Form 8916-A Form 8916-A Supplemental Attachment to Schedule M-3

Form

8916-A

OMB No. 1545-2061

Supplemental Attachment to Schedule M-3

Department of the Treasury
Internal Revenue Service

©

2009

Attach to Schedule M-3 for Form 1065, 1120, 1120-L, 1120-PC, or 1120S.

Name of common parent

Employer identification number

Name of subsidiary

Employer identification number

Part I

Cost of Goods Sold
(a)
Expense per
Income Statement

Cost of Goods Sold Items

1

Amounts attributable to cost flow assumptions

2

Amounts attributable to:
a Stock option expense .

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b Other equity based compensation .

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c Meals and entertainment .

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d Parachute payments .

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e Compensation with section 162(m) limitation .

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f Pension and profit sharing

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g Other post-retirement benefits .

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h Deferred compensation .

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i Section 198 environmental remediation costs .

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j Amortization .

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k Depletion .

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l Depreciation .

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m Corporate owned life insurance premiums .

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n Other section 263A costs .

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Inventory shrinkage accruals.

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Excess inventory and obsolescence reserves

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Lower of cost or market write-downs .

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Other items with differences (attach schedule) .

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Other items with no differences .

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Total cost of goods sold. Add lines 1 through 7,
in columns a, b, c, and d . . . . . . . . .

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For Paperwork Reduction Act Notice, see page 4.

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(c)
Permanent
Difference

(d)
Deduction per Tax
Return

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(b)
Temporary
Difference

Cat. No. 48657X

Form 8916-A (2009)

Page 2

Form 8916-A (2009)

Part II

Interest Income
Interest Income Item

1
2
3

(a)
Income (Loss) per Income
Statement

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Income (Loss) per
Tax Return

(a)
Expense per Income
Statement

(b)
Temporary
Difference

(c)
Permanent
Difference

(d)
Deduction per Tax Return

Tax-exempt interest
income
Interest income from hybrid
securities
Sale/lease interest income

4a Intercompany interest
income — From outside tax
affiliated group
4b Intercompany interest
income — From tax
affiliated group
5

Other interest income

6

Total interest income. Add
lines 1 through 5. Enter total
on Schedule M-3 (Forms
1120, 1120-PC, and 1120-L),
Part II, line 13 or Schedule
M-3 (Forms 1065 and 1120S)
Part II, line 11.

Part III

Interest Expense
Interest Expense Item

1
2

Interest expense from
hybrid securities
Lease/purchase interest
expense

3a Intercompany interest
expense — Paid to outside
tax affiliated group
3b Intercompany interest
expense — Paid to tax
affiliated group
4

Other interest expense

5

Total interest expense. Add
lines 1 through 4. Enter total
on Schedule M-3 (Form 1120)
Part III, line 8; Schedule M-3
(Forms 1120-PC and 1120-L),
Part III, line 36; Schedule M-3
(Form 1065) Part III, line 27; or
Schedule M-3 (Form 1120S)
Part III, line 26.
Form 8916-A (2009)

Page 3

Form 8916-A (2009)

General Instructions
Section references are to the Internal Revenue Code
unless otherwise noted.

Purpose of Form
Use Form 8916-A to provide a detailed schedule of the
amounts reported on the applicable Schedule M-3 for
cost of goods sold, interest income and interest expense.

Who Must File
Form 8916-A must be filed for each separate entity
required to file a Schedule M-3 for Form 1120, Form
1065, Form 1065-B, Form 1120-L, Form 1120-PC, or
Form 1120S.
Consolidated groups. In the case of a consolidated tax
group, a Form 8916-A must be filed as part of the
Schedules M-3 prepared for the parent company, each
subsidiary, the eliminations Schedule M-3, and the
consolidated Schedule M-3. It is not required that the
supporting detail for Form 8916-A, Part I, line 6, be
presented for the eliminations Schedule M-3 or the
consolidated Schedule M-3.
Mixed groups. In the case of a mixed group (as
described in the instructions for Schedule M-3 for Form
1120, Form 1120-L, and 1120-PC), a Form 8916-A, if
applicable, is required at the sub-consolidated level and
the sub-consolidated elimination level.

How To File
Attach Form 8916-A to each applicable separate
Schedule M-3.

Specific Instructions
A corporation is not required to complete columns (a) and
(d) if the corporation is not required to complete these
columns on Schedule M-3. See the instructions for Parts
II and III of the applicable Schedule M-3.
Columns (b) and (c) must be completed for any tax year
for which the corporation files Form 8916-A.

263A costs computed after LIFO computations. LIFO
taxpayers not using a simplified section 263A method
should report costs attributable to additional section
263A prior to performing LIFO computation. Differences
due to purchasing, and storage and handling costs,
should generally be reported on line 2n (to the extent not
already included in lines 2a through 2m). Report the
additional section 263A costs adjustments to ending
inventory on line 2n (and the reversal of the prior year
ending inventory, if applicable).
Lines 4 and 5
If the taxpayer does not distinguish between
obsolescence and excess inventory reserves and lower
of cost or market write-downs in its general ledger, report
all amounts relating to these reserves on line 4 for excess
inventory and obsolescence reserves.
Line 6
Attach a schedule that separately states and adequately
discloses the nature and amount of each expense
reported on this line. See the instructions for the
applicable Schedule M-3 for a definition of “separately
stated and adequately disclosed.” It is not required that
the supporting detail for Form 8916-A, Part I, line 6, be
presented for the eliminations Schedule M-3 or the
consolidated Schedule M-3. Report differences between
book inventory costs and section 471 inventory costs on
this line.
Line 7
Report all other items with no differences on this line. For
example, if book inventory costs equal section 471
inventory costs, this line should report total book
inventory and section 471 inventory costs without regard
to amounts reported on lines 1 through 5.
Line 8
Line 8 should equal the amount reported on the
applicable Schedule M-3 (Form 1120), Part II, line 17;
Schedule M-3 (Form 1120S), Part II, line 15; or Schedule
M-3 (Form 1065), Part II, line 15.

Part II. Interest Income

Part I. Cost of Goods Sold

Line 1

Line 1

Report on line 1, column (a), tax-exempt interest income
defined under section 103. Complete columns (b) and (c),
as applicable.

Report differences attributable to cost flow assumptions,
for example, differences between book and tax LIFO
computations. Generally, differences in the LIFO reserves
for book and tax purposes should be reported on this
line.
Line 2n
Report differences attributable to section 263A. For
example, if book inventory costs equal section 471
inventory costs, report differences between section 471
inventory costs and section 263A inventory costs. This
includes all costs of goods sold differences, not just
differences attributable to additional section 263A costs
adjustments to ending inventory. LIFO taxpayers using
the simplified production method or the simplified resale
method should report the amount of additional section

Line 2
Report on line 2, column (a), the total amount of interest
income included on Schedule M-3, Part I, line 11, from
hybrid securities characterized as debt for financial
accounting and as equity for tax purposes. Report on line
2, column (d), the total amount of interest income from
hybrid securities characterized as equity for financial
accounting and as debt for tax purposes. Complete
columns (b) and (c), as applicable. Report interest income
from a debt that is both a hybrid debt and a related party
debt on line 2 and not on line 4a or 4b.

Form 8916-A (2009)

Line 3
Report on line 3, column (a), the total interest income
from periodic payments from transactions characterized
as a lease for financial accounting and as a sale for tax
purposes. Report on line 3, column (d), the total interest
income from periodic payments from transactions
characterized as a sale for financial accounting and as a
lease for tax purposes. Complete columns (b) and (c), as
applicable. See the instructions for sale versus lease for
Schedule M-3, Part II, line 18 (Forms 1120 and 1120-L),
line 17 (Form 1120-PC), or line 16 (Forms 1120S and
1065).
Line 4a
Report on line 4a total intercompany interest income
from an entity included on Schedule M-3, Part I, line 4
but not included on Schedule M-3, Part I, line 11. Report
hybrid security interest income on line 2 and sale/lease
interest income on line 3 and not on line 4a.
Line 4b

Page 4

Line 3a
Report on line 3a total intercompany interest expense
included on Schedule M-3, Part I, line 4 but not included
on Schedule M-3, Part I, line 11. Report hybrid security
interest expense or deduction on line 1 and purchase/
lease interest expense or deduction on line 2 and not on
line 3a.
Line 3b
Report on line 3b total intercompany interest expense to
an entity within the tax affiliated group. Report hybrid
security interest expense or deduction on line 1 and
purchase/lease interest expense or deduction on line 2
and not on line 3b.
Note. Report interest expense from a debt that is both a
hybrid debt and a related party debt on line 1 and not on
line 3a or 3b.
Line 4
Report on line 4 total interest income not required to be
reported on lines 1 through 3b.

Report on line 4b total intercompany interest income
from an entity within the tax affiliated group. Report
hybrid security interest income on line 2 and sale/lease
interest income on line 3 and not on line 4b.
Note. Report interest income from a debt that is both a
hybrid debt and a related party debt on line 2 and not on
line 4a or 4b.

Line 5
Line 5 must equal the amounts for all columns reported
on the applicable Schedule M-3 (Form 1120), Part III, line
8; Schedule M-3 (Forms 1120-PC and 1120-L), Part III,
line 36; Schedule M-3 (Form 1065), Part III, line 27; or
Schedule M-3 (Form 1120S), Part III, line 26.

Line 5

Paperwork Reduction Act Notice. We ask for the
information on this form to carry out the Internal Revenue
laws of the United States. You are required to give us the
information. We need it to ensure that you are complying
with these laws and to allow us to figure and collect the
right amount of tax.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its
instructions must be retained as long as their contents
may become material in the administration of any Internal
Revenue law. Generally, tax returns and return
information are confidential, as required by section 6103.

Report on line 5 total interest income not required to be
reported on lines 1 through 4b.
Line 6
Line 6 must equal the amount for all columns reported on
the applicable Schedule M-3, Part II, line 13 (Forms 1120,
1120-L, and 1120-PC) or line 11 (Forms 1120S and
1065).

Part III. Interest Expense
Line 1
Report on line 1, column (a), total interest expense from
hybrid securities characterized as debt for financial
accounting and as equity for tax purposes. Report on line
1, column (d), total interest expense from hybrid
securities characterized as equity for financial accounting
and as debt for tax purposes. Complete columns (b) and
(c), as applicable. Report interest expense from a debt
that is both a hybrid debt and a related party debt on line
1 and not on line 3a or 3b.
Line 2
Report on line 2, column (a), total interest expense from
periodic payments from transactions characterized as a
lease for financial accounting and as a purchase for tax
purposes. Report on line 2, column (d), total interest
expense from periodic payments from transactions
characterized as a purchase for financial accounting and
as a lease for tax purposes. Complete columns (b) and
(c), as applicable. See the instructions for Schedule M-3,
Part III, line 34 (Form 1120), line 35 (Forms 1120-L and
1120-PC), or line 28 (Forms 1120S and 1065).

The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
average time is:
Recordkeeping . . . . . . . . . . 30 hr., 51 min.
Learning about the
law or the form . . . . . . . . . . . . 30 min.
Preparing, copying,
assembling, and
sending the form to the IRS . . . . . . 1 hr., 1 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making this form
simpler, we would be happy to hear from you. See the
instructions for the tax return with which this form is filed.