SCHEDULE B-1 
                            Information on Certain Shareholders of an S Corporation
(Form 1120S)                                      ▶ Attach to Form 1120S.                                                       OMB No. 1545-0123
(Rev. December 2016)                     ▶ Information about Schedule B-1 (Form 1120S) and 
Department of the Treasury                         its instructions is at www.irs.gov/form1120s.
Internal Revenue Service  
Name of corporation                                                                                                             Employer identification number 

Information on Any Shareholder That Was a Disregarded Entity, a Trust, an Estate, or a Nominee or Similar 
Person at Any Time During the Tax Year (Form 1120S, Schedule B, Question 3)
                                                    (b)                                                                         (d) 
                            (a)                                                Social Security Number (SSN) (c)                         Name and SSN or EIN (if any) of Individual or 
Name of Shareholder of Record—Disregarded Entity, or Employer Identification                                Type of Shareholder Entity Responsible for Reporting Shareholder’s 
Trust, Estate, Nominee or Similar Person          Number (EIN) (if any) of                                   of Record          Income, Deductions, Credits, etc., From 
                                                  Shareholder of Record                                                         Schedule K-1

For Paperwork Reduction Act Notice, see the Instructions for Form 1120S.                                    Cat. No. 60837X     Schedule B-1 (Form 1120S) (Rev. 12-2016)

Schedule B-1 (Form 1120S) (Rev. 12-2016)                                                                                     Page 2

General Instructions                                             Specific Instructions
Section references are to the Internal Revenue Code unless       Column (a)
otherwise noted.
                                                                 Enter the name of the shareholder (owner) of record in column 
Future Developments                                              (a). For example:
For the latest information about developments related to         • If a disregarded entity  (for example, a single member limited 
Schedule B-1 (Form 1120S) and its instructions, such as          liability company (LLC) that did not elect to be taxed as a 
legislation enacted after they were published, go to             corporation for federal income tax purposes) is the shareholder 
www.irs.gov/form1120s.                                           (owner) of record, enter the name of the disregarded entity.
Purpose of Form                                                  • If a nominee or similar person (for example, a guardian, 
                                                                 custodian, or agent) is the shareholder (owner) of record, enter 
Use Schedule B-1 (Form 1120S) to provide the information         the name of the nominee or similar person.
applicable to any shareholder in the S corporation that was a 
disregarded entity, a trust, an estate, or a nominee or similar  Column (c)
person at any time during the tax year.                          Enter the type of shareholder (owner) of record. For example, 
If the shareholder was a disregarded entity, provide the         the shareholder (owner) of record may be a disregarded entity, 
information even if the name, address, and social security       trust, estate, nominee, guardian, custodian, agent, or similar 
number (SSN) or employer identification number (EIN) (if any) of person.
the owner of the disregarded entity was entered on Schedule 
K-1 (Form 1120S), Shareholder's Share of Income, Deductions,     Column (d)
Credit, etc. If the shareholder was a nominee, guardian,         Enter the name and SSN or EIN (if any) of the individual or entity 
custodian, or agent, provide the information even if the name,   responsible for reporting shareholder's income, deductions, 
address, and SSN or EIN (if any) of the person for whom the      credits, etc., from Schedule K-1 (Form 1120S). For example:
stock was held was entered on Schedule K-1 (Form 1120S).
                                                                 1. If a disregarded entity is the shareholder (owner) of record, 
Who Must File                                                    the owner of the disregarded entity must be eligible to be an     
                                                                 S corporation shareholder. Enter the name and SSN or EIN (if 
Schedule B-1 (Form 1120S) must be filed by all S corporations    any) of the owner. For example, if a single member LLC owns 
that answer “Yes” to Form 1120S, Schedule B, question 3.         stock in the corporation, and the LLC is treated as a 
Attach Schedule B-1 to Form 1120S.                               disregarded entity for federal income tax purposes, enter the 
                                                                 member's name and SSN or EIN (if any). An LLC that elects to 
                                                                 be treated as a corporation for federal income tax purposes is 
                                                                 not eligible to be an S corporation shareholder.
                                                                 2. If a trust is the shareholder (owner) of record, the information 
                                                                 entered in column (d) is dependent on the type of trust.
                                                                 a. If the trust is a grantor trust, the grantor must be an 
                                                                 individual. Enter the name and SSN of the grantor.
                                                                 b. If the trust is a qualified subchapter S trust (QSST), there 
                                                                 can only be one beneficiary, who must be an individual. Enter 
                                                                 the name and SSN of the individual beneficiary.
                                                                 c. If the trust is an electing small business trust (ESBT), enter 
                                                                 the information you entered under columns (a) and (b). Do not 
                                                                 enter any beneficiary information. 
                                                                 3. If an estate is the shareholder (owner) of record, enter the 
                                                                 information you entered under columns (a) and (b). Do not enter 
                                                                 any beneficiary information.