U.S. Income Tax Return for an S Corporation O

Form 1120S

For calendar year 2004, or tax year beginning , 2004, and ending , 

Department of the Treasury

Internal Revenue Service  See separate instructions.

Effective date of S

election

A Name C Employer id

Use the

IRS

label.

Otherwise,

print or

type.

Number, street, and room or suite no. (If a P.O. box, see page 12 of the instructions.) D Date incorp

Business code

number (see pages

36–38 of the Insts.)

B

Total assets 

instructions)

City or town, state, and ZIP code E

$

F Check applicable boxes: Initial return Final return Address change 

G Enter number of shareholders in the corporation at end of the tax year 

Caution: Include only trade or business income and expenses on lines 1a through 21. See page 13 of the instructions for 

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

2 Cost of goods sold (Schedule A, line 8) 2

3 Gross profit. Subtract line 2 from line 1c 3

4 Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797) 4

Income

5 Other income (loss) (attach schedule) 5

6 Total income (loss). Add lines 3 through 5  6

7 Compensation of officers 7

8 Salaries and wages (less employment credits) 8

9 Repairs and maintenance 9

10 Bad debts 10

11 Rents 11

12 Taxes and licenses 12

13 Interest 13

14a Depreciation (attach Form 4562) 14a

b Depreciation claimed on Schedule A and elsewhere on return 14b

c Subtract line 14b from line 14a 14c

15 Depletion (Do not deduct oil and gas depletion.) 15

16 Advertising 16

17 Pension, profit-sharing, etc., plans 17

18 Employee benefit programs 18

Deductions (see page 14 of the instructions for limitations)

19 Other deductions (attach schedule) 19

20 Total deductions. Add the amounts shown in the far right column for lines 7 through 19  20

21 Ordinary business income (loss). Subtract line 20 from line 6 21

22 Tax: a Excess net passive income tax (attach schedule) 22a

b Tax from Schedule D (Form 1120S) 22b

c Add lines 22a and 22b (see page 18 of the instructions for additional taxes) 22c

23 Payments: a 2004 estimated tax payments and amount applied from 2003 return 23a

b Tax deposited with Form 7004 23b

c Credit for Federal tax paid on fuels (attach Form 4136)

d Add lines 23a through 23c

24 Estimated tax penalty (see page 18 of instructions). Check if Form 2220 is attached  24

Tax and Payments

25 Tax due. If line 23d is smaller than the total of lines 22c and 24, enter amount owed. 25

26 Overpayment. If line 23d is larger than the total of lines 22c and 24, enter amount overpaid 26

27 Enter amount of line 26 you want: Credited to 2005 estimated tax  Refunded  27

Paid

Preparer’s

Use Only

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11510H 

c Bal 

23c

23d

 Do not file this form unless the corporation has timely filed

Form 2553 to elect to be an S corporation.

(1) (2) (4) (5) (3) Name change

Date Prepar

Preparer’s

signature

Check if

self-employed

Firm’s name (or

yours if self-employed),

address, and ZIP code

EIN

Phone no. ( 





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

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

May the 

with the 

  (see instruc
Form 1120S (2004) 

Cost of Goods Sold (see page 18 of the instructions)

1 Inventory at beginning of year

2 Purchases

3 Cost of labor

4 Additional section 263A costs (attach schedule)

Other costs (attach schedule)

Total. Add lines 1 through 5

5

Inventory at end of year

6

Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2

7

9a Check all methods used for valuing closing inventory: (i) Cost as described in Regulations section 1.471-

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

(iii) Other (specify method used and attach explanation) 

c Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) 

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

inventory computed under LIFO 9d

e If property is produced or acquired for resale, do the rules of Section 263A apply to the corporation? 

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

Other Information (see page 19 of instructions) 

At the end of the tax year, did the corporation own, directly or indirectly, 50% or more of the voting stock of a dome

corporation? (For rules of attribution, see section 267(c).) If “Yes,” attach a schedule showing: (a) name, address, 

employer identification number and (b) percentage owned

3

2 See pages 36 through 38 of the instructions and enter the:

(a) Business activity 

4 Was the corporation a member of a controlled group subject to the provisions of section 1561?

5

1 Check method of accounting: Accrual (a) Cash (b) (c) Other (specify) 

Check this box if the corporation has filed or is required to file Form 8264, Application for Registration of a Tax Shelter 

6 Check this box if the corporation issued publicly offered debt instruments with original issue discount 

If checked, the corporation may have to file Form 8281, Information Return for Publicly Offered Original Issue Disco

Instruments.

If the corporation: (a) was a C corporation before it elected to be an S corporation or the corporation acquired 

asset with a basis determined by reference to its basis (or the basis of any other property) in the hands o

C corporation and (b) has net unrealized built-in gain (defined in section 1374(d)(1)) in excess of the net recogn

built-in gain from prior years, enter the net unrealized built-in gain reduced by net recognized built-in gain from p

years  $

Check this box if the corporation had accumulated earnings and profits at the close of the tax year 

Schedule A

Schedule B

8

If “Yes,” attach explanation.

7

8

1

2

3

4

5

6

7

8

b Check if there was a writedown of subnormal goods as described in Regulations section 1.471-2(c) 

Note: If the corporation had assets or operated a business in a foreign country or U.S. possession, it may be re

Schedule N (Form 1120), Foreign Operations of U.S. Corporations, to this return. See Schedule N for details.

Are the corporation’s total receipts (see page 19 of the instructions) for the tax year and its total assets at the 

of the tax year less than $250,000? If “Yes,” the corporation is not required to complete Schedules L and M-1.

9

Dividends: a Ordinary dividends

Shareholders’ Shares of Income, Deductions, Credits, etc.

Shareholders’ Pro Rata Share Items Tota

1 Ordinary business income (loss) (page 1, line 21) 1

2 Net rental real estate income (loss) (attach Form 8825) 2

3a Other gross rental income (loss) 3a

b Expenses from other rental activities (attach schedule) 3b

c Other net rental income (loss). Subtract line 3b from line 3a 3c

4 Interest income 4

5 5a

6 Royalties 6

Income (Loss)

7

8a 8a

Schedule K

7

9

10 10

Net short-term capital gain (loss)

Net long-term capital gain (loss)

Net section 1231 gain (loss) (attach Form 4797)

Collectibles (28%) gain (loss) 8b

c Unrecaptured section 1250 gain (attach schedule) 8c

b

b Qualified dividends

9

5b

Other income (loss) (attach schedule)

(b) Product or service 
Form 1120S (2004) 

11 11 Section 179 deduction (attach Form 4562)

12a

13a Low-income housing credit (section 42(j)(5)) 13a

Low-income housing credit (other)

c Qualified rehabilitation expenditures (rental real estate) (attach Form 3468) 13c

d Other rental real estate credits 13d

e Other rental credits 13e

f Credit for alcohol used as fuel 13f (attach Form 6478)

g Other credits and credit recapture (attach schedule) 13g

15a 15a

b Adjusted gain or loss 15b

15c

Post-1986 depreciation adjustment

c Depletion (other than oil and gas)

d Oil, gas, and geothermal properties—gross income 15d

Alternative

Minimum Tax

(AMT) Items

Oil, gas, and geothermal properties—deductions 15e

f Other AMT items (attach schedule) 15f

14a Name of country or U.S. possession 

Foreign gross income sourced at corporate level:

c

Deductions allocated and apportioned at shareholder level:

Foreign taxes paid

Foreign taxes accrued

l

Foreign Transactions

Gross income sourced at shareholder level

d Passive

e Listed categories (attach schedule)

f General limitation

g Interest expense

h Other

Deductions allocated and apportioned at corporate level to foreign source income:

i Passive

j

k General limitation

14d

14e

14f

14i

14j

14k

14g

14h

14l

Listed categories (attach schedule)

b Gross income from all sources 14b

m

14c

e

Deductions

Credits & Credit 

Recapture

Contributions

b Deductions related to portfolio income (attach schedule)

e Other deductions (attach schedule)

d Section 59(e)(2) expenditures

c Investment interest expense

(2) Amount 

12a

12b

12c

12d(2)

12e

b 13b

n Reduction in taxes available for credit (attach schedule)

Other information:

14m

14n

16a 16a

b Other tax-exempt income 16b

16c

Tax-exempt interest income

c Nondeductible expenses

d Property distributions 16d

Repayment of loans from shareholders 16e

Items Affecting

Shareholder

Basis

e

17a Investment income

Investment expenses

c Dividend distributions paid from accumulated earnings and profits

d Other items and amounts (attach schedule)

Income/loss reconciliation. (Required only if Schedule M-1 must be completed.) Combine

the amounts on lines 1 through 10 in the far right column. From the result, subtract the sum

of the amounts on lines 11 through 12e and lines 14l or 14m, whichever applies

e

Other Information

b

17a

17b

17c

17e

(1) Type 

Shareholders’ Pro Rata Share Items (continued) To
Form 1120S (2004) 

Balance Sheets per Books Beginning of tax year End of tax 

(b) (c) 

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

6 Other current assets (attach schedule)

7 Loans to shareholders

8 Mortgage and real estate loans

9 Other investments (attach schedule)

10a Buildings and other 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 Shareholders’ Equity

16 Accounts payable

17 Mortgages, notes, bonds payable in less than 1 year

18 Other current liabilities (attach schedule)

19 Loans from shareholders

20 Mortgages, notes, bonds payable in 1 year or more

21 Other liabilities (attach schedule)

22 Capital stock

23 Additional paid-in capital

24 Retained earnings

26 Less cost of treasury stock ( 

) (

27 Total liabilities and shareholders’ equity

Reconciliation of Income (Loss) per Books With Income (Loss) per Return

Income recorded on books this year not included

on Schedule K, lines 1 through 10 (itemize):

1 Net income (loss) per books 5

Income included on Schedule K, lines 1, 2, 3c, 4,

5a, 6, 7, 8a, 9, and 10, not recorded on books this

year (itemize):

2

a Tax-exempt interest $

Expenses recorded on books this year not

included on Schedule K, lines 1 through 12,

and 14l or (14m) (itemize):

3 Deductions included on Schedule K, lines

1 through 12, and 14l or (14m), not charged

against book income this year (itemize):

6

a Depreciation $ a Depreciation $

b Travel and entertainment $

7 Add lines 5 and 6

4 Add lines 1 through 3 8 Income (loss) (Schedule K, line 17e). Line 4 less line 7

Analysis of Accumulated Adjustments Account, Other Adjustments Account, and 

Undistributed Taxable Income Previously Taxed (see page 32 of the instructions)

(a) Accumulated

adjustments account

(b) Other adjustments

account

(c) Share

taxable in

1 Balance at beginning of tax year

2 Ordinary income from page 1, line 21

3 Other additions

( ) 4 Loss from page 1, line 21

( ) ( ) 5 Other reductions

6 Combine lines 1 through 5

7 Distributions other than dividend distributions

8 Balance at end of tax year. Subtract line 7 from line 6

Schedule M-2

Schedule M-1

Schedule L

(a)

25 Adjustments to shareholders’ equity (attach schedule)

Note: The corporation is not required to complete Schedules L and M-1 if question 9 of Schedule B is an