5227 Split-Interest Trust Information Return

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 5227, PAGE 1 of 4
PRINTS: HEAD TO FOOT
MARGINS: TOP 13mm (1⁄2"), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2") x 559mm (22"), FOLD TO: 216mm (81⁄2") x 279mm (11")
PERFORATE: ON FOLD

5227

Date

Signature

O.K. to print

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Form

Action

Revised proofs
requested

OMB No. 1545-0196

Split-Interest Trust Information Return

Department of the Treasury
Internal Revenue Service

䊳

2005

See separate instructions.

Full name of trust

A

Employer identification number

Name of trustee

B

Type of Entity

Number, street, and room or suite no. (If a P.O. box, see page 3 of the instructions.)

(1)

Charitable lead trust

(2)

Charitable remainder annuity trust
described in section 664(d)(1)

(3)

Charitable remainder unitrust
described in section 664(d)(2)

(4)

Pooled income fund described in
section 642(c)(5)

(5)

Other

City, state, and ZIP code

C

Fair market value (FMV) of assets at end of tax year

E

Check applicable
Initial return
boxes (see
Change in trustee’s
instructions)

䊳

D

Date the trust was created

Final return
Name

Amended return
Address

Did the split-interest trust have any unrelated business taxable income (section 664 trusts
only)? If “Yes,” file Form 1041

F

Part I
1
2a
b
3
4
5
6
7
8

Yes

No

Ordinary Income (Section 664 trust only)

Interest income
2a
Qualified dividends (see instructions)
Ordinary dividends (including qualified dividends)
Business income or (loss). Attach Schedule C or C-EZ (Form 1040)
Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040)
Farm income or (loss). Attach Schedule F (Form 1040)
Ordinary gain or (loss). Attach Form 4797
Other income. State nature of income 䊳
Total ordinary income. Combine lines 1, 2b, and 3 through 7

1
2b
3
4
5
6
7
8

Deductions Allocable to Ordinary Income
9
10
11
12
13

Interest
Taxes
Other deductions. Attach a separate sheet listing deductions
Total deductions. Add lines 9 through 11
Ordinary income less deductions. Subtract line 12 from line 8. Enter here and on line 21, column (a)

9
10
11
12
13

Capital Gains (Losses) and Allocable Deductions
Total short-term capital gain or (loss) for tax year. Attach Schedule D
14
(Form 1041)
15
15 Deductions allocable to short-term capital gains
16 Balance. Subtract line 15 from line 14. Enter here and on line 21, column (b)
17a Total long-term capital gain or (loss) for tax year. Attach Schedule D
17a
(Form 1041)
17b
b 28% rate gain or (loss)
17c
c Unrecaptured section 1250 gain
18
18 Deductions allocable to long-term capital gains
19 Balance. Subtract line 18 from line 17a. Enter here and on line 21, column (c)
14

Part II

19

Accumulation Schedule (Section 664 trust only)
(a) Ordinary
income

Accumulations

20
21
22
23

16

Capital gains and (losses)
(b) Net short-term

(c) Net long-term

(d) Nontaxable
income

Undistributed from prior tax years
Current tax year (before distributions)
Total. Add lines 20 and 21
Undistributed at end of tax year

Part III

Current Distributions Schedule (Section 664 trust only)
Name of recipient

Identifying
number

(a) Ordinary
income

Capital gains
(b) Short-term

(c) Long-term

(d) Nontaxable
income

(e) Corpus

24a
b
c
For Privacy Act and Paperwork Reduction Act Notice, see page 10 of the instructions.

Cat. No. 13227T

Form

5227

(2005)

4
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 5227, PAGE 2 of 4
PRINTS: HEAD TO FOOT
MARGINS: TOP 13mm (1⁄2"), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2") x 559mm (22"), FOLD TO: 216mm (81⁄2") x 279mm (11")
PERFORATE: ON FOLD

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 5227 (2005)

Part IV

25
26
27a
b
28
29a
b
30
31
32a
b
c
33a
b
34
35a
b
36
37

Balance Sheet (see page 6 of the instructions)

Assets
Cash—non-interest-bearing
Savings and temporary cash investments
27a
Accounts receivable
27b
Less: allowance for doubtful accounts
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule)
29a
Other notes and loans receivable
29b
Less: allowance for doubtful accounts
Inventories for sale or use
Prepaid expenses and deferred charges
Investments—U.S. and state government obligations (attach schedule)
Investments—corporate stock. Attach schedule
Investments—corporate bonds. Attach schedule
Investments—land, buildings, and equipment:
33a
basis (attach schedule)
33b
Less: accumulated depreciation

Investments—other (attach schedule)
35a
Land, buildings, and equipment: basis
35b
Less: accumulated depreciation
Other assets. Describe 䊳
Total assets. Add lines 25 through 36 (must equal line 47)
Liabilities
38 Accounts payable and accrued expenses
39 Deferred revenue
40 Loans from officers, directors, trustees, and other disqualified persons
41 Mortgages and other notes payable. Attach schedule
42 Other liabilities. Describe 䊳
43 Total liabilities. Add lines 38 through 42
Net Assets
44 Trust principal or corpus
45a Undistributed income
b Undistributed capital gains
c Undistributed nontaxable income
46 Total net assets. Add lines 44 through 45c
47 Total liabilities and net assets. Add lines 43 and 46

Part V-A

(a) Beginning-ofYear Book Value

(b) End-of-Year
Book Value

(c) FMV (see
instructions)

25
26

28

30
31
32a
32b
32c

34

36
37
38
39
40
41
42
43
44
45a
45b
45c
46
47

Charitable Remainder Annuity Trust Information (to be completed only by a section 664 charitable
remainder annuity trust)

48a Enter the initial fair market value (FMV) of the property placed in the trust
b Enter the total annual annuity amounts for all recipients. Attach schedule showing the amount for each
recipient if more than one

Part V-B

2

Page

48a
48b

Charitable Remainder Unitrust Information (to be completed only by a section 664 charitable
remainder unitrust)

49a Enter the unitrust fixed percentage to be paid to the recipients
If there is more than one recipient, attach a schedule showing the percentage of the total unitrust
dollar amount payable to each recipient.
b Unitrust amount. Subtract line 43, column (c), from line 37, column (c), and multiply the result by the
percentage on line 49a. Do not enter less than -0Note. Complete lines 50a through 51b only for those unitrusts whose governing instruments provide
for determining required distributions with reference to the unitrust’s income. Otherwise, enter the
amount from line 49b on line 52.
50a Trust’s accounting income for 2005
b Enter the smaller of line 49b or line 50a here, and on line 52 on page 3, unless the Caution below applies
Caution: Lines 51a and b need to be completed by those unitrusts whose governing instruments
provide for current distributions to make up for any distribution deficiencies in previous years due to
the trust income limit. See Regulations section 1.664-3(a)(1)(i)(b)(2). For these trusts, when completing
line 52, enter the smaller of line 50a or line 51b.

49a

%

49b

50a
50b

Form 5227 (2005)

4
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 5227, PAGE 3 of 4
PRINTS: HEAD TO FOOT
MARGINS: TOP 13mm (1⁄2"), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
1
FLAT SIZE: 216mm (8 ⁄2") x 559mm (22"), FOLD TO: 216mm (81⁄2") x 279mm (11")
PERFORATE: ON FOLD

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 5227 (2005)

51a
b
52
53
54
55

2

Yes

No

Yes

No

Statements Regarding Activities (see page 8 of the instructions)

Are the requirements of section 508(e) satisfied either:
● 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?
Are you using this return only to report the income and assets of a segregated amount under section
4947(a)(2)(B)?

Part VI-B

3

51a
51b
52
53

Total accrued distribution deficiencies from previous years (see page 8 of the instructions)
Add lines 49b and 51a
Unitrust distributions for 2005
Carryover of distribution deficiency. Subtract line 52 from line 51b
Did the trustee change the method of determining the fair market value of the assets?
If “Yes,” attach an explanation.
Were any additional contributions received by the trust during 2005?
If “Yes,” attach a schedule that lists the assets and the date(s) received.

Part VI-A
1

Page

Yes No

1
2

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.
1 Self-dealing (section 4941):
a During 2005, did the trust (either directly or indirectly):
Yes
(1) Engage in the sale or exchange, or leasing of property with a disqualified person?
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
Yes
a disqualified person?
Yes
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?

Yes No

No
No
No
No

(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)?

Yes

No

(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.)

Yes

No

b If any answer is “Yes” to 1a(1)—(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 page 9
of the instructions)?
䊳
Organizations relying on a current Notice regarding disaster assistance, check here
c Did the trust engage in a prior year in any of the acts described in 1a, other than excepted acts, that were
not corrected before January 1, 2005?
2 Does section 4947(b)(3)(A) or (B) apply? (See page 9 of the instructions.) (If “Yes,” check
Yes
No
the “N/A” box in questions 3 and 4.)
N/A
3 Taxes on excess business holdings (section 4943):
a Did the trust hold more than a 2% direct or indirect interest in any business enterprise
at any time during 2005?

Yes

1c

No

b If “Yes,” did the trust have excess business holdings in 2005 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?
Use Schedule C, Form 4720, to determine if the trust had excess business holdings in 2005.
N/A
4 Taxes on investments that jeopardize charitable purposes (section 4944):
a Did the trust invest during 2005 any amount in a manner that would jeopardize its charitable purpose?
b 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, 2005?
5 Taxes on taxable expenditures (section 4945) and political expenditures (section 4955):
a During 2005 did the trust pay or incur any amount to:
Yes
No
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
(2) Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
(3) Provide a grant to an individual for travel, study, or other similar purposes?
(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)?
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
educational, or for the prevention of cruelty to children or animals?

1b

Yes
Yes

No
No

Yes

No

Yes

No

3b

4a
4b

Form 5227 (2005)

4
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 5227, PAGE 4 of 4
PRINTS: HEAD TO FOOT
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 559mm (22"), FOLD TO: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD

Investments — other (attach schedule)

Form 5227 (2005)

Page

Yes No

5b If any answer is “Yes” to 5a(1)—(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 page 9 of the
instructions)?
䊳
Organizations relying on a current Notice regarding disaster assistance, check here
c If the answer is “Yes” to question 5a(4), does the trust claim exemption from the tax
because it maintained expenditure responsibility for the grant? (See page 9 of the
Yes
instructions.)
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
Yes
on a personal benefit contract?
b Did the trust, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
If “ Yes” to 6b, file Form 8870 (see instructions).

Part VII

4

5b

No

No
6b

Questionnaire for Charitable Lead Trusts, Pooled Income Funds, and Charitable Remainder Trusts
Section A—Charitable Lead Trusts

1

2
3
4

Does the governing instrument require income in excess of the required annuity or unitrust payments to be
paid for charitable purposes?

Yes

No

2

Enter the amount of any excess income required to be paid for charitable purposes for 2005
Enter the amount of annuity or unitrust payments required to be paid to charitable beneficiaries
for 2005
Enter the amount of annuity or unitrust payments required to be paid to private beneficiaries for
2005

3
4

Section B—Pooled Income Funds
1

Enter the amount of contributions received during 2005

1

2
3

Enter the amount required to be distributed for 2005 to satisfy the remainder interest
Enter any amounts that were required to be distributed to the remainder beneficiary that remain
undistributed

2

4

Enter the amount of income required to be paid to private beneficiaries for 2005

4

5

Enter the amount of income required to be paid to the charitable remainder beneficiary for 2005

5

3

Section C—Charitable Remainder Trusts and Other Information
(All split-interest trusts, check applicable boxes.)
1
2

3

Check this box if you are filing for a charitable remainder annuity trust or a charitable remainder unitrust whose
䊳
charitable interests involve only cemeteries or war veterans’ posts
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
䊳
of the tax year. (See page 10 of the instructions.)
䊳
Check this box if any of the split-interest trust’s income interests expired during 2005

Sign
Here
Paid
Preparer’s
Use Only

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
has any knowledge.

䊳

䊳

Signature of trustee or officer representing trustee

Preparer’s
signature

䊳

Firm’s name (or yours
if self-employed),
address, and ZIP code

Date

䊳

Check if selfemployed

Date

Preparer’s SSN or PTIN

EIN
Phone no. (

)
Form 5227 (2005)