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                                                                                                                                                                          671121
                                                                                                                   Final K-1             Amended K-1                    OMB No. 1545-0123
Schedule K-1                                                                                                    Part III Shareholder’s Share of Current Year Income,  
(Form 1120-S)                                                                              2021                          Deductions, Credits, and Other Items 
Department of the Treasury                                                  For calendar year 2021, or tax year 1  Ordinary business income (loss)      13 Credits 
Internal Revenue Service 
                                  beginning /             /   2021            ending     / /                    2  Net rental real estate income (loss) 

Shareholder’s Share of Income, Deductions,                                                                      3  Other net rental income (loss) 
Credits, etc.                                                           ▶ See separate instructions. 
                                                                                                                4  Interest income 
                                  Part I Information About the Corporation 
A                                 Corporation’s employer identification number                                  5a Ordinary dividends 

B                                 Corporation’s name, address, city, state, and ZIP code                        5b Qualified dividends                  14 Schedule K-3 is attached if 
                                                                                                                                                           checked  .   .    . .  ▶
                                                                                                                6  Royalties                            15 Alternative minimum tax (AMT) items 

                                                                                                                7  Net short-term capital gain (loss) 

C                                 IRS Center where corporation filed return                                     8a Net long-term capital gain (loss) 

D                                 Corporation’s total number of shares                                          8b Collectibles (28%) gain (loss) 
                                  Beginning of tax year   .   .    .    .   .    
                                  End of tax year  .    . .   .    .    .   .                                   8c Unrecaptured section 1250 gain 

                                                                                                                9  Net section 1231 gain (loss)         16 Items affecting shareholder basis 
Part II                                  Information About the Shareholder 
E                                 Shareholder’s identifying number                                              10 Other income (loss) 

F                                 Shareholder’s name, address, city, state, and ZIP code 

                                                                                                                                                        17 Other information 
G                                 Current year allocation percentage  . .   .                        % 
                                                                                                                11 Section 179 deduction 
H                                 Shareholder’s number of shares 
                                  Beginning of tax year   .   .    .    .   .                                   12 Other deductions 
                                  End of tax year  .    . .   .    .    .   .    

I                                 Loans from shareholder
                                  Beginning of tax year   .   .    .    .   .   $ 
                                  End of tax year  .    . .   .    .    .   .   $ 

                 For IRS Use Only                                                                               18 More than one activity for at-risk purposes*
                                                                                                                19 More than one activity for passive activity purposes*

                                                                                                                   * See attached statement for additional information. 

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-S.                            www.irs.gov/Form1120S          Cat. No. 11520D        Schedule K-1 (Form 1120-S) 2021 






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