OMB No. 1545-0126 U.S. Income Tax Return of a Foreign Corporation

Name Employer identification number

Number, street, and room or suite no. (see instructions) Check applicable boxes:

initial return amended return

City or town, state and ZIP code, or country final return change of address

Please type or print

(2) Did any individual, partnership, corporation,

estate, or trust at the end of the tax year own,

directly or indirectly, 50% or more of your voting

stock? (For rules of attribution, see section 267(c).)

A Country of incorporation G

Foreign country under whose laws the income reported on this return

is subject to tax

B

Yes No

C Date incorporated If “Yes,” attach a schedule showing: (a) name, address, and

D Your books and records are maintained by: identifying number; and (b) percentage owned.

Name Have you filed a U.S. income tax return for the

preceding tax year?

H

Address

I If you had an agent in the U.S. at any time during the tax year, enter:

Were you, at any time during the tax year, engaged Kind of agent

in a trade or business in the U.S.?

E

Yes No Name

Did you, at any time during the tax year, have a Address

permanent establishment in the U.S. for purposes

of applying section 894(b) and any applicable tax

treaty between the U.S. and a foreign country?

F

Are you a foreign personal holding company? (See

section 552 for definition.)

J

If “Yes,” has Form 5471 been filed? (Sec. 6035)

If “Yes,” enter name of foreign country

Are you a personal holding company? (See section

542 for definition.)

K

(1) Did you at the end of the tax year own, directly

or indirectly, 50% or more of the voting stock of a

U.S. corporation? (For rules of attribution, see

section 267(c).)

G

Are you a controlled foreign corporation? (See

section 957 for definition.)

L

If ‘‘Yes,’’ attach a schedule showing: (a) name, address, and identifying

number of such U.S. corporation; (b) percentage owned; and (c) taxable

income or (loss) before NOL and special deductions of such U.S.

corporation for the tax year ending with or within your tax year.

M Are you a personal service corporation? (See

instructions for definition.)

Note: Additional information is required at the bottom of page 5.

Computation of Tax Due or Overpayment

1 Tax from Section I (line 11, page 2) 1

2 Tax from Section II (line 9, Schedule J, page 4) 2

3 Tax from Section III (add line 6, Part I, page 5 and line 4, Part II, page 5) 3

4 Personal holding company tax (attach Schedule PH (Form 1120)) 4

5 Total tax—Add lines 1 through 4 5

6 Payments:

a 1990 overpayment credited to 1991 6a

b 1991 estimated tax payments 6b

c Less 1991 refund applied for on Form 4466 6c ( ) Bal © 6d

e Tax deposited with Form 7004 6e

Credit from regulated investment companies (attach Form 2439) 6f f

Credit for Federal tax on fuels (attach Form 4136) 6g g

U.S. income tax paid or withheld at source (add line 12, page 2, and amounts

from Forms 8288-A and 8805 (attach Forms 8288-A and 8805))

h

6h

Total payments—Add 6i i lines 6d through 6h

7 Enter any penalty for underpayment of estimated tax—Check if Form 2220 is attached © 7

8 Tax due—If the total of lines 5 and 7 is larger than line 6i, enter amount owed 8

9 Overpayment—If line 6i is larger than the total of lines 5 and 7, enter amount overpaid 9

10 Enter amount of line 9 you want: Credited to 1992 estimated tax © Refunded © 10

Form 1120F

For calendar year 1991, or tax year beginning , 1991, and ending , 19 Department of the Treasury

Internal Revenue Service © See separate instructions.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge Please 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.

Sign

Here © Signature of officer Date Title

Date Preparer’s social security number Preparer’s

signature Check if selfemployed ©

Paid

Preparer’s

Use Only

Firm’s name (or

yours if self-employed)

and address

E.I. No. ©

ZIP code ©

For Paperwork Reduction Act Notice, see page 1 of separate instructions. Cat. No. 11470I Form 1120F (1991)

©

©

©

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No
Form 1120F (1991) Page 2

SECTION I.—Certain Gains, Profits, and Income From U.S. Sources That Are NOT Effectively Connected With

the Conduct of a Trade or Business in the U.S. (see instructions)

If you are required to complete Section II or are using Form 1120F as a claim for refund of tax withheld at source, include below ALL income

from U.S. sources that is NOT effectively connected with the conduct of a trade or business in the U.S. Otherwise, include only those items

of income on which the U.S. income tax was not fully paid at the source. The rate of tax on each item of gross income — no deductions are

allowed against these types of income — listed below is 30% (4% for the gross transportation tax) or such lower rate specified by tax treaty.

Fill in treaty rates where applicable. If the corporation claimed a lower treaty rate, also complete Item Q, page 5.

Name of treaty country, if any ©

(e) Amount of U.S. income

tax paid or withheld at the

source

(a)

Nature of income

(b)

Gross income

(c)

Rate of tax (%)

(d)

Amount of tax

1 Interest

2 Dividends

3 Rents

4 Royalties

5 Annuities

6 Gains from disposal of timber, coal, or

domestic iron ore with a retained

economic interest (attach supporting

schedule)

7 Gains from sale or exchange of

patents, copyrights, etc.

8 Fiduciary distributions (attach supporting schedule)

Gross transportation income (see

instructions)

9

4

Other fixed or determinable annual or

periodic gains, profits, and income 

10

11 Total—Enter here and on line 1, page 1 ©

12 Total—Enter here and include on line 6h, page 1 ©
SECTION II.—Income Effectively Connected With the Conduct of a Trade or Business in the U.S. (see instructions)

IMPORTANT—Fill in all applicable lines and schedules. If you need more space, see General Instruction E3.

1a Gross receipts or sales b Less returns and allowances c Bal © 1c

2 Cost of goods sold (Schedule A, line 7) 2

3 Gross profit (subtract line 2 from line 1c) 3

4 Dividends (Schedule C, line 14) 4

5 Interest 5

6 Gross rents 6

Income

7 Gross royalties 7

8 Capital gain net income (attach Schedule D (Form 1120)) 8

9 Net gain or (loss) from Form 4797, Part II, line 18 (attach Form 4797) 9

10 Other income (see instructions—attach schedule) 10

11 Total income—Add lines 3 through 10 and enter here © 11

12 Compensation of officers (Schedule E, line 4). Deduct only amounts connected with a U.S. business 12

13a b Salaries and wages Less jobs credit 13c

14 Repairs 14

15 Bad debts 15

16 Rents 16

17 Taxes 17

18 Interest deduction allowable under Regulations section 1.882-5 18

19 Contributions (see instructions for 10% limitation) 19

20 Depreciation (attach Form 4562) 20

21 Less depreciation claimed on Schedule A and elsewhere on return 21

22 Balance (subtract line 21 from line 20) 22

23 Depletion 23

24 Advertising 24

25 Pension, profit-sharing, etc., plans 25

26 Employee benefit programs 26

27 Other deductions (attach schedule) 27

28 Total deductions—Add lines 12 through 27 and enter here © 28

29

Taxable income before net operating loss deduction and special deductions (subtract line

28 from line 11)

29

Deductions 

30 Less: a Net operating loss deduction 30a

(See Instructions for limitations on deductions)

b Special deductions (Schedule C, line 15) 30b 30c

31 Taxable income or (loss) — Subtract line 30c from line 29 31

Cost of Goods Sold (see instructions)

1 Inventory at beginning of year 1

2 Purchases 2

3 Cost of labor 3

4a Additional section 263A costs (see instructions—attach schedule) 4a

b Other costs (attach schedule) 4b

5 Total—Add lines 1 through 4b 5

6 Inventory at end of year 6

7 Cost of goods sold—Subtract line 6 from line 5. Enter here and on Section II, line 2 7

8a Check all methods used for valuing closing inventory:

(i) Cost

(ii) Lower of cost or market as described in Regulations section 1.471-4 (see instructions)

(iii) Writedown of ‘‘subnormal’’ goods as described in Regulations section 1.471-2(c) (see instructions)

(iv) Other (Specify method used and attach explanation.) ©

b Check if the LIFO inventory method was adopted this tax year for any goods ©

If checked, attach Form 970.

c If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing

inventory computed under LIFO 8c

d Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the

corporation? Yes No

e Was there any change in determining quantities, cost, or valuations between opening and closing inventory?

If ‘‘Yes,’’ attach explanation.

Form 1120F (1991) Page 3

c Bal ©

Yes No

Schedule A
SECTION II (continued)

Dividends and Special Deductions (see instructions)

(a) Dividends

received

(c) special deductions:

(a) 3 (b) (b) %

Dividends from less-than-20%-owned domestic corporations that are

subject to the 70% deduction (other than debt-financed stock)

1

70

Dividends from 20%-or-more-owned domestic corporations that are

subject to the 80% deduction (other than debt-financed stock)

2

80

see

3 Dividends on debt-financed stock of domestic and foreign corporations (section 246A) instructions

4 Dividends on certain preferred stock of less-than-20%-owned public utilities 41.176

5 Dividends on certain preferred stock of 20%-or-more-owned public utilities 47.059

Dividends from less-than-20%-owned foreign corporations that are

subject to the 70% deduction

6

70

Dividends from 20%-or-more-owned foreign corporations that are subject

to the 80% deduction

7

80

8 Total—Add lines 1 through 7. See instructions for limitation

9 0ther dividends from foreign corporations not included on lines 3, 6, and 7

10 Foreign dividend gross-up (section 78)

11 IC-DISC and former DISC dividends not included on line 1, 2, or 3 (section 246(d))

12 Other dividends

13 Deduction for dividends paid on certain preferred stock of a public utility

14 Total dividends—Add lines 1 through 12. Enter here and on line 4, page 3

15 Total deductions—Add lines 8 and 13. Enter here and on line 30b, page 3

Compensation of Officers (See instructions for line 12, page 3.)

Complete Schedule E only if your total receipts (line 1a plus lines 4 through 10 of Section II, page 3) are $500,000 or more.

Percent of corporation

stock owned (c) Percent of

time devoted

to business

(f) Amount of

compensation

(b) Social security

number (a) Name of officer

(d) Common (e) Preferred

1 % % %

% % %

% % %

% % %

% % %

% % %

% % %

2 Total compensation of officers

Less: Compensation of officers claimed on Schedule A and elsewhere on this return ( ) 3

4 Compensation of officers deducted on line 12, page 3

Tax Computation (see instructions)

1 Check if you are a member of a controlled group (see sections 1561 and 1563) ©

2 If the box on line 1 is checked:

a Enter your share of the $50,000 and $25,000 taxable income bracket amounts (in that order):

(i) $ (ii) $

b Enter your share of the additional 5% tax (not to exceed $11,750) $

3

3

4a Foreign tax credit (attach Form 1118) 4a

4b

b Credit for fuel produced from a nonconventional source (see

instructions)

c Orphan drug credit (attach Form 6765) 4c

4d

d General business credit. Enter here and check which forms are

attached:

Form 3800 Form 3468 Form 5884 Form 6478

Form 6765 Form 8586 Form 8830 Form 8826

e Credit for prior year minimum tax (attach Form 8827) 4e

5 Total—Add lines 4a through 4e 5

6 Subtract line 5 from line 3 6

7 Recapture taxes. Check if from: Form 4255 Form 8611 7

8a Alternative minimum tax (attach Form 4626). See instructions 8a

b Environmental tax (attach Form 4626) 8b

9 Total tax under section 882(a)—Add lines 6 through 8b. Enter here and on line 2, page 1 9

Form 1120F (1991) Page 4

Schedule J

Schedule E

Schedule C

Income tax (see instructions to figure the tax). Check this box if the corporation is a qualified

personal service corporation (see page 11 of the instructions) ©
SECTION III.— Branch Profits Tax and Tax on Excess Interest

Part I—Computation of Branch Profits Tax

1 Enter the amount from line 29, Section II on page 3 1

2 Enter total amount of adjustments to arrive at effectively connected earnings and profits. (See

instructions for types of adjustments as well as exceptions for certain types of income included

in effectively connected taxable income but not taken into account when computing effectively

connected earnings and profits, and the treatment of deductions apportioned to that income.

Attach a schedule showing the nature and amount of these adjustments.) 2

Effectively connected earnings and profits. Combine line 1 and line 2 and enter the result here.

Attach a historical summary (see instructions). (If you are a foreign insurance company, see the

regulations under section 884 for a special rule for the computation of effectively connected earnings

and profits. If the special rule applies, attach a supporting schedule showing the computation.)

3

3

4a Enter U.S. net equity at the end of the current tax year and attach schedule (see instructions) 4a

b Enter U.S. net equity at the end of the prior tax year. Attach schedule (see instructions) 4b

Increase in U.S. net equity. If line 4a is greater than or equal to line 4b, subtract line 4b from

line 4a. Enter the result here and skip to line 4e

c

4c

d Decrease in U.S. net equity. If line 4b is greater than line 4a, subtract line 4a from line 4b and

enter the result here 4d

e Non-previously taxed accumulated effectively connected earnings and profits. Enter excess,

if any, of effectively connected earnings and profits for tax years beginning after 1986 over any

dividend equivalent amounts for those tax years 4e

5 Dividend equivalent amount. If an amount is entered on line 4c, subtract that amount from line

3 and enter the result here. Enter -0- if the result is equal to or less than zero. If no increase

is entered on line 4c, add the lesser of line 4d or line 4e to line 3 and enter the total here.

Attach a historical summary (see instructions) 5

Branch profits tax. Multiply the amount on line 5 by 30% (or lower treaty rate if the corporation

is a qualified resident or otherwise qualifies for treaty benefits). Enter here and include on line

3, page 1. See instructions for: the requirements for qualification for treaty benefits; the definition

of qualified resident; and special rules for foreign corporations that have completely terminated

their U.S. trade or business during the tax year. If treaty benefits apply, attach a statement

explaining why the corporation is a qualified resident or otherwise qualifies for treaty benefits

and describe the benefits that apply. Also complete Item Q below

6

6

Part II—Computation of Tax on Excess Interest

Enter the interest allowable as a deduction under Regulations section 1.882-5 (line 18, Section

II on page 3)

1

1

Enter the interest paid by the foreign corporation’s U.S. trade or business (other than

nondeductible interest). (See instructions for definition.) If the interest paid by the foreign

corporation’s U.S. trade or business was increased because 80% or more of the foreign

corporation’s assets are U.S. assets, check this box ©

2

2

3a Excess interest. Subtract line 2 from line 1. Enter -0- if the result is equal to or less than zero 3a

b If the foreign corporation is a bank, enter the amount of excess interest treated as interest on

deposits. Otherwise, enter -0- 3b

3c c Subtract line 3b from line 3a

4 Tax on excess interest. Multiply line 3c by 30% or lower treaty rate (if the corporation is a

qualified resident or otherwise qualifies for treaty benefits). Enter here and include on line 3,

page 1. (If treaty rate applies, attach a statement explaining why the corporation is a qualified

resident or otherwise qualifies for treaty benefits.) Also complete Item Q below 4

Additional Information Required (continued from page 1)

N Business description (see last page of instructions):

(1) Business activity code number ©

(2) Business activity ©

If “Yes,” enter the treaty country

and article(s)

(3) Product or service © Also attach a statement describing each treaty-based position

taken.

Are you claiming a reduction in, or exemption

from, the branch profits tax due to a complete

termination of all U.S. trades or businesses, the

tax-free liquidation or reorganization of a

foreign corporation, or the tax-free incorporation of a U.S. trade or business?

R

O Check method of accounting: (1) Cash (2) Accrual

(3) Other (specify) ©

Enter amount of tax-exempt interest received or accrued

during the tax year (see instructions) ©

P

Yes No

Form 1120F (1991) Page 5

Yes No

Are you taking a position on this return that any Internal

Revenue law is overruled or otherwise modified by a treaty

Q

between the U.S. and a foreign country? (See

instructions.)
Additional schedules to be completed with respect to Section II or Section III (see instructions)

Balance Sheets Beginning of tax year End of tax year

(a) (b) (c) (d) ASSETS

1 Cash

2a Trade notes and accounts receivable

( ) ) b Less allowance for bad debts

3 Inventories

4 U.S. government obligations

5 Tax-exempt securities (see instructions)

6 Other current assets (attach schedule)

7 Loans to stockholders

8 Mortgage and real estate loans

9 Other investments (attach schedule)

10a Buildings and other fixed depreciable assets

( ) ( ) b Less accumulated depreciation

11a Depletable assets

( ) ( ) b Less accumulated depletion

12 Land (net of any amortization)

13a Intangible assets (amortizable only)

( ) ( ) b Less accumulated amortization

14 Other assets (attach schedule)

15 Total assets

LIABILITIES AND STOCKHOLDERS’ EQUITY

16 Accounts payable

17 Mtges., notes, bonds payable in less than 1 year

18 Other current liabilities (attach schedule)

19 Loans from stockholders

20 Mtges., notes, bonds payable in 1 year or more

21 Other liabilities (attach schedule)

22 Capital stock: a Preferred stock

b Common stock

23 Paid-in or capital surplus

24 Retained earnings—Appropriated (attach schedule)

25 Retained earnings—Unappropriated ( ) ( ) 26 Less cost of treasury stock

27 Total liabilities and stockholders’ equity

Reconciliation of Income per Books With Income per Return (You are not required to complete

this schedule if your total assets (line 15, column (d), above) are less than $25,000.)

1 Net income per books Income recorded on books this year

not included on this return (itemize):

7

2 Federal income tax

3 Excess of capital losses over capital gains a Tax-exempt interest $

Income subject to tax not recorded on

books this year (itemize):

4

8 Deductions on this return not charged

against book income this year (itemize):

Expenses recorded on books this year

not deducted on this return (itemize):

5 a Depreciation

b

a

Contributions carryover

Depreciation

b Contributions carryover $

c Travel and entertainment $ 9 Total of lines 7 and 8

6 Total of lines 1 through 5 10 Income (line 29, page 3)—line 6 less line 9

Analysis of Unappropriated Retained Earnings per Books (line 25 above) (You are not required

to complete this schedule if your total assets (line 15, column (d), above) are less than $25,000.)

1 Balance at beginning of year 5 Distributions: a Cash

2 Net income per books b Stock

3 Other increases (itemize): c Property

6 Other decreases (itemize):

7 Total of lines 5 and 6

4 Total of lines 1, 2, and 3 8 Balance at end of year (line 4 less line 7)

Form 1120F (1991) Page 6

Schedule M-2

Schedule M-1

Schedule L

$

$

$

(