OMB No. 1545-0196
                                                 Split-Interest Trust Information Return
Form  5227                                                            See separate instructions.
                                             Go to www.irs.gov/Form5227 for instructions and the latest information.                              2022
Department of the Treasury  Do not enter social security numbers on this form (except on Schedule A) as it may be made public.                    Open to Public  
Internal Revenue Service    For the calendar year 2022 or tax year beginning                   , 2022, and ending                    , 20         Inspection 
A  Full name of trust                                                                                                       B  Employer identification number 

Name of trustee                                                                                                             C  Type of Entity 
Number, street, and room or suite no. (If a P.O. box, see the instructions.)                                                   (1)   Charitable lead trust 
                                                                                                                               (2)   Charitable remainder annuity trust  
                                                                                                                                     described in section 664(d)(1) 
                                                                                                                               (3)   Charitable remainder unitrust  
City or town, state or province, country, and ZIP or foreign postal code                                                             described in section 664(d)(2) 
                                                                                                                               (4)   Pooled income fund described in  
                                                                                                                                     section 642(c)(5) 
D  Fair market value (FMV) of assets at end of tax year                      E  Gross Income                                   (5)   Other—Attach explanation

F  Check applicable           Initial return            Final return             Amended return incl. amended K-1s, if nec. G  Date the trust was created 
   boxes (see  
   instructions)          Change in trustee’s           Name                     Address 
 Part I  Income and Deductions (All trusts complete Sections A through D) 
                                                 Section A—Ordinary Income 
   1  Interest income  .        . . .          . . .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        1 
   2a Ordinary dividends (including qualified dividends)                     . . . .     .   . . . . .  . .                  . .   . .        2a 
   b  Qualified dividends (see instructions) .            .  . .         .   . . . .     .   . . .   2b 
   3  Business income or (loss). Attach Schedule C (Form 1040)                     .     .   . . . . .  . .                  . .   . .        3 
   4  Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040)                                 . .        4 
   5  Farm income or (loss). Attach Schedule F (Form 1040)  .                    . .     .   . . . . .  . .                  . .   . .        5 
   6  Ordinary gain or (loss). Attach Form 4797  .             .         .   . . . .     .   . . . . .  . .                  . .   . .        6 
   7  Other income. List type and amount                                                                                                      7 
   8  Total ordinary income. Combine lines 1, 2a, and 3 through 7                        .   . . . . .  . .                  . .   . .        8 
                                             Section B—Capital Gains (Losses) 
   9  Total short-term capital gain or (loss). Attach Schedule D, Part I (Form 1041)                 .  . .                  . .   . .        9 
10    Total long-term capital gain or (loss). Attach Schedule D, Part II (Form 1041) .               .  . .                  . .   . .        10 
11    Unrecaptured section 1250 gain  .                 . .  . .         .   . . . .     .   . . .   11 
12    28% gain  .           . . . . .          . . .    . .  . .         .   . . . .     .   . . .   12 
13    Total capital gains (losses). Combine lines 9 and 10  .                    . .     .   . . . . .  . .                  . .   . .        13 
                                               Section C—Nontaxable Income 
14    Tax-exempt interest  .        .          . . .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        14 
15    Other nontaxable income. List type and amount 
                                                                                                                                              15 
16    Total nontaxable income. Add lines 14 and 15  .                        . . . .     .   . . . . .  . .                  . .   . .        16 
                                                   Section D—Deductions 
17    Interest        .     . . . . .          . . .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        17 
18    Taxes (see the instructions)  .            . .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        18 
19    Trustee fees  .         . . . .          . . .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        19 
20    Attorney, accountant, and return preparer fees                     .   . . . .     .   . . . . .  . .                  . .   . .        20 
21    Other allowable deductions. Attach statement (see the instructions)                      . . . .  . .                  . .   . .        21 
22    Total. Add lines 17 through 21  .            .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        22 
23    Charitable deduction  .       .          . . .    . .  . .         .   . . . .     .   . . .   23 
        Section E—Deductions Allocable to Income Categories (Section 664 trust only) 
24a   Enter the amount from line 22 allocable to ordinary income                   .     .   . . . . .  . .                  . .   . .        24a 
   b  Subtract line 24a from line 8              . .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        24b 
25 a  Enter the amount from line 22 allocable to capital gains (losses)  .                   . . . . .  . .                  . .   . .        25a 
   b  Subtract line 25a from line 13  .            .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        25b 
26 a  Enter the amount from line 22 allocable to nontaxable income                       .   . . . . .  . .                  . .   . .        26a 
   b  Subtract line 26a from line 16  .            .    . .  . .         .   . . . .     .   . . . . .  . .                  . .   . .        26b 
For Paperwork Reduction Act Notice, see the instructions.                                        Cat. No. 13227T                                          Form 5227 (2022) 

Form 5227 (2022)                                                                                                                                      Page 2 
Part II          Schedule of Distributable Income (Section 664 trust only) (See instructions) 
                  Accumulations                                  (a) Ordinary income         (b) Capital gains (losses)                (c) Nontaxable income 
           Net Investment Income (NII) Classification            Excluded      Accumulated   Excluded    Accumulated                  Excluded Accumulated 
                                                                 Income        NII post 2012 Income      NII post 2012                 Income  NII post 2012
1  Undistributed income from prior tax years  .           .
2  Current tax year net income (before distributions): 
   • In column (a), enter the amount from Part I, line 24b   
   • In column (b), enter the amount from Part I, line 25b   
   • In column (c), enter the amount from Part I, line 26b
3  Total distributable income. Add lines 1 and 2  .
Part III         Distributions of Principal for Charitable Purposes 
                                                      Section A
1  Principal distributed in prior tax years for charitable purposes            . . . .     . . . .    .  .     . .                    1
2  Principal distributed during the current tax year for charitable purposes. Fill in the information for 
   columns  (A),  (B),  and  (C)  and  enter  the  amount  distributed  on  the  space  to  the  right.  (see  the
   instructions) 
                      (A)                                   (B)                              (C)                                              
                 Payee’s name and address               Date of distribution Charitable purpose and description of assets distributed 
a 
 
                                                                                                                                      2a 
b  
 
                                                                                                                                      2b 
c 
 
                                                                                                                                      2c 
3  Attachment total  .    .      . . .    . .         . . . . .  . .         . . . . .     . . . .    .  .     . .                    3
4  Total. Add lines 1 through 3 .    .    . .         . . . . .  . .         . . . . .     . . . .    .  .     . .                    4
                 Accumulated Income Set Aside and Income Distributions for Charitable Purposes 
                 Grantor type trusts complete only lines 7 through 9 (see instructions) 
                                                                 Section B
5a Income  set  aside  in  prior  tax  years  for  which  a  deduction  was  claimed  under 
   section 642(c)  . .    .      . . .    . .         . . . . .  . .         . . . . .     . . . .    .  .     . .                    5a 
b  Enter the amount shown on Part I, line 23  .           . . .  . .         . . . . .     . . . .    .  .     . .                    5b 
6  Add lines 5a and 5b  .        . . .    . .         . . . . .  . .         . . . . .     . . . .    .  .     . .                    6
7  Distributions made during the tax year (see the instructions): 
   • For income set aside in prior tax years for which a deduction was claimed under section 642(c),
   •  For  charitable  purposes  for  which  a  charitable  deduction  was  claimed  under  section  642(c)  in
         the current tax year, or
   •  For  charitable  purposes  by  a  grantor  type  trust  for  which  a  charitable  deduction  was  claimed 
        under section 170 upon contribution to the trust
   Fill  in  the  information  for  columns  (A),  (B),  and  (C)  and  enter  the  amount  distributed  on  the  line 
   to the right. 
                      (A)                                   (B)                              (C)                                              
                 Payee’s name and address               Date of distribution Charitable purpose and description of assets distributed 
a 
 
                                                                                                                                      7a 
b 
 
                                                                                                                                      7b 
c 
 
                                                                                                                                      7c 
8  Attachment total  .    .      . . .    . .         . . . . .  . .         . . . . .     . . . .    .  .     . .                    8
9  Add lines 7a through 8        . . .    . .         . . . . .  . .         . . . . .     . . . .    .  .     . .                    9
10 Carryover. Subtract line 9 from line 6 .           . . . . .  . .         . . . . .     . . . .    .  .     . .                    10
                                                                                                                                              Form 5227 (2022) 

Form 5227 (2022)                                                                                                           Page 3 
Part IV          Balance Sheet (see instructions) 
                                                                                   (a) Beginning-of- (b) End-of-Year  (c) FMV (see the 
                        Assets                                                     Year Book Value        Book Value      instructions)
1   Cash—non-interest-bearing .     . .  . .   .  . . .   .    . . . . .       1
2   Savings and temporary cash investments  .     . . .   .    . . . . .       2
3a  Accounts receivable  .      . . . .  . .   .  .   3a 
b   Less: allowance for doubtful accounts  .   .  .   3b 
4   Receivables due from officers, directors, trustees, and other disqualified 
    persons (attach statement)  .   . .  . .   .  . . .   .    . . . . .       4 
5a  Other notes and loans receivable  .  . .   .  .   5a 
b   Less: allowance for doubtful accounts  .   .  .   5b 
6   Inventories for sale or use   . . .  . .   .  . . .   .    . . . . .       6
7   Prepaid expenses and deferred charges      .  . . .   .    . . . . .       7
8a  Investments—U.S. and state government obligations (attach statement)       8a 
b   Investments—corporate stock (attach statement) .  .   .    . . . . .       8b 
c   Investments—corporate bonds (attach statement)  .     .    . . . . .       8c 
9a  Investments—land,  buildings,  and  equipment:  
    basis (attach statement)  .   . . .  . .   .  .   9a 
b   Less: accumulated depreciation  .    . .   .  .   9b 
10  Investments—other (attach statement)  .    .  . . .   .    . . . . .       10
11a Land, buildings, and equipment: basis  .   .  .   11a 
b   Less: accumulated depreciation  .    . .   .  .   11b 
12  Other assets. Describe                                                     12
13  Total assets. Add lines 1 through 12 (must equal line 23)  . . . . .       13
                        Liabilities                                                                                        
14  Accounts payable and accrued expenses  .      . . .   .    . . . . .       14
15  Deferred revenue  . .       . . . .  . .   .  . . .   .    . . . . .       15
16  Loans from officers, directors, trustees, and other disqualified persons   16
17  Mortgages and other notes payable (attach statement)  .    . . . . .       17
18  Other liabilities. Describe                                                18
19  Total liabilities. Add lines 14 through 18 .  . . .   .    . . . . .       19
                        Net Assets                                                                                        
20  Trust principal or corpus  .  . . .  . .   .  . . .   .    . . . . .       20
21a Undistributed income  .     . . . .  . .   .  . . .   .    . . . . .       21a 
b   Undistributed capital gains  .  . .  . .   .  . . .   .    . . . . .       21b 
c   Undistributed nontaxable income  .   . .   .  . . .   .    . . . . .       21c 
22  Total net assets. Add lines 20 through 21c    . . .   .    . . . . .       22
23  Total liabilities and net assets. Add lines 19 and 22  .   . . . . .       23
                                                                                                                      Form 5227 (2022) 

Form 5227 (2022)                                                                                                              Page 4 
Part V           Charitable Remainder Annuity Trust (CRAT) Information (to be completed only by a Section 664 CRAT) 
1 a Enter the initial fair market value (FMV) of the property placed in the trust  . . . . .        . . . .        1a 
b   Enter the total annual annuity amounts for all recipients  . .  .     . .   .    . . . .        . . . .        1b 
Part VI          Charitable Remainder Unitrust (CRUT) Information (to be completed only by a Section 664 CRUT)  
                 (See instructions) 
1   Is  the  CRUT  a  net  income  charitable  remainder  unitrust  (NICRUT)  as  described  in  Regulations  section 
    1.664-3(a)(1)(i)(b)(1)?  . .    . . . .  .  . . .  .     . . .  .     . .   .    . . . .        . . . . .      . .    Yes     No 
2   Is the CRUT a net income with make-up charitable remainder unitrust (NIMCRUT) as described in Regulations 
    section 1.664-3(a)(1)(i)(b)(2)? . . . .  .  . . .  .     . . .  .     . .   .    . . . .        . . . . .      . .    Yes     No 
3   Did the trust change its method of payment during the tax year?       . .   .    . . . .        . . . . .      . .    Yes     No 
    If “Yes,” describe the triggering event including the date of the event and the old method of payment 

4a  Enter the unitrust fixed percentage to be paid to the recipients  .   . .   .    . . . .        . . . .        4a             % 
b  Unitrust amount. Subtract Part IV, line 19, column (c), from Part IV, line 13, column (c), and multiply
    the result by the percentage on line 4a. Do not enter less than -0-  .  .   .    . . . .        . . . .        4b 
    If the answer is “Yes” on line 1 or line 2, go to line 5a. Otherwise, skip lines 5a through 6b and 
    enter the line 4b amount on line 7. 
5a  Trust’s accounting income for 2022. Attach statement  .    . .  .     . .   .    . . . .        . . . .        5a 
    If the answer is “Yes” on line 1, go to line 5b. If the answer is “Yes” on line 2, skip line 5b and 
    go to line 6a. 
b   Enter the smaller of line 4b or line 5a here and on line 7. Skip lines 6a and 6b   . . .        . . . .        5b 
6a  Total accumulated distribution deficiencies from previous years (see instructions)  .  .        . . . .        6a 
b   Add lines 4b and 6a  .     .    . . . .  .  . . .  .     . . .  .     . .   .    . . . .        . . . .        6b 
    If lines 6a and 6b are completed, enter the smaller of line 5a or line 6b on line 7. 
7   Required unitrust distribution for 2022  .  . . .  .     . . .  .     . .   .    . . . .        . . . .        7
8   Carryover  of  accumulated  distribution  deficiency  (only  for  trusts  that  answered  “Yes”  on  line  2). 
    Subtract line 7 from line 6b  .   . . .  .  . . .  .     . . .  .     . .   .    . . . .        . . . .        8
9   If this is the final return, enter the initial FMV of all assets placed in trust by the donor . . . . .        9
10  Did the trustee change the method of determining the FMV of the assets?          . . . .        . . . . .      . .    Yes     No 
    If “Yes,” attach an explanation. 
11  Were any additional contributions received by the trust during 2022?  .     .    . . . .        . . . . .      . .    Yes     No 
    If “Yes,” be sure to complete all columns of line 2 in Schedule A, Part V. 
Part VII         Statements Regarding Activities (see instructions) 
1   Are the requirements of section 508(e) satisfied either:                                                                  Yes  No
    •  By the language in the governing instrument; or 
    •  By  state  legislation  that  effectively  amends  the  governing  instrument  so  that  no  mandatory  directions
        that conflict with the state law remain in the governing instrument?  . .    . . . .        . . . . .      . .   1
2   Are  you  using  this  return  only  to  report  the  income  and  assets  of  a  segregated  amount  under  section
    4947(a)(2)(B)? .  . .      .    . . . .  .  . . .  .     . . .  .     . .   .    . . . .        . . . . .      . .   2
                                                                                                                         Form 5227 (2022) 

Form 5227 (2022)                                                                                                                      Page 5 
Part VIII        Statements Regarding Activities for Which Form 4720 May Be Required 
File Form 4720 if any item is checked in the “Yes” column (to the right), unless an exception applies.                                Yes  No 
1  Self-dealing (section 4941): 
a  During 2022, did the trust (either directly or indirectly): 
   (1) Engage in the sale or exchange, or leasing of property with a disqualified person?    .   . . .   . . .                   1a(1)
   (2) Borrow  money  from,  lend  money  to,  or  otherwise  extend  credit  to  (or  accept  it  from)  a  disqualified
       person?  .    . .  . .   . . .    .    . .   . .   .         . . . . . . . . .    . . .   . . .   . . .                   1a(2)
   (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?  . . . .   . . .                   1a(3)
   (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?      .   . . .   . . .                   1a(4)
   (5) Transfer any income or assets to a disqualified person (or make any of either available  for the benefit or 
       use of a disqualified person)?  . .    . .   . .   .         . . . . . . . . .    . . .   . . .   . . .                   1a(5)
   (6) Agree  to  pay  money  or  property  to  a  government  official?  (Exception.            Check  “No”  if
       the trust agreed to make a grant to or to employ the official for a period after termination of government 
       service, if terminating within 90 days.)  .  . .   .         . . . . . . . . .    . . .   . . .   . . .                   1a(6)
b  If  any  answer  is  “Yes”  to  lines  1a(1)  through  (6),  did any of  the  acts  fail  to  qualify  under  the  exceptions
   described in Regulations sections 53.4941(d)-3 and 4, or in a current Notice regarding disaster assistance
   (see instructions)?  . . .   . . .    .    . .   . .   .         . . . . . . . . .    . . .   . . .   . . .                   1b 
c  Organizations relying on a current Notice regarding disaster assistance, check here  .    .   . . .   .
d  Did the trust engage in a prior year in any of the acts described in line 1a, other than excepted acts, that 
   were not corrected before January 1, 2022?  .      .   .         . . . . . . . . .    . . .   . . .   . . .                   1d
2  Does section 4947(b)(3)(A) or (B) apply? (see instructions)  .       . . . . . . .    . . .   . . .   . . .                   2
   If “Yes,” check the “N/A” box in lines 3 and 4.
3a Taxes on excess business holdings (section 4943):                N/A 
b  Did the trust hold more than a 2% direct or indirect interest in any business enterprise at any time during 
   2022?  .      . . . .  . .   . . .    .    . .   . .   .         . . . . . . . . .    . . .   . . .   . . .                   3b
c  If “Yes,” did the trust have excess business holdings in 2022 as a result of   (1) any purchase by the trust or 
   disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the 
   Commissioner  under  section  4943(c)(7))  to  dispose  of  holdings  acquired  by  gift  or  bequest;  or 
   (3) the lapse of the 10-, 15-, or 20-year first phase holding period?  .   . . . .    . . .   . . .   . . .                   3c
   Use Form 4720, Schedule C, to determine if the trust had excess business holdings in 2022. 
4a Taxes on investments that jeopardize charitable purposes (section 4944):       N/A 
b  Did the trust invest during 2022 any amount in a manner that would jeopardize its charitable purpose?  .  .                   4b
c  Did the trust make any investment in a prior year (but after December 31, 1969) that could jeopardize its 
   charitable purpose that had not been removed from jeopardy before January 1, 2022?  .         . . .   . . .                   4c
5  Taxes on taxable expenditures (section 4945) and political expenditures (section 4955): 
a  During 2022, did the trust pay or incur any amount to: 
   (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?     . . .   . . .                   5a(1)
   (2) Influence  the  outcome  of  any  specific  public  election  (see  section  4955);  or  to  carry  on,  directly  or 
       indirectly, any voter registration drive?  . . .   .         . . . . . . . . .    . . .   . . .   . . .                   5a(2)
   (3) Provide a grant to an individual for travel, study, or other similar purposes?  . . . .   . . .   . . .                   5a(3)
   (4) Provide a grant to an organization other than a charitable, etc., organization described  in section 509(a)(1), 
       (2), or (3), or section 4940(d)(2)?  . . .   . .   .         . . . . . . . . .    . . .   . . .   . . .                   5a(4)
   (5) Provide  for  any  purpose  other  than  religious,  charitable,  scientific,  literary,  or    educational,  or  for  the
       prevention of cruelty to children or animals?  .   .         . . . . . . . . .    . . .   . . .   . . .                   5a(5)
b  If  any  answer  is  “Yes”  to  lines  5a(1)  through  (5),  did   any of  the  transactions  fail  to  qualify  under  the
   exceptions described in Regulations section 53.4945, or in a current Notice regarding disaster assistance
   (see instructions)?  . . .   . . .    .    . .   . .   .         . . . . . . . . .    . . .   . . .   . . .                   5b 
c  Organizations relying on a current Notice regarding disaster assistance, check here  .    .   . . .   .
d  If  the  answer  is  “Yes”  to  line  5a(4),  does  the  trust  claim  exemption  from  the  tax  because  it  maintained 
   expenditure responsibility for the grant?    .   . .   .         . . . . . . . . .    . . .   . . .   . . .                   5d
   If “Yes,” attach the statement required by Regulations section 53.4945-5(d). 
6  Personal benefit contracts (section 170(f)(10)): 
a  Did the trust, during the year, receive any funds, directly or indirectly, to pay premiums on  a personal benefit 
   contract?  .    . . .  . .   . . .    .    . .   . .   .         . . . . . . . . .    . . .   . . .   . . .                   6a
b  Did the trust, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . .                   6b 
   If “Yes” to line 6b, file Form 8870 (see instructions).
7  Section 664 trusts: Did the trust have unrelated business taxable income during the year? .     . .   . . .                   7
   If “Yes,” file Form 4720.
                                                                                                                                 Form 5227 (2022)

Form 5227 (2022)                                                                                                                          Page 6 
Part IX          Questionnaire for Charitable Lead Trusts, Pooled Income Funds, and Charitable Remainder Trusts  
                 (see instructions) 
                                                                      Section A—All Trusts 
1    Check this box if any of the split-interest trust’s income interests expired during 2022        . . . . .     . .  .       . .
2    Check this box if all of the split-interest trust’s income interests expired before 2022  .     . . . . .     . .  .       . .    
     If line 2 is checked and this is not a final return, attach an explanation. 
                                                  Section B—Charitable Lead Trusts 
3    Does the governing instrument require income in excess of the required annuity or unitrust payments to be 
     paid for charitable purposes?  .         . . . . .               . . . . . . . .      . . . . . . . . . .     . .            Yes     No 

4    Enter the amount of any excess income required to be paid for charitable purposes for 2022  .       . .       4 
5    Enter the amount of annuity or unitrust payments required to be paid to charitable beneficiaries for 2022     5 
                                                  Section C—Pooled Income Funds 

6    Enter the amount of contributions received during 2022                 . . . . .      . . . . . . . . .       6 

7    Enter the amount required to be distributed for 2022 to satisfy the remainder interest  .       . . . .       7 
8    Enter  any  amounts  that  were  required  to  be  distributed  to  the  remainder  beneficiary  that  remain 
     undistributed . .          .   . .     . . . . . .               . . . . . . . .      . . . . . . . . .       8 

9    Enter the amount of income required to be paid to the charitable remainder beneficiary for 2022  .            9 
                                              Section D—Charitable Remainder Trusts 
10   Check  this  box  if  you  are  filing  for  a  charitable  remainder  annuity  trust  or  a  charitable  remainder  unitrust  whose 
     charitable interests involve only cemeteries or war veterans’ posts  .         .      . . . . . . . . . .     . .  .       . .
11   Check this box if you are making an election under Regulations section 1.664-2(a)(1)(i)(a)(2) or 1.664-3(a)(1)(i)(g)(2) to 
     treat income generated from certain property distributions (other than cash) by the trust as occurring on the last day 
     of the tax year. (see instructions)  .     . . . .               . . . . . . . .      . . . . . . . . . .     . .  .       . .
12   Are  you  making  an  election  under  Regulations  section  1.1411-10(g)  with  respect  to  a  controlled  foreign
     corporation or a qualified electing fund? (see instructions)  .          . . . .      . . . . . . . . . .     . .            Yes     No 
13   Is this the initial return? If “Yes,” attach a copy of the trust instrument  .        . . . . . . . . . .     . .            Yes     No 
14   Was the trust instrument amended during the year? If “Yes,” attach a copy  .              . . . . . . . .     . .            Yes     No 
15a  If this is the final return, were final distributions made according to the trust instrument?  .  . . . .     . .            Yes     No 
b    If “Yes,” did you complete Part III, Section A, line 2?              . . . . . .      . . . . . . . . . .     . .            Yes     No 
c    If either line 15a or 15b is “No,” explain why 

16   At any time during calendar year 2022, did the trust have an interest in or a signature or other authority over a 
     bank, securities, or other financial account in a foreign country? .         . .      . . . . . . . . . .     . .            Yes     No 
     See the instructions for exceptions and filing requirements for FinCEN Form 114. 
     If “Yes,” enter the name of the foreign country 

                 Under  penalties  of  perjury,  I  declare  that  I  have  examined  this  return,  including  accompanying  schedules  and  statements,  and  to  the  best  of  my 
                 knowledge  and  belief,  it  is  true,  correct,  and  complete.  Declaration  of  preparer  (other  than  trustee)  is  based  on  all  information  of  which  preparer
Sign             has any knowledge. 
Here 
                 Signature of trustee or officer representing trustee                                                Date 
                 Print/Type preparer’s name           Preparer’s signature                         Date
Paid                                                                                                         Check          if    PTIN
                                                                                                             self-employed 
Preparer 
                 Firm’s name                                                                                 Firm’s EIN 
Use Only
                 Firm’s address                                                                              Phone no. 
                                                                                                                                Form 5227 (2022)

Form 5227 (2022)                                                                                                                                             Page 7 
Full name of trust                                                                                                Employer identification number 

                                                            NOT Open To Public Inspection 
                                      Schedule A—Distributions, Assets, and Donor Information 
Part I             Accumulation Schedule (Section 664 trust only) (see instructions) 
                        Accumulations                                      (a) Ordinary income          (b) Capital gain (loss)          (c) Nontaxable income 
            Net Investment Income (NII) Classification                     Excluded    Accumulated    Excluded      Accumulated        Excluded      Accumulated 
                                                                           Income          NII         Income             NII          Income              NII
1  Total distributable income. Enter the amount from 
   Part II, line 3 .       .   . .    . .  .   .     . .    .   .  
2a Total distributions for 2022: 
b  2022 distributions from income              .     . .    .   .
3  Undistributed income at end of tax year. Subtract 
   line 2b from line 1  .        .    . .  .   .     . .    .   .
Part II            Simplified Net Investment Income Calculation
                       (a) Accumulated NII                        (b) Current Year NII                     (c) Distributions                 (d) Ending NII
1
Part III           Current Distributions Schedule (Section 664 trust only) (see instructions)
                                           (a)                                                     (b)                                          (c) 
                                   Name of recipient                                       Identifying number                 Percentage of total unitrust amount 
                                                                                                                                     payable (if applicable) 
1a                                                                                                                                                             % 
b                                                                                                                                                              % 
                                                                  Capital gains 
                                               (d)                                                (g)               (h)                (i)              (j) 
                                           Ordinary  Income                                     Nontaxable        Corpus             Add cols.      Net investment 
                                                            (e) Short-term   (f) Long-term      income                          (d) through (h)      income
1a 
b 
2     Attachment total         .
3     Total        . . .   .   .
4  If line 3, Total, column (i) does not agree with Part V, line 1b of Form 5227 for a CRAT or Part VI, line 7 of Form 5227 for a   
   CRUT, check here                and attach an explanation. 
Part IV            Current Distributions (charitable lead trusts or pooled income funds only) (see instructions) 
1  Enter the amount required to be paid to private beneficiaries for 2022  .                    .  .  .    .   .  . .     .  .  .
Part V             Assets and Donor Information (Section 664 trust or charitable lead trust only) 
1  Is this the initial return or were additional assets contributed to the trust in 2022?  .                   .  . .     .  .  .    .   .          Yes       No 
   If “Yes,” complete the schedule below. 
   If “No,” complete only column (a) of the schedule below. 
                           (a)                                    (b)                                      (c)                                  (d) 
            Name and address of donor                Description of each asset donated               FMV of each                           Date of donation 
                                                                                                asset on date of donation 

2a 

2b 

2c 
3  Attachment total            . .    . .  .   .     . .    .   . . .      . .   .   
4  Total .         . . .   .   . .    . .  .   .     . .    .   . . .      . .   .      
5  For charitable remainder trusts: If this was the final year, was an early termination agreement signed 
   by all parties to the trust?         .  .   .     . .    .   . . .      . .   .  .   .  .    .  .  .    .   .  . .     .  .         Yes          No       N/A 
   If “Yes,” attach a copy of the signed agreement. 
                                                                                                                                                Form 5227 (2022)