adjustment         
                                                                                                                        line
loss adjustment         required          on   line      8.                                                               claim   a   reduced          credit.     
                                                                                                                        to
The function            of this form                 is to demonstrate that                 a taxpayer that            
                                                                                                                        Try   the  calculation more               than        once.      Substitute         the   numbers               
otherwise would            have       been     disqualified              from     the     SBAC          due        to   
                                                                                                                        shown on        the   chart       below     on         line   12        to maximize the           claimed       
ABI,      or fully      or partially disqualified                  due           to owner’s allocated                
                                                                                                                        SBAC       within  the limits             of  available          loss    adjustment.         If                  a   
income, after      application                 of loss adjustment,                    is allowed      to claim  
                                                                                                                        negative  number                 is reached      on  line 14,                  a greater  disqualifier          
   a full      or partial SBAC.          
                                                                                                                        amount      is needed            from  the  disqualifier chart                    here    on  line       12.    
   If loss     adjustment         is     successfully applied                 to    cure    an  ABI                     Begin    this  calculation with               the       shareholder            with    the   highest            
                                                                                                                        disqualifier. 
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                          DISQUALIFIER CHART                                                              than   one     member      of the      UBG        must  calculate  Part                      3 using        the  
                                                                                                          Loss  Adjustment  for  UBGs  Worksheet  and  Instructions.      If using  
                   Line 12                                   Eligible % of Credit 
                                                                                                          the worksheet,      enter    the   resulting         numbers             in Part     3     of Form       4895   
                  $ 160,000                                  100% - no reduction                          only      as instructed      by these  instructions  and  worksheet. 
                  $164,999                                                  80% 
                                                                                                              If more    than    one  shareholder           of  the UBG              has   an    allocated                
                  $169,999                                                  60%                           income  disqualifier,  begin  this  calculation  with  the  shareholder  
                  $174,999                                                  40%                           with  the  highest  disqualifier. 
                  $180,000                                                  20% 
                                                                                                          The    worksheet  should always                  be  calculated            initially      using                 
                                                                                                          $160,000       from  the disqualifier            chart.               This  calculation will                  
                                                                                                          establish      taxpayer  eligibility without                 the   need     to  reduce          the             
Line 14:    If       the  result          is a negative number,             some   reduction          
                                                                                                          SBAC.        Try  the calculation      more         than     once.        Substitute          the             
of  credit      is necessary. Return            to      line 12  and     enter    the  higher         
                                                                                                          numbers shown           on   the   disqualifier          chart      when          calculating             line  
disqualifier       amount  from the             chart.   Continue           this  process             
                                                                                                          8      of this worksheet          to maximize the            claimed  SBAC  within  the  
until  line  14      is greater than      or      equal to      zero. This        calculation         
                                                                                                          limits      of available  loss  adjustment. 
establishes  the  maximum  allowable  SBAC. 
                                                                                                          Shareholder Loss Adjustment Worksheet for Shareholder 
Part 4: Available Loss for Shareholder Allocated                                                          with Multiple Allocations, Special Instructions:                                                See  the        
Income Disqualifier                                                                                       worksheet      at the  end      of these  instructions. 
UBGs, see “Special Instructions for UBGs” that follow for                                                 Part 4: Special Instructions for UBGs 
guidance on completing Part 4. 
                                                                                                          This  part  must be         completed         on           a member         by      member  basis.            
Use   Part      4 to determine      the      loss  available        from the       five                   Each      member  must  determine its                own,        separately         calculated                
preceding  years.                                                                                         loss   adjustment for       use      against      the allocated            income                             
               Enter  each  tax year            end  date    for     years      where    loss             disqualifier.   This  will require              each member                  contributing      to the  
Line 17: 
occurred.   Begin  with the             earliest   year      in the       left  column.                   disqualifier      to calculate      a pro forma             Form 4893              for  the  purpose  
Each   short  period return         is      treated as  a separate            year     when               of completing       certain    line     items,            as noted.  
determining  the  available  loss.                                                                        Line 17: follow  general  instructions on                                a member         by    member  
Complete  lines      through18              23,  one  column          time.at a          Complete         basis for     each  member        listed       on  line             2 of the worksheet           used      for   
only   columns  for  years that              reported        a      loss (either  generated               Part    3.
or  used)  and received  an  SBAC.   the   If                      taxpayer  did  not  report             Line 18:       On      a member  by  member,  pro forma                            basis:  enter  (as  
   a loss  or     did  not  receive     an  SBAC for             a      tax year,  leave   that              a positive     number)     the    negative         ABI    from          Form  4893,  line                      9,
column,  lines      through5         10,  blank.                                                          for  tax  years  where an          SBAC  was  received  by  the  group      or the  
Line 18: Enter  (as a      positive number)                  the    negative       ABI     from           member.  For  MBT  years,  enter  the  ABI  from  Form  4571,  line      8.
Form  4893,  line      for9,      tax  years  where      SBACan                 was  received.            Line 19:  On      a member  by member,                       pro       forma        basis:      enter           
For  MBT  years,  enter  the  ABI  from  Form  4571,  line    8.                                          the   amount  of loss       entered    on        line  18  that       was  used           as an                 
                                                                                                          adjustment          in a prior      year      (including         loss  adjustment  used                            in
Line 19:  Enter  the  amount of      loss  entered  on  line  18  that  was                               MBT  years). 
used          asadjustmentanin a          prior year          (including       loss   adjustment  
used in      MBT  years).                                                                                 Line 20: Subtract  line      19 from  line          18 to arrive      at loss  available  
                                                                                                          on  the  current return      for     this     member.                  If less   than  zero,  enter           
Line 20: Subtract  line   from   19               line          18arrivetoat     loss     available                 no  loss       is available.      If loss  adjustment                        is successfully          
                                                                                                          zero;
on  the  current return.        If      less than  zero,     enter       zero;    no loss    is                         to  fully or  partially         cure               a shareholder’s  allocated                   
                                                                                                          applied
available.                                                                                                             disqualifier,  enter on          Form     4893,          line  12,     the   number                
                                                                                                          income
    If loss  adjustment      is successfully             applied      to fully      or partially          from  Form  4895,  line  12. 
cure       a shareholder’s         allocated  income disqualifier,                  enter     on        
                                                                                                          Line 21:  Enter  the  amount  from  line  12  from  the  worksheet  for  
Form 4893,         line  12,  the   number         from       Form    4895,        line  12.  
                                                                                                          the  member,      in the  first  column  where   a   loss                        is available  on  line  
Line 21:     Enter   the      amount  from line              16,    in      the first  column             20      of the  previous  column. 
where       a loss   available   is on      line     the     20 of previous        column.       
                                                                                                          Line 22:   If     line  21      is larger  than  20,  subtract  line  20  from  line  
Line 22:     If line  21   larger   is        than   20, subtract            line  20    from     line    21.  Enter  here  and  on  line          21 of the  next  column  where   a   loss                                is
21. Enter     here    and  on     line     the     21 of next      column         where      aloss      isavailable  on  line  20.   Losses  can  only  be  used  on      a member  by  
available on        line  20.                                                                             member  basis  for  this  disqualifier.  
Line 23:     If line  20      largeris        than   line 21,         subtract line         21  from      Line 23:   If      line  20      is larger than        line 21,         subtract  line 21              from  
line 20.    This     amount      isavailable to      use in   subsequent                years.            line 20.     This amount            is available      to use      in subsequent  years by                       
                                                                                                          the member.        
Special Instructions for UBGs 
                                                                                                          Complete       and  file  as many        Part              4 schedules           as  required for             
Part 3: Special Instructions for UBGs 
                                                                                                          members listed       on      line           2 of the worksheet         used   for      Part        3.   
    A shareholder that          is paid      or allocated items            of income from        more  
                                                                                                          Include completed Form 4895 as part of the tax return filing. 
                                                                                                                                                                                                                      43 



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     Worksheet — Loss Adjustment for a Shareholder with Multiple Allocations 

Begin this worksheet with information on the shareholder that has the highest disqualifier. 

Shareholder Name                                                                              Shareholder FEIN or Social Security Number 

“Member 1,” “Member 2,” and “Member 3” will reflect the data of the UBG members allocating items or income to the 
shareholder listed above. Use additional worksheets if necessary, and combine the member data from all shareholder 
worksheets to create the shareholder total. Include all members allocating items or income to shareholder. 

PART A: ALLOCATED BUSINESS INCOME AND COMPENSATION                                              
                                                                                                                                          SHAREHOLDER 
                                                                          MEMBER 1 MEMBER 2   MEMBER 3                                    TOTAL 
1.  Business Income, from a pro forma 
     Form 4893, line 6, for each member. 
     Combine the amounts for all members for 
     the Shareholder Total Business Income, 
     and carry to Form 4895, line 11...................  1. 
2.  Compensation, from Form 4894, line 3, 
     column L ......................................................  2. 
3.  Percentage of Ownership in Entity, from 
     Form 4894 line 3, column G ........................  3. 

PART B: CALCULATE SHAREHOLDER DISQUALIFIER

4.  Share of Business Income, per member  .....  4. 

5.   Shareholder disqualifier, line 2 plus line 4  ...  5. 
6.  Disqualifying amount of business income, 
     all members. Enter the total of line 4 for all 
     members......................................................  6. 
7.   Total disqualifier, all members. Enter the 
     total of line 5 for all members  ......................  7. 

PART C: CALCULATE LOSS               ADJUSTMENT                           NEEDED 

8.   Amount over disqualifier ..............................  8. 

9.   Percentage of disqualifier by member .........  9. 
10.  Proportionate share of disqualifier by 
     member  .......................................................  10. 
11.  Amount from Form 4895, Line 15, for each 
     member. Combine the amounts for all 
     members, and carry the Shareholder Total 
     to Form 4895, line 15...................................  11. 

12.  Loss Adjustment needed by member ..........  12. 

13.  Total Loss Adjustment needed for Shareholder. This amount should equal Form 4895, line 16......................................  13. 

                                                                                              See instructions on following page 

44 



- 7 -
                                                                                       Instructions 

          Worksheet — Loss Adjustment for a Shareholder with Multiple Allocations 
Line 1: Enter the      business      income     allocated              to shareholder by                   If the result       of this calculation                is a negative number,            a greater  
each member      listed.    Calculate   a   pro    forma       CIT Small Business                       disqualifier  amount      is needed  from  the  disqualifier  chart.  This  
Alternative Credit   (Form  4893),  lines 3-9,               for     each   member                      calculation  establishes  the loss              adjustment                  or SBAC        reduction  
listed. Enter  here    the   pro   forma    Form     4893,      line           6 amount for             needed   when  the amount                on  line               7 minus  the disqualifier             
each      member.  Enter  the total    for   all  members          and             carry to             amount  from  the  chart      is equal          to or greater  than  zero. 
Form 4895, line 11. 
                                                                                                        Carry  the  disqualifer amount               from      the     chart  used               to calculate  
Line 2:  Enter  the compensation             allocated       to  shareholder           by               this  line      to Form  4895,  line  12. 
each member      listed;  from     Form    4894,     line        3, column   L.   
                                                                                                        Line 9: Divide  line                 4 by  line      6 “total.”    Enter       result  per  UBG        
For Tax Years Less Than 12 Months:                       Business  Income and                           member.   This      is the  percentage of                 the    disqualifier      amount              
Shareholder compensation             must        be calculated on              an annualized            contributed  per  UBG  member.  
basis.   Enter  annualized numbers           on  lines                 1 and         2 of  the         
worksheet.   To  annualize, multiply           each  applicable             amount,                     Line 10:                                                                                             
                                                                                                                     Multiply percentage                  of disqualifier          by   member from           
                                                                                                        line      9 by  line      8 total,     amount  over disqualifier.               Enter       result    
ABI,      or shareholder  compensation,  by  12  and  divide  the  result  
                                                                                                        per   UBG  member. This                is  the  proportionate         share       of the              
by  the  number      of months      in the  tax  year. 
                                                                                                        disqualifier  contributed  per  UBG  member.  
If      a shareholder owned     stock   for  less    than   the   entire     tax    year           of   
the corporation,         or an officer  served          as an officer      less     than    the         Line 11:                                                                                             
                                                                                                                      Divide line 10 by            line         3, percentage           of ownership.         
                                                                                                        Enter  result  per UBG         member.          Enter        total  for  all   members                   in
entire  tax  year, shareholder         compensation        must      be   annualized                   
                                                                                                        the  “total”  column.  
when determining       disqualifiers.                                                                                                Enter this amount on Form 4895, line 15. 
Line  3:  Enter  shareholder’s  percentage                    of ownership      in each                 Line 12:                                                                                             
                                                                                                                       Subtract line 11            from   line       1. This   is the loss                    
                                                                                                        adjustment  needed      by member.  
member  listed;  from  Form  4894  line      3, column    G.
                                                                                                        Line 13: Add  line  12 for             all  members.           Enter  total     disqualifier          
Part B: Calculate Shareholder Disqualifier 
                                                                                                        needed   for  shareholder.               This  amount should  equal Form 
Line 4: Multiply  business income             on    line           1 for  each     member               4895, line 16. 
listed   by shareholder’s         percentage   of ownership            of that                    
member,  from  line      3. Enter  resulting  share      of business  income                               If more      than   one   shareholder  of the               UBG    has                a potential   
per  UBG  member.                                                                                       allocated      income  disqualifier, move                    on  to the    shareholder                 
                                                                                                        with  the  next  highest  disqualifier.  Begin  the  worksheet  for  the                               
Line 5: Add  shareholder’s  compensation from                        line                2 to share     next  shareholder  by reducing               line            1 per  UBG        member  on  the         
of  business  income  from  line      4. Enter  resulting  disqualifier  for                            second  worksheet  by line               12  per  UBG          member       from    the     first      
shareholder  per  UBG  member.                                                                          worksheet.   This  initial reduction                 will    indicate    whether           more        
Part C: Calculate Loss Adjustment Needed                                                                loss   adjustment      is needed  for the              second       shareholder            with        
                                                                                                        the   next  highest  disqualifier. Complete                     worksheet         for  second          
Line 8: Subtract  the disqualifier          amount      from       the    disqualifier                 
                                                                                                        shareholder.      If the      worksheet  line  12      is negative,  no  additional  
chart   (from  earlier      in these   form  instructions) from                the     total           
                                                                                                        loss  adjustment      is needed. 
amount   on  line            7 of the  worksheet.   This      is the      amount  over                 
disqualifier.  Start  the  calculation  with  $160,000  from  the  chart.                               Complete  and  file              as many     Form  4895,  Part                 3, schedules        and  
                                                                                                        as  many  worksheets      as necessary      to properly  calculate  the  loss  
                                                                                                        adjustment. 

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