Form 5227 Split-Interest Trust Information Return

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requested

Cumulative Changes Copy/OMB Copy
Yellow highlights are changes.

Form

5227

OMB No. 1545-0196

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Department of the Treasury
Internal Revenue Service (77)



Full name of trust

Name of trustee

Open to Public
Inspection

See separate instructions.

A

Employer identification number

B

Type of Entity

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

City, state, and ZIP code

C

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

E

Check applicable
Initial return
Final return
Amended return
boxes (see
Change in trustee’s 
Name
Address
instructions)
If the trust is a section 664 trust, did it have unrelated business taxable income? If “Yes,” file Form 4720

G

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

09

Split-Interest Trust Information Return

D

Gross Income

F

(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—Attach explanation

Date the trust was created

Income and Deductions (All trusts complete Sections A through D)
Section A—Ordinary Income

Interest income
Ordinary dividends (including qualified dividends)
2b
Qualified dividends (see page 4 of the instructions)
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. List type and amount 
Total ordinary income. Combine lines 1, 2a, and 3 through 7

1
2a



3
4
5
6
7
8

Section B—Capital Gains (Losses)
9
10
11
12
13

Total short-term capital gain or (loss). Attach Schedule D, Part I (Form 1041)
Total long-term capital gain or (loss). Attach Schedule D, Part II (Form 1041)
11
Unrecaptured section 1250 gain
12
28% gain
Total capital gains (losses). Combine lines 9 and 10

14
15

Tax-exempt interest
Other nontaxable income. List type and amount

16

Total nontaxable income. Add lines 14 and 15

17
18
19
20
21
22
23

Interest
Taxes (see page 5 of the instructions)
Trustee fees
Attorney, accountant, and return preparer fees
Other allowable deductions. Attach schedule (see page 5 of the instructions)
Total. Add lines 17 through 21
Charitable deduction
23

9
10



13

Section C—Nontaxable Income
14



15
16

Section D—Deductions
17
18
19
20
21
22

Section E—Deductions Allocable to Income Categories (Section 664 trust only)
24a Enter the amount from line 22 allocable to ordinary income
b Subtract line 24a from line 8
25a Enter the amount from line 22 allocable to capital gains (losses)

24a
24b
25a
25b

Yes

No

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Form 5227 (2009)

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Schedule of Distributable Income (Section 664 trust only) See page 6 of the instructions

Part II

Accumulations

27
28

(a) Ordinary
income

(b) Capital gains
(losses)

Undistributed income from prior tax years
Current tax year net income (before distributions):
● In column (a), enter the amount from line 24b
● In column (b), enter the amount from line 25b
● In column (c), enter the amount from line 26b
Total distributable income. Add lines 27 and 28

29

Part III-A

Distributions of Principal for Charitable Purposes

Principal distributed in prior tax years for charitable purposes
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 page 6 of
the instructions)

30
31

(A)
Payee’s name and address

a

(B)
Date of distribution

30

(C)
Charitable purpose and description of assets distributed

31a

b

31b
c

32

31c
32

Total. Add lines 30 through 31c

Part III-B

Accumulated Income Set Aside and Income Distributions for Charitable Purposes
(see page 6 of the instructions)

33a Accumulated income set aside in prior tax years for which a deduction was claimed under
section 642(c)
b Enter the amount shown on line 23
34 Add lines 33a and 33b
35 Distributions made during the tax year (see page 6 of the instructions):
● For income set aside in prior tax years for which a deduction was claimed under section 642(c),
or
● For charitable purposes for which a charitable deduction was claimed under section 642(c) in
the current tax year.

33a
33b
34

Fill in the information for columns (A), (B), and (C) and enter the amount distributed on the line
to the right.
(A)
Payee’s name and address

(B)
Date of distribution

(C)
Charitable purpose and description of assets distributed

a
35a
b
35b
c

36

Page

Add lines 35a through 35c

35c
36

(c) Nontaxable
income

2

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Form 5227 (2009)

Part IV

38
39
40a
b
41
42a
b
43
44
45a
b
c
46a
b
47
48a
b
49
50
51
52
53
54
55
56
57
58a
b
c
59
60

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Page

3

Balance Sheet (see pages 6 through 8 of the instructions)

Assets
Cash—non-interest-bearing
Savings and temporary cash investments
40a
Accounts receivable
40b
Less: allowance for doubtful accounts
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule)
42a
Other notes and loans receivable
42b
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:
46a
basis (attach schedule)
46b
Less: accumulated depreciation
Investments—other (attach schedule)
48a
Land, buildings, and equipment: basis
48b
Less: accumulated depreciation
Other assets. Describe 

Total assets. Add lines 38 through 49 (must equal line 60)
Liabilities
Accounts payable and accrued expenses
Deferred revenue
Loans from officers, directors, trustees, and other disqualified persons
Mortgages and other notes payable. Attach schedule
Other liabilities. Describe 

Total liabilities. Add lines 51 through 55
Net Assets
Trust principal or corpus
Undistributed income
Undistributed capital gains
Undistributed nontaxable income
Total net assets. Add lines 57 through 58c
Total liabilities and net assets. Add lines 56 and 59

(a) Beginning-ofYear Book Value

(b) End-of-Year
Book Value

(c) FMV (see
instructions)

38
39

41

43
44

45a
45b
45c

47

49
50
51
52
53
54
55
56
57
58a
58b
58c
59
60
Form

5227

(2009)

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Form 5227 (2009)

Part V-A

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Charitable Remainder Annuity Trust (CRAT) Information (to be completed only by a section
664 CRAT)

61a Enter the initial fair market value (FMV) of the property placed in the trust
b Enter the total annual annuity amounts for all recipients

Part V-B
62
63
64

Charitable Remainder Unitrust (CRUT) Information (to be completed only by a section 664 CRUT)
See page 8 of the instructions

65a Enter the unitrust fixed percentage to be paid to the recipients
b Unitrust amount. Subtract line 56, column (c), from line 50, column (c), and mutiply the result by the
percentage on line 65a. Do not enter less than -0If the answer is “Yes” on line 62 or line 63, go to line 66a. Otherwise, skip lines 66a through 67b
and enter the line 65b amount on line 68.
66a Trust’s accounting income for 2009. Attach schedule
If the answer is “Yes” on line 62, go to line 66b. If the answer is “Yes” on line 63, skip line 66b
and go to line 67a.
b Enter the smaller of line 65b or line 66a here and on line 68. Skip lines 67a and 67b
67a Total accumulated distribution deficiencies from previous years (see page 8 of the instructions)
b Add lines 65b and 67a
If lines 67a and 67b are completed, enter the smaller of line 66a or line 67b on line 68.
68 Required unitrust distribution for 2009
69 Carryover of accumulated distribution deficiency (only for trusts that answered “Yes” on line 63).
Subtract line 68 from line 67b
70 If this is the final return, enter the initial FMV of all assets placed in trust by the donor
71 Did the trustee change the method of determining the fair market value of the assets?
If “Yes,” attach an explanation.
72 Were any additional contributions received by the trust during 2009?
If “Yes,” be sure to complete all columns of line 7 in Schedule A, Part III.
73

74

61a
61b

Is the CRUT a net income charitable remainder unitrust (NICRUT) as described in Regulations section
1.664-3(a)(1)(i)(b)(1)?
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)?
Did the trust change its method of payment during the tax year?
If “Yes,” describe the triggering event including the date of the event and the old method of payment 

Part VI-A

4

Page

Yes

No

Yes
Yes

No
No

%

65a

65b

66a

66b
67a
67b
68
69
70
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)?

Yes No

73
74
Form

5227

(2009)

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Form 5227 (2009)

Part VI-B

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Page

5

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
75 Self-dealing (section 4941):
a During 2009, did the trust (either directly or indirectly):
(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)
a disqualified person?
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
(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)?
(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.)

applies.

Yes

No

Yes
Yes
Yes

No
No
No

Yes

No

Yes

No

b If any answer is “Yes” to 75a(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 page
75b
9 of the instructions)?

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 75a, other than excepted acts, that were
75c
not corrected before January 1,, 2009?
Yes
No
76 Does section 4947(b)(3)(A) or (B) apply? (See page 9 of the instructions.)
If “Yes,” check the “N/A” box in questions 77 and 78.
N/A
77 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
Yes
No
any time during 2009?
b If “Yes,” did the trust have excess business holdings in 2009 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
77b
(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 2009.
N/A
78 Taxes on investments that jeopardize charitable purposes (section 4944):
78a
a Did the trust invest during 2009 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
78b
charitable purpose that had not been removed from jeopardy before January 1, 2009?
79 Taxes on taxable expenditures (section 4945) and political expenditures (section 4955):
a During 2009, 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?

Yes
Yes

No
No

Yes

No

Yes

No

b If any answer is “Yes” to 79a(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 page 9
79b
of the instructions)?

Organizations relying on a current Notice regarding disaster assistance, check here
c If the answer is “Yes” to question 79a(4), does the trust claim exemption from the tax
because it maintained expenditure responsibility for the grant? (See page 9 of the
instructions.)
If “Yes,” attach the statement required by Regulations section 53.4945-5(d).

Yes

No

Yes No

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6
Questionnaire for Charitable Lead Trusts, Pooled Income Funds, and Charitable Remainder Trusts
(see instructions beginning on page 9)

Form 5227 (2009)

Part VII

Page

Section A—All Trusts

81
82



Check this box if any of the split-interest trust’s income interests expired during 2009
Check this box if all of the split-interest trust’s income interests expired before 2009
If 82 (above) is checked and this is not a final return, attach an explanation.



Section B—Charitable Lead Trusts

83

84
85

Does the governing instrument require income in excess of the required annuity or unitrust payments to be
paid for charitable purposes?
Enter the amount of any excess income required to be paid for charitable purposes for 2009
Enter the amount of annuity or unitrust payments required to be paid to charitable beneficiaries for 2009

Yes

No

84
85

Section C—Pooled Income Funds
86

Enter the amount of contributions received during 2009

86

87
88

Enter the amount required to be distributed for 2009 to
t satisfy the remainder interest
Enter any amounts that were required to be distributed to the remainder beneficiary that remain
undistributed

87

Enter the amount of income required to be paid to the charitable remainder beneficiary for 2009

89

89

88

Section D—Charitable Remainder Trusts
90

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

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 page 10 of the instructions.)
92 Is this the initial return? If “Yes,” attach a copy of the trust instrument
Yes
93 Was the trust instrument amended during the year? If “Yes,” attach a copy
Yes
94a If this is the final return, were final distributions made according to the trust instrument?
Yes
b If “Yes,” did you complete line 31?
Yes
c If either line 94a or 94b is “No,” explain why 
91

95

At any time during calendar year 2009, 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?
See the instructions beginning on page 10 for exceptions and filing requirements for Form TD F 90-22.1.
If “Yes,” enter the name of the foreign country 

Sign
Here
Paid

Yes

No
No
No
No

No

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.





Signature of trustee or officer representing trustee

Preparer’s
signature



Date

Check if selfemployed

Date

Preparer’s SSN or PTIN

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Form 5227 (2009)
Full name of trust

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Page

7

Employer identification number

NOT Open To Public Inspection

Schedule A—Distributions, Assets, and Donor Information
Part I

Accumulation Schedule (Section 664 trust only) See page 10 of the instructions
(a)
Ordinary income

Accumulations

1
2a
b
3

(b)
Capital gain (loss)

(c)
Nontaxable income

Total distributable income. Enter the amount from line 29
Total distributions for 2009:
2009 distributions from income
Undistributed income at end of tax year. Subtract line 2b from
line 1

Part II-A Current Distributions Schedule (Section 664 trust only) See instructions beginning on page 10
(b)
Identifying number

(a)
Name of recipient

4a
b
c

(c)
Percentage of total unitrust
amount payable (if applicable)

%
%
%

Capital gains
(d)
Ordinary
Income

(e) Short-term

(f) Long-term

(g)
Nontaxable Income

(i)
Total (add cols.
(d) through (h)

(h)
Corpus

4a
b
c
Total
If Part II-A, Total, column (i) does not agree with line 61b of Form 5227 for a CRAT or line 68 of Form 5227 for a CRUT, check
here 
and attach an explanation.

Part II-B Current Distributions (charitable lead trusts or pooled income funds only) See page 12 of the instructions


5 Enter the amount required to be paid to private beneficiaries for 2009

Part III

Assets and Donor Information (Section 664 trust or charitable lead trust only)

6 Is this the initial return or were additional assets contributed to the trust in 2009?
If “Yes,” complete the schedule below.
If “No,” complete only column (a) of the schedule below.
(a)
Name and address of donor

7a

7b

(b)
Description of each asset donated

(c)
Fair market value of each
asset on date of donation

Yes

(d)
Date of donation

No