SCHEDULE PH

U.S. Personal Holding Company Tax

(Form 1120)

Department of the Treasury

Interal Revenue Service

> See separate instructions. Attach to tax return.

OMB No. 1545-0123

1991

For Paperwork Reduction Act Notice, see page 1 of the Instructions for Forms 1120 and 1120-A_

Name

Employer identification number

Part I—Undistributed Personal Holding Company Income

1 Taxable income before net operating loss deduction and special deductions. Enter amount
a
5 from Form 1120, line 28. See instructions . . . 4
% | 2 Contributions deducted in figuring tine 1. Enter amount from Form 1120, tine 19. 2
3 3 Excess expenses and depreciation under section SASS). Enter amount from Schedule
< A, line 2. See instructions . Le coe ee LB
4 Total. Add lines 1 through 3 . . . . ee 4
5 Federal and foreign income, war profits, and excess profits taxes not deducted in founna
line 1. See instructions (attach schedule) . Lok 5
6 Contributions deductible under section 545(b)(2). See instructions for limitation : 6
7 Net operating loss for the preceding tax year deductible under section 545(b)(4). See instructions 7
8a Net capital gain. Enter amount from Schedule D (Form 1120),
line 10. Foreign corporations, see instructions . . . 8a
b Less: Income tax on this net capital gain (see section
2 545(b)(5)). Attach computation . . . 8b 8c
2 9 Deduction for dividends paid (other than dividends paid after the end of the tax “year. Enter |
3 amount from Schedule B, line 5 . rn .. 2
o
© }10 Total. Add lines 5 through 9 40
11 Subtract line 10 from line 4 . 14
12 Dividends paid after the end of the tax year (other th than | deficiency | dividends defined in
section 547(d)), but not more than the smaller of line 11 or 20% of line 1, Schedule B. See |
instructions . 42
13 ~Undistributed personal ‘holding company income. 2, Subtract line ‘12. from line 11. Foreign
corporations, see instructions . 13 |

Part Il—Information Required Under Section 6501 (qn the information on n personal h

\jolding company income and

stock ownership is not submitted with the corporation’s return, the limitation period for assessment and collection of personal
holding company tax is 6 years.

Personal Holding Company Income (See instructions.)

14 Dividends. a 14
15a Interest . 2. . . [ga
b Less: Amounts excluded | under section 543(a)(1NA), “sA3taN1\ (B),
543(a)(1)(D), or 543(b\(2(C). Attach schedule... . (18 15¢
16 Royalties (other than mineral, oil, gas, or copyright royalties) 16
17 Annuities . ee soe ee AT
18a Rents. . . . 18a
b Less: Adjustments described in section  SHSN2NA (attach
schedule). . . . . 18b 18c
19a Mineral, oil, and gas royalties toe 19a ~
b Less: Adjustments described in section | $43(b)(2)(B) aan
schedule). 2 2. 2. we . . 19b 19¢
20 Copyright royalties. 1 20
21 Produced film rents . 21
22 Compensation received for use Sof corporation property by 25% shareholder . 22
23 Amounts received under personal service contracts and from their sale . 23
24 Amounts includible in taxable income from estates and trusts . 24
25 Personal holding company income. Add amounts in right column for lines 14 through 24 25
Part Ill—Tax on Undistributed Personal Holding Company Income
26 = ©Personai holding company tax. Enter 28% of line 13 here and on Schedule J Form 1120),
line 7, or on the proper line of the appropriate tax return |. | 26

Cat. No. 11465P

Schedule PH (Form 1120) 1991


‘Schedule PH (Form 1120) 1991

Page 2

Stock Ownership

Enter the names and addresses of the individuals who together owned directly or indirectly at any time
during the last half of the tax year more than 50% in value of the outstanding stock of the corporation.

Highest percentage of shares
(a) Name (b) Address owned dunng last naif of tax year

(c) Preferred_| (a) Common

% %

| | __ %

% %

% %

% %

Excess of Expenses and Depreciation Over Income From Property Not Allowable
ne Cue Under Section 545(b)(6) (See instructions for Part |, line 3.)

{b) Date

{a) Kind of property acquired

{c) Cost or
other basis

(@) Depreciation

{e) Repairs,
insurance, and
other expenses

{section 162)
{attach schedule)

{g) Income from | (h) Excess
Suns © rent or other | (Col. () less
‘and (e) compensation col. (g))

2 Total excess of expenses and depreciation over rent or other compensation. Enter here and on line 3, Part |.
Note: Attach a statement showing the names and addresses of persons from whom rent or other

compensation was received for the use of, or the right to use, each property.

Slaitig= Deduction for Dividends Paid (Determined Under Section 562)

1 Taxable dividends paid. Do not include dividends considered as paid in the Preceding tax year

under section 563 or deficiency dividends as defined in section 547 .

2 Consent dividends. Attach Forms 972 and 973 .

3 Taxable distributions. Add lines 1 and 2

4 Dividend carryover from first and second preceding tax years. Attach computation .

5 Deduction for dividends paid. Add lines 3 and 4 and enter the result here and on Part |,

line Q .