SCHEDULE K                      Shareholder's Statement of IC-DISC Distributions                                                        OMB No. 1545-0123
(Form 1120-IC-DISC)                            For calendar year 20                             or tax year
(Rev. November 2018)                                                                                                                   COPY A—Attach to 
                             beginning                                          , 20   , ending                            , 20
Department of the Treasury                                                                                                             Form 1120-IC-DISC
Internal Revenue Service        (Complete for each shareholder. See instructions on back of Copy C.)
Part I   Taxable Distributions
1  Deemed distributions:     a Under section 995(b)(1)  .                            . . . .    . .        . . . . .       .   . .   . 1a
                             b Annual installment under section 995(b)(2)  .                               . . . . .       .   . .   . 1b
                             c Total. Add lines 1a and 1b .                            . . .    . .        . . . . .       .   . .   . 1c
2  Actual taxable distributions  .     . . . . . .                              . .  . . . .    . .        . . . . .       .   . .   . 2
3  Total taxable distributions. Add line 1c and line 2. Enter here and in Section A or B below .                                 .   . 3
Section A—C Corporations
4a Part of line 3 above entitled to section 243 dividends-received deduction .                               . . . .       .   . .   . 4a
b  Part of line 3 above not entitled to section 243 dividends-received deduction  .                              . .       .   . .   . 4b
Section B—Shareholders Other Than C Corporations
5  Amount of taxable dividends included on line 3  .                              .  . . . .    . .        . . . . .       .   . .   . 5
Part II  Nontaxable Distributions
6  Actual distributions from previously taxed income and accumulated pre-1985 DISC income                                        .   . 6
7  Other actual nontaxable distributions .   . . .                              . .  . . . .    . .        . . . . .       .   . .   . 7
8  Total nontaxable distributions. Add lines 6 and 7  .                              . . . .    . .        . . . . .       .   . .   . 8
Part III Other Information
9  Accumulated IC-DISC income attributable to stock sold during the year  .                                  . . . .       .   . .   . 9
10 Deferred DISC income. See instructions .    . .                              . .  . . . .    . .        . . . . .       .   . .   . 10
                                                                                         Name, employer identification number, and address (including ZIP code)  
Shareholder’s name, identifying number, and address (including ZIP code)                 of IC-DISC, former DISC, or former IC-DISC

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-IC-DISC. www.irs.gov/Form1120icdisc Cat. No. 11474A Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

SCHEDULE K                      Shareholder's Statement of IC-DISC Distributions                                            OMB No. 1545-0123
(Form 1120-IC-DISC)                            For calendar year 20                   or tax year                            COPY B— 
(Rev. November 2018)         beginning             , 20                      , ending                     , 20             For Shareholder's 
Department of the Treasury                                                                                                   records
Internal Revenue Service   
Part I   Taxable Distributions
1  Deemed distributions:     a Under section 995(b)(1)  .                  . . . .    . . .       . . . . . .   .        . 1a
                             b Annual installment under section 995(b)(2)  .              .       . . . . . .   .        . 1b
                             c Total. Add lines 1a and 1b .                  . . .    . . .       . . . . . .   .        . 1c
2  Actual taxable distributions  .     . . . . . . .                     . . . . .    . . .       . . . . . .   .        . 2
3  Total taxable distributions. Add line 1c and line 2. Enter here and in Section A or B below .                .        . 3
Section A—C Corporations
4a Part of line 3 above entitled to section 243 dividends-received deduction .                    . . . . . .   .        . 4a
b  Part of line 3 above not entitled to section 243 dividends-received deduction  .                   . . . .   .        . 4b
Section B—Shareholders Other Than C Corporations
5  Amount of taxable dividends included on line 3  .                     . . . . .    . . .       . . . . . .   .        . 5
Part II  Nontaxable Distributions
6  Actual distributions from previously taxed income and accumulated pre-1985 DISC income                       .        . 6
7  Other actual nontaxable distributions .   . . . .                     . . . . .    . . .       . . . . . .   .        . 7
8  Total nontaxable distributions. Add lines 6 and 7  .                    . . . .    . . .       . . . . . .   .        . 8
Part III Other Information
9  Accumulated IC-DISC income attributable to stock sold during the year  .                       . . . . . .   .        . 9
10 Deferred DISC income. See instructions .    . . .                     . . . . .    . . .       . . . . . .   .        . 10
                                                                               Name, employer identification number, and address (including ZIP code)  
Shareholder’s name, identifying number, and address (including ZIP code)       of IC-DISC, former DISC, or former IC-DISC

www.irs.gov/Form1120icdisc                   Cat. No. 11474A                                          Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

Instructions for Shareholder                      Line 5. If you are an individual, partnership,    Part II—Nontaxable Distributions
                                                  S corporation, estate, or trust, line 5 shows 
Section references are to the Internal Revenue    the amount of line 3 distributions taxable to     Actual distributions from previously taxed 
Code.                                             you as a dividend.                                income and accumulated pre-1985 DISC 
                                                                                                    income are generally not taxable to the extent 
Purpose of forms. Copy B of Schedule K            For a tax-exempt entity, treat any deemed         of your basis in the stock for which the 
(Form 1120-IC-DISC) reports an actual or          distribution or actual distribution of previously distribution was made. Except for 
deemed distribution from an IC-DISC, former       untaxed income as derived from the conduct        distributions of accumulated IC-DISC income 
IC-DISC, or former DISC. It also reports          of an unrelated trade or business.                and of earnings and profits from the time 
deferred DISC income from an IC-DISC.                                          If you disposed      before the corporation became an IC-DISC, 
Keep it for your records; do not file it with     Disposing of IC-DISC stock. 
your income tax return.                           of stock in an IC-DISC, former IC-DISC, or        actual distributions are not taxable to the 
                                                  former DISC, you may need to include all or       extent of your basis in the stock for which the 
Part I—Taxable Distributions                      part of the gain in your income. The gain,        distribution was made. Treat distributions in 
                                                  reported as a dividend under section 995(c),is    excess of your basis as a gain from the sale 
Report as distributions from an IC-DISC:          included to the extent of accumulated             or exchange of property. See section 996(e).
1. Deemed and actual taxable distributions;       IC-DISC income attributable to the stock 
and                                               while you held it (line 9). This dividend is not  Part III—Other Information
2. Gain, to the extent of accumulated             eligible for the section 243 deduction.           Line 10—Deferred DISC income. Line 10 
IC-DISC income, on the sale of stock (see         For a tax-exempt entity, treat the gain           shows your share of the IC-DISC’s deferred 
Disposing of IC-DISC Stock below).                under section 995(c) as derived from the          income for the year. Section 995(f) imposes 
Line 1—Deemed distributions. You are              conduct of an unrelated trade or business.        an interest charge on the additional tax you 
                                                                                                    would pay if you included this deferred
treated as having received deemed                 Foreign shareholders treat all gains on the                                               
                                                                                                    income in your income for your tax year that
distributions (line 1c) as of the last day of the disposition of stock in an IC-DISC, former                                                         
                                                                                                    ends with or includes the IC-DISC’s tax year
IC-DISC tax year. You must pay tax on the         IC-DISC, or former DISC, and all distributions                                                     
                                                                                                    end shown on Schedule K. Complete Form
distributions in your tax year that includesthat  from accumulated IC-DISC income or                                                                
                                                                                                    8404, Interest Charge on DISC-Related
date.                                             accumulated pre-1985 DISC income,                                                         
                                                                                                    Deferred Tax Liability, to figure the interest
Line 2—Actual taxable distributions. You          including deemed distributions, as effectively                                                   
                                                                                                    charge.
must pay tax on actual taxable distributionsin    connected with the conduct of a trade or 
the year of receipt.                              business through a permanent establishment        Future developments. For the latest 
                                                  within the United States. See section 996(g)      information about developments related to 
Line 4. Line 4a shows the part of the total       for details.                                      Schedule K (Form 1120-IC-DISC) and its 
taxable distribution on line 3 that qualifies for                                                   instructions, such as legislation enacted after 
the 50% or 65% dividends-received                 Acquiring IC-DISC stock. If you acquired          they were published, go to www.irs.gov/
deduction under section 243. Line 4b shows        stock in an IC-DISC and subsequently              Form1120icdisc.
the part that does not qualify for the            received a distribution with respect to that 
deduction.                                        stock, you may be able to treat part of that 
                                                  distribution as a nontaxable distribution. See 
                                                  section 996(d) for details.
                                                                                                    Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

SCHEDULE K                      Shareholder's Statement of IC-DISC Distributions                                            OMB No. 1545-0123
(Form 1120-IC-DISC)                            For calendar year 20                   or tax year
(Rev. November 2018)                                                                                                         COPY C— 
                             beginning             , 20                      , ending                    , 20
Department of the Treasury                                                                                                 For IC-DISC's records
Internal Revenue Service        (Complete for each shareholder. See instructions on back of Copy C.)
Part I   Taxable Distributions
1  Deemed distributions:     a Under section 995(b)(1)  .                  . . . .    . . .      . . . . .   . .         . 1a
                             b Annual installment under section 995(b)(2)  .              .      . . . . .   . .         . 1b
                             c Total. Add lines 1a and 1b .                  . . .    . . .      . . . . .   . .         . 1c
2  Actual taxable distributions  .     . . . . . . .                     . . . . .    . . .      . . . . .   . .         . 2
3  Total taxable distributions. Add line 1c and line 2. Enter here and in Section A or B below .               .         . 3
Section A—C Corporations
4a Part of line 3 above entitled to section 243 dividends-received deduction .                   . . . . .   . .         . 4a
b  Part of line 3 above not entitled to section 243 dividends-received deduction  .                  . . .   . .         . 4b
Section B—Shareholders Other Than C Corporations
5  Amount of taxable dividends included on line 3  .                     . . . . .    . . .      . . . . .   . .         . 5
Part II  Nontaxable Distributions
6  Actual distributions from previously taxed income and accumulated pre-1985 DISC income                      .         . 6
7  Other actual nontaxable distributions .   . . . .                     . . . . .    . . .      . . . . .   . .         . 7
8  Total nontaxable distributions. Add lines 6 and 7  .                    . . . .    . . .      . . . . .   . .         . 8
Part III Other Information
9  Accumulated IC-DISC income attributable to stock sold during the year  .                      . . . . .   . .         . 9
10 Deferred DISC income. See instructions .    . . .                     . . . . .    . . .      . . . . .   . .         . 10
                                                                               Name, employer identification number, and address (including ZIP code)  
Shareholder’s name, identifying number, and address (including ZIP code)       of IC-DISC, former DISC, or former IC-DISC

www.irs.gov/Form1120icdisc                   Cat. No. 11474A                                         Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)

Instructions for IC-DISC                         Line 2.Enter the amount of actualdistributions    earnings and profits. The total of this line for 
                                                 that are taxable to theshareholder. These         all shareholders should equal the total 
Section references are to the Internal Revenue   distributions come fromaccumulated  IC-DISC       nontaxable income reported on Form 1120-
Code.                                            income and otherearnings      and profits.        IC-DISC, Schedule J, Part IV, line 4d.
Future developments. For the latest              Line 4a. Enter on line 4a each shareholder’s      Part III—Other Information
information about developments related to        amount of dividends out of other earningsand 
Schedule K (Form 1120-IC-DISC) and its           profits that are eligible for thedividends-       Line 9. If (1) a shareholder disposes of stock 
instructions, such as legislation enacted after  received deduction under section243.      No      in an IC-DISC or former DISC, or (2) the stock 
they were published, go to www.irs.gov/          dividends-received deduction isallowed      for a of an IC-DISC, former IC-DISC, or former 
Form1120icdisc.                                  dividend from an IC-DISC,former   IC-DISC, or     DISC is disposed of in a transaction that 
                                                 former DISC if it is:                             terminates the separate corporate existence 
General Instructions                             1. Paid out of accumulated IC-DISC income         of an IC-DISC, former IC-DISC, or former 
Complete Schedule K (Form 1120-IC-DISC) for      or accumulated pre-1985 DISC income,              DISC (other than a mere change in the place 
                                                                                                   of organization), enter on line 9 the 
each shareholder who had an actual or deemed     2. Paid out of previously taxed income, or        accumulated IC-DISC income attributable to 
distribution during the tax year or to whom the 
corporation is reporting deferred DISC income    3. A deemed distribution under section            the stock that was accumulated during the 
for the tax year. Attach Copy A to Form 1120-    995(b)(1).                                        period the shareholder held the stock.
IC-DISC. Give Copy B to the shareholder by the   Line 5. Complete for shareholders that are        Line 10. Enter the shareholder’s share of the 
last day of the second month after your tax year individuals, partnerships, S corporations,        corporation’s deferred DISC income at tax 
ends. Keep Copy C for your records.              estates, or trusts. Enter on line 5 each          year end. See section 995(f) and the 
Note: Do not report on Form 1099-DIV actual      shareholder’s pro rata share of taxable           instructions for Schedule J, Part V, in the 
and deemed distributions or deferred DISC        dividends included on line 3.                     Instructions for Form 1120-IC-DISC for 
income.                                                                                            information on figuring deferred DISC income. 
                                                 Part II—Nontaxable Distributions                  The total of this line for all shareholders 
Specific Instructions                            Line 6. Enter the shareholder’s pro rata share    should equal the total amount reported on 
                                                 of actual distributions from previously taxed     Form 1120-IC-DISC, Schedule J, Part V,     
Part I—Taxable Distributions                     income and distributions from accumulated         line 3.
Line 1. On line 1a, enter the shareholder’spro   pre-1985 DISC income. The total of line 6 for 
rata share of the deemed distributionsunder      all shareholders should equal the total the 
section 995(b)(1). On line 1b, enter the         corporation reports on Form 1120-IC-DISC, 
shareholder’s pro rata share of the annual       Schedule J, Part IV, line 4a.
installment under section 995(b)(2). The sum     Line 7. Enter the shareholder’s pro rata share 
of the amounts on these lines for all            of actual nontaxable distributions out of other 
shareholders should equal the total the          than (1) previously taxed income or 
corporation reports in Part I and Part III,      accumulated pre-1985 DISC income,(2) 
Schedule J, Form 1120-IC-DISC.                   accumulated IC-DISC income, and (3) other 
                                                                                                   Schedule K (Form 1120-IC-DISC) (Rev. 11-2018)