1120-SF U.S. Income Tax Return for Settlement Funds (Under Secti

Form

1120-SF

U.S. Income Tax Return for Settlement Funds
(Under Section 468B)

(Rev. November 2018)

▶

Department of the Treasury
Internal Revenue Service

For calendar year 20
Employer identification number of fund (see instructions)

Please Type or Print

Name of fund
Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state or province, country, and ZIP or foreign postal code
Name and address of administrator (see instructions for definition)

Check applicable boxes:

Income

Part I

Deductions

OMB No. 1545-0123

Go to www.irs.gov/Form1120SF for instructions and the latest information.

(1)

Final return

(2)

Name change

(3)

Address change

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14
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d
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f
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18

Subtract line 16c from the total of lines 16a and 16b . . . .
16d
Tax deposited with Form 7004
. . . . . . . . . . .
16e
Total credits and payments (add lines 16d and 16e) . . . . . . . . . . .
Estimated tax penalty. See instructions. Check if Form 2220 is attached . . . .
Tax due. If the total of lines 15 and 17 is more than line 16f, enter amount owed .

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16f
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19

Overpayment. If line 16f is more than the total of lines 15 and 17, enter amount overpaid

19

20

Enter amount of line 19 you want: Credited to next year’s estimated tax ▶
Refunded ▶ . . . . . . . . . . . . . . . . . . . .

20

Taxable interest . . . . . . . . . . . . .
Dividends . . . . . . . . . . . . . . .
Capital gain net income (attach Schedule D (Form 1120))
Items of income or gain from a partnership interest . .
Other income (attach statement) . . . . . . . .
Gross income. Add lines 1 through 5 . . . . . .
Trustee/administrator fees . . . . . . . . . .
Taxes . . . . . . . . . . . . . . . . .
Accounting and legal services (attach statement)
. .
Notification of claimants and claim processing expenses
Other deductions (attach statement) . . . . . . .
Net operating loss deduction . . . . . . . . .
Total deductions. Add lines 7 through 12 . . . . .

Part II

Amended return

Tax Computation (see instructions)

14
15
16
a

Modified gross income. Subtract line 13 from line 6 .
Total tax. Multiply the amount on line 14 by 37% (0.37)
Credits and payments:
Overpayment from prior year allowed as
a credit . . . . . . . . . . . 16a

b Current year estimated tax payments .
c Refund of overpaid estimated tax
applied for on Form 4466 . . . . .

16b
16c

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Paid
Preparer
Use Only

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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 taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
with the preparer shown below?
Yes No
See instructions.
Title
Date
Signature of fund administrator
▲

Sign
Here

(4)

Income and Deductions (see instructions)

Print/Type preparer’s name

Firm’s name

Preparer’s signature

Date

PTIN

Firm’s EIN ▶

▶

Firm’s address ▶

For Paperwork Reduction Act Notice, see separate instructions.

Check
if
self-employed
Phone no.

Cat. No. 14989I

Form 1120-SF (Rev. 11-2018)

Page 2

Form 1120-SF (Rev. 11-2018)

Balance Sheets

Schedule L

(a) Beginning of year

Assets
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State and local government obligations .

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Other investments (attach statement) .

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Other assets (attach statement)

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6

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6

7

Total assets. Add lines 1 through 5 . . . . . .
Liabilities and Fund Balance
Liabilities . . . . . . . . . . . . . . .

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7

8

Fund balance

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Total. Add lines 7 and 8 .

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Cash

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U.S. Government obligations

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(b) End of year

Additional Information

Yes No

1a

Enter the amount of cash and the fair market value of property, valued at the date of the transfer,
transferred to the fund during the tax year . . . . . . . . . . . . . . . . . . $
b For transfers of property included on line 1a, attach a copy of each qualified appraisal and the statements received
from a transferor under Regulations sections 1.468B-3(b) and 1.468B-3(e).
c Were amounts transferred to the fund during the tax year by a person other than a transferor? . . . . . . ▶

2

Enter the amount of tax-exempt interest received or accrued during the tax year

3a Were direct and indirect distributions made to claimants during the tax year?
b If “Yes,” enter the amount of the total distributions . . . . . . . . .
4a

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$

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Did the fund make any distributions (including deemed distributions) to a transferor or related party during the tax
year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

b If “Yes,” enter the amount of the total distributions and attach a statement showing the name,
identifying number, and the amount of distributions to each transferor or related party . . . $
5a

Check the type of liability (or liabilities) for which the fund was established.
Tort
Breach of Contract
Violation of Law
CERCLA
Other

b If “Other” is checked, enter the percent (by value) of the assets of the fund that are allocated to the
“Other” liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶
Attach a statement describing the type of liability (or liabilities).
6
If the fund was established by a court order, enter the Court Order Number under which the fund
was established . . . . . . . . . . . . . . . . . . . . . . . . . . .

%

Form 1120-SF (Rev. 11-2018)