Form 5227

Department of the Treasury 

Internal Revenue Service 

Split-Interest Trust Information Return

▶ See separate instructions.

▶ Go to www.irs.gov/Form5227 for instructions and the latest information.

▶ Do not enter social security numbers on this form (except on Schedule A) as it may be made public.

For the calendar year 2021 or tax year beginning , 2021, and ending , 20

OMB No. 1545-0196

2021

Open to Public 

Inspection 

A Full name of trust 

Name of trustee 

Number, street, and room or suite no. (If a P.O. box, see the instructions.) 

City or town, state or province, country, and ZIP or foreign postal code 

B Employer identification number 

C Type of Entity 

(1) Charitable lead trust 

(2) Charitable remainder annuity trust 

described in section 664(d)(1) 

(3) Charitable remainder unitrust 

described in section 664(d)(2) 

(4) Pooled income fund described in 

section 642(c)(5) 

D Fair market value (FMV) of assets at end of tax year E Gross Income (5) Other—Attach explanation

F Check applicable 

boxes (see 

instructions) 

Initial return Final return Amended return incl. amended K-1s, if nec.

Change in trustee’s ▶ Name Address 

G Date the trust was created 

Part I Income and Deductions (All trusts complete Sections A through D) 

Section A—Ordinary Income 

1 Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

2a Ordinary dividends (including qualified dividends) . . . . . . . . . . . . . . . . 2a 

b Qualified dividends (see instructions) . . . . . . . . . . . . . 2b 

3 Business income or (loss). Attach Schedule C (Form 1040) . . . . . . . . . . . . . 3 

4 Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040) . . 4 

5 Farm income or (loss). Attach Schedule F (Form 1040) . . . . . . . . . . . . . . . 5 

6 Ordinary gain or (loss). Attach Form 4797 . . . . . . . . . . . . . . . . . . . 6 

7 Other income. List type and amount ▶ 7 

8 Total ordinary income. Combine lines 1, 2a, and 3 through 7 . . . . . . . . . . . ▶ 8 

Section B—Capital Gains (Losses) 

9 Total short-term capital gain or (loss). Attach Schedule D, Part I (Form 1041) . . . . . . . 9 

10 Total long-term capital gain or (loss). Attach Schedule D, Part II (Form 1041) . . . . . . . . 10 

11 Unrecaptured section 1250 gain . . . . . . . . . . . . . . 11 

12 28% gain . . . . . . . . . . . . . . . . . . . . . . 12 

13 Total capital gains (losses). Combine lines 9 and 10 . . . . . . . . . . . . . . ▶ 13 

Section C—Nontaxable Income 

14 Tax-exempt interest . . . . . . . . . . . . . . . . . . . . . . . . . . 14 

15 Other nontaxable income. List type and amount ▶

15 

16 Total nontaxable income. Add lines 14 and 15 . . . . . . . . . . . . . . . . ▶ 16 

Section D—Deductions 

17 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 

18 Taxes (see the instructions) . . . . . . . . . . . . . . . . . . . . . . . . 18 

19 Trustee fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 

20 Attorney, accountant, and return preparer fees . . . . . . . . . . . . . . . . . 20 

21 Other allowable deductions. Attach statement (see the instructions) . . . . . . . . . . 21 

22 Total. Add lines 17 through 21 . . . . . . . . . . . . . . . . . . . . . . . 22 

23 Charitable deduction . . . . . . . . . . . . . . . . . . 23 

Section E—Deductions Allocable to Income Categories (Section 664 trust only) 

24a Enter the amount from line 22 allocable to ordinary income . . . . . . . . . . . . . 24a 

b Subtract line 24a from line 8 . . . . . . . . . . . . . . . . . . . . . . . 24b 

25 a Enter the amount from line 22 allocable to capital gains (losses) . . . . . . . . . . . . 25a 

b Subtract line 25a from line 13 . . . . . . . . . . . . . . . . . . . . . . . 25b 

26 a Enter the amount from line 22 allocable to nontaxable income . . . . . . . . . . . . 26a 

b Subtract line 26a from line 16 . . . . . . . . . . . . . . . . . . . . . . . 26b 

For Paperwork Reduction Act Notice, see the instructions. Cat. No. 13227T Form 5227 (2021) 
Form 5227 (2021) Page 2 

Part II Schedule of Distributable Income (Section 664 trust only) (See instructions) 

 Accumulations (a) Ordinary income (b) Capital gains (losses) (c) Nontaxable income 

 Net Investment Income (NII) Classification Excluded 

Income 

Accumulated 

NII post 2012

Excluded 

Income 

Accumulated 

NII post 2012

Excluded 

Income 

Accumulated 

NII post 2012

1 Undistributed income from prior tax years . .

2 Current tax year net income (before distributions): 

• In column (a), enter the amount from Part I, line 24b 

• In column (b), enter the amount from Part I, line 25b 

• In column (c), enter the amount from Part I, line 26b

3 Total distributable income. Add lines 1 and 2 .

Part III Distributions of Principal for Charitable Purposes 

Section A

1 Principal distributed in prior tax years for charitable purposes . . . . . . . . . . . . 1

2 Principal distributed during the current tax year for charitable purposes. Fill in the information for 

columns (A), (B), and (C) and enter the amount distributed on the space to the right. (see the 

instructions) 

 (A) 

Payee’s name and address 

(B) 

Date of distribution 

(C) 

Charitable purpose and description of assets distributed 

 

a 

2a 

b 

2b 

c 

2c 

3 Attachment total . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Total. Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . . . . . . 4

Accumulated Income Set Aside and Income Distributions for Charitable Purposes 

Grantor type trusts complete only lines 7 through 9 (see instructions) 

Section B

5a Income set aside in prior tax years for which a deduction was claimed under 

section 642(c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a 

b Enter the amount shown on Part I, line 23 . . . . . . . . . . . . . . . . . . . 5b 

6 Add lines 5a and 5b . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Distributions made during the tax year (see the instructions): 

• For income set aside in prior tax years for which a deduction was claimed under section 642(c),

• For charitable purposes for which a charitable deduction was claimed under section 642(c) in 

the current tax year, or

• For charitable purposes by a grantor type trust for which a charitable deduction was claimed 

under section 170 upon contribution to the trust

Fill in the information for columns (A), (B), and (C) and enter the amount distributed on the line 

to the right. 

 (A) 

Payee’s name and address 

(B) 

Date of distribution 

(C) 

Charitable purpose and description of assets distributed 

 

a 

7a 

b 

7b 

c 

7c 

8 Attachment total . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Add lines 7a through 8 . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Carryover. Subtract line 9 from line 6 . . . . . . . . . . . . . . . . . . . . . 10

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Part IV Balance Sheet (see instructions) 

 Assets (a) Beginning-ofYear Book Value 

(b) End-of-Year 

Book Value 

(c) FMV (see the 

instructions)

1 Cash—non-interest-bearing . . . . . . . . . . . . . . . 1

2 Savings and temporary cash investments . . . . . . . . . . 2

3a Accounts receivable . . . . . . . . . . 3a 

b Less: allowance for doubtful accounts . . . . 3b 

4 Receivables due from officers, directors, trustees, and other disqualified 

persons (attach statement) . . . . . . . . . . . . . . . 4 

5a Other notes and loans receivable . . . . . . 5a 

b Less: allowance for doubtful accounts . . . . 5b 

6 Inventories for sale or use . . . . . . . . . . . . . . . 6

7 Prepaid expenses and deferred charges . . . . . . . . . . 7

8a Investments—U.S. and state government obligations (attach statement) 8a 

b Investments—corporate stock (attach statement) . . . . . . . . 8b 

c Investments—corporate bonds (attach statement) . . . . . . . 8c 

9a Investments—land, buildings, and equipment: 

basis (attach statement) . . . . . . . . . 9a 

b Less: accumulated depreciation . . . . . . 9b 

10 Investments—other (attach statement) . . . . . . . . . . . 10

11a Land, buildings, and equipment: basis . . . . 11a 

b Less: accumulated depreciation . . . . . . 11b 

12 Other assets. Describe ▶ 12

13 Total assets. Add lines 1 through 12 (must equal line 23) . . . . ▶ 13

 Liabilities 

14 Accounts payable and accrued expenses . . . . . . . . . . 14

15 Deferred revenue . . . . . . . . . . . . . . . . . . 15

16 Loans from officers, directors, trustees, and other disqualified persons 16

17 Mortgages and other notes payable (attach statement) . . . . . . 17

18 Other liabilities. Describe ▶ 18

19 Total liabilities. Add lines 14 through 18 . . . . . . . . . ▶ 19

 Net Assets 

20 Trust principal or corpus . . . . . . . . . . . . . . . . 20

21a Undistributed income . . . . . . . . . . . . . . . . . 21a 

b Undistributed capital gains . . . . . . . . . . . . . . . 21b 

c Undistributed nontaxable income . . . . . . . . . . . . . 21c 

22 Total net assets. Add lines 20 through 21c . . . . . . . . . 22

23 Total liabilities and net assets. Add lines 19 and 22 . . . . . . 23

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Part V Charitable Remainder Annuity Trust (CRAT) Information (to be completed only by a Section 664 CRAT) 

1 a Enter the initial fair market value (FMV) of the property placed in the trust . . . . . . . . . 1a 

b Enter the total annual annuity amounts for all recipients . . . . . . . . . . . . . . 1b 

Part VI Charitable Remainder Unitrust (CRUT) Information (to be completed only by a Section 664 CRUT) 

(See instructions) 

1 Is the CRUT a net income charitable remainder unitrust (NICRUT) as described in Regulations section 

1.664-3(a)(1)(i)(b)(1)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 

2 Is the CRUT a net income with make-up charitable remainder unitrust (NIMCRUT) as described in Regulations 

section 1.664-3(a)(1)(i)(b)(2)? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 

3 Did the trust change its method of payment during the tax year? . . . . . . . . . . . . . . Yes No 

If “Yes,” describe the triggering event including the date of the event and the old method of payment ▶

4a Enter the unitrust fixed percentage to be paid to the recipients . . . . . . . . . . . . 4a % 

b Unitrust amount. Subtract Part IV, line 19, column (c), from Part IV, line 13, column (c), and multiply

the result by the percentage on line 4a. Do not enter less than -0- . . . . . . . . . . . 4b 

If the answer is “Yes” on line 1 or line 2, go to line 5a. Otherwise, skip lines 5a through 6b and 

enter the line 4b amount on line 7. 

5a Trust’s accounting income for 2021. Attach statement . . . . . . . . . . . . . . . 5a 

If the answer is “Yes” on line 1, go to line 5b. If the answer is “Yes” on line 2, skip line 5b and 

go to line 6a. 

b Enter the smaller of line 4b or line 5a here and on line 7. Skip lines 6a and 6b . . . . . . . 5b 

6a Total accumulated distribution deficiencies from previous years (see instructions) . . . . . . 6a 

b Add lines 4b and 6a . . . . . . . . . . . . . . . . . . . . . . . . . . 6b 

If lines 6a and 6b are completed, enter the smaller of line 5a or line 6b on line 7. 

7 Required unitrust distribution for 2021 . . . . . . . . . . . . . . . . . . . . 7

8 Carryover of accumulated distribution deficiency (only for trusts that answered “Yes” on line 2). 

Subtract line 7 from line 6b . . . . . . . . . . . . . . . . . . . . . . . . 8

9 If this is the final return, enter the initial FMV of all assets placed in trust by the donor . . . . . 9

10 Did the trustee change the method of determining the FMV of the assets? . . . . . . . . . . . Yes No 

If “Yes,” attach an explanation. 

11 Were any additional contributions received by the trust during 2021? . . . . . . . . . . . . . Yes No 

If “Yes,” be sure to complete all columns of line 2 in Schedule A, Part V. 

Part VII Statements Regarding Activities (see instructions) 

1 Are the requirements of section 508(e) satisfied either: Yes No

• By the language in the governing instrument; or 

• By state legislation that effectively amends the governing instrument so that no mandatory directions

that conflict with the state law remain in the governing instrument? . . . . . . . . . . . . . . 1

2 Are you using this return only to report the income and assets of a segregated amount under section

4947(a)(2)(B)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

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Part VIII Statements Regarding Activities for Which Form 4720 May Be Required 

File Form 4720 if any item is checked in the “Yes” column (to the right), unless an exception applies. Yes No 

1 Self-dealing (section 4941): 

a During 2021, did the trust (either directly or indirectly): 

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? . . . . . . . 1a(1)

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified

person? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a(2)

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? . . . . . . . 1a(3)

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? . . . . . . . 1a(4)

(5) Transfer any income or assets to a disqualified person (or make any of either available for the benefit or 

use of a disqualified person)? . . . . . . . . . . . . . . . . . . . . . . . . . 1a(5)

(6) Agree to pay money or property to a government official? (Exception. Check “No” if

the trust agreed to make a grant to or to employ the official for a period after termination of government 

service, if terminating within 90 days.) . . . . . . . . . . . . . . . . . . . . . . 1a(6)

b If any answer is “Yes” to lines 1a(1) through (6), did any of the acts fail to qualify under the exceptions

described in Regulations sections 53.4941(d)-3 and 4, or in a current Notice regarding disaster assistance

(see instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b 

c Organizations relying on a current Notice regarding disaster assistance, check here . . . . . . ▶

d Did the trust engage in a prior year in any of the acts described in line 1a, other than excepted acts, that 

were not corrected before January 1, 2021? . . . . . . . . . . . . . . . . . . . . . 1d

2 Does section 4947(b)(3)(A) or (B) apply? (see instructions) . . . . . . . . . . . . . . . . . 2

If “Yes,” check the “N/A” box in lines 3 and 4.

3a Taxes on excess business holdings (section 4943): N/A 

b Did the trust hold more than a 2% direct or indirect interest in any business enterprise at any time during 

2021? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3b

c If “Yes,” did the trust have excess business holdings in 2021 as a result of (1) any purchase by the trust or 

disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the 

Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or 

(3) the lapse of the 10-, 15-, or 20-year first phase holding period? . . . . . . . . . . . . . . 3c

Use Form 4720, Schedule C, to determine if the trust had excess business holdings in 2021. 

4a Taxes on investments that jeopardize charitable purposes (section 4944): N/A 

b Did the trust invest during 2021 any amount in a manner that would jeopardize its charitable purpose? . . 4b

c Did the trust make any investment in a prior year (but after December 31, 1969) that could jeopardize its 

charitable purpose that had not been removed from jeopardy before January 1, 2021? . . . . . . . 4c

5 Taxes on taxable expenditures (section 4945) and political expenditures (section 4955): 

a During 2021, did the trust pay or incur any amount to: 

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? . . . . . . 5a(1)

(2) Influence the outcome of any specific public election (see section 4955); or to carry on, directly or 

indirectly, any voter registration drive? . . . . . . . . . . . . . . . . . . . . . . 5a(2)

(3) Provide a grant to an individual for travel, study, or other similar purposes? . . . . . . . . . . 5a(3)

(4) Provide a grant to an organization other than a charitable, etc., organization described in section 509(a)(1), 

(2), or (3), or section 4940(d)(2)? . . . . . . . . . . . . . . . . . . . . . . . . 5a(4)

(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational, or for the

prevention of cruelty to children or animals? . . . . . . . . . . . . . . . . . . . . 5a(5)

b If any answer is “Yes” to lines 5a(1) through (5), did any of the transactions fail to qualify under the

exceptions described in Regulations section 53.4945, or in a current Notice regarding disaster assistance

(see instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b 

c Organizations relying on a current Notice regarding disaster assistance, check here . . . . . . ▶

d If the answer is “Yes” to line 5a(4), does the trust claim exemption from the tax because it maintained 

expenditure responsibility for the grant? . . . . . . . . . . . . . . . . . . . . . . 5d

If “Yes,” attach the statement required by Regulations section 53.4945-5(d). 

6 Personal benefit contracts (section 170(f)(10)): 

a Did the trust, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit 

contract? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a

b Did the trust, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . 6b 

If “Yes” to line 6b, file Form 8870 (see instructions).

7 Section 664 trusts: Did the trust have unrelated business taxable income during the year? . . . . . . 7

If “Yes,” file Form 4720.

Form 5227 (2021)
Form 5227 (2021) Page 6 

Part IX Questionnaire for Charitable Lead Trusts, Pooled Income Funds, and Charitable Remainder Trusts 

(see instructions) 

Section A—All Trusts 

1 Check this box if any of the split-interest trust’s income interests expired during 2021 . . . . . . . . . ▶

2 Check this box if all of the split-interest trust’s income interests expired before 2021 . . . . . . . . . . ▶

If line 2 is checked and this is not a final return, attach an explanation. 

Section B—Charitable Lead Trusts 

3 Does the governing instrument require income in excess of the required annuity or unitrust payments to be 

paid for charitable purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 

4 Enter the amount of any excess income required to be paid for charitable purposes for 2021 . . . 4 

5 Enter the amount of annuity or unitrust payments required to be paid to charitable beneficiaries for 2021 5 

Section C—Pooled Income Funds 

6 Enter the amount of contributions received during 2021 . . . . . . . . . . . . . . 6 

7 Enter the amount required to be distributed for 2021 to satisfy the remainder interest . . . . . 7 

8 Enter any amounts that were required to be distributed to the remainder beneficiary that remain 

undistributed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

9 Enter the amount of income required to be paid to the charitable remainder beneficiary for 2021 . 9 

Section D—Charitable Remainder Trusts 

10 Check this box if you are filing for a charitable remainder annuity trust or a charitable remainder unitrust whose 

charitable interests involve only cemeteries or war veterans’ posts . . . . . . . . . . . . . . . . ▶

11 Check this box if you are making an election under Regulations section 1.664-2(a)(1)(i)(a)(2) or 1.664-3(a)(1)(i)(g)(2) to 

treat income generated from certain property distributions (other than cash) by the trust as occurring on the last day 

of the tax year. (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

12 Are you making an election under Regulations section 1.1411-10(g) with respect to a controlled foreign

corporation or a qualified electing fund? (see instructions) . . . . . . . . . . . . . . . . . Yes No 

13 Is this the initial return? If “Yes,” attach a copy of the trust instrument . . . . . . . . . . . . . Yes No 

14 Was the trust instrument amended during the year? If “Yes,” attach a copy . . . . . . . . . . . Yes No 

15a If this is the final return, were final distributions made according to the trust instrument? . . . . . . . Yes No 

b If “Yes,” did you complete Part III, Section A, line 2? . . . . . . . . . . . . . . . . . . Yes No 

c If either line 15a or 15b is “No,” explain why ▶

16 At any time during calendar year 2021, did the trust have an interest in or a signature or other authority over a 

bank, securities, or other financial account in a foreign country? . . . . . . . . . . . . . . . Yes No 

See the instructions for exceptions and filing requirements for FinCEN Form 114. 

If “Yes,” enter the name of the foreign country ▶

Sign 

Here 

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 trustee) is based on all information of which preparer

has any knowledge. 

▲

Signature of trustee or officer representing trustee ▲

Date 

Paid 

Preparer 

Use Only

Print/Type preparer’s name Preparer’s signature Date Check if 

self-employed 

PTIN

Firm’s name ▶

Firm’s address ▶

Firm’s EIN ▶

Phone no. 

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Form 5227 (2021) Page 7 

Full name of trust Employer identification number 

NOT Open To Public Inspection 

Schedule A—Distributions, Assets, and Donor Information 

Part I Accumulation Schedule (Section 664 trust only) (see instructions) 

 Accumulations (a) Ordinary income (b) Capital gain (loss) (c) Nontaxable income 

Net Investment Income (NII) Classification Excluded 

Income 

Accumulated 

NII 

Excluded 

Income 

Accumulated 

NII 

Excluded 

Income 

 Accumulated 

NII

1 Total distributable income. Enter the amount from 

Part II, line 3 . . . . . . . . . . . .

2a Total distributions for 2021: 

b 2021 distributions from income . . . . .

3 Undistributed income at end of tax year. Subtract 

line 2b from line 1 . . . . . . . . . .

Part II Simplified Net Investment Income Calculation

(a) Accumulated NII (b) Current Year NII (c) Distributions (d) Ending NII

1

Part III Current Distributions Schedule (Section 664 trust only) (see instructions)

(a) 

Name of recipient 

(b) 

Identifying number 

(c) 

Percentage of total unitrust amount 

payable (if applicable) 

1a % 

b % 

(d) 

Ordinary Income 

Capital gains (g) 

Nontaxable 

income 

(h) 

Corpus 

(i) 

Add cols. 

(d) through (h) 

(j) 

Net investment 

income

 (e) Short-term (f) Long-term 

1a 

b 

2 Attachment total . .

3 Total . . . . . .

4 If line 3, Total, column (i) does not agree with Part V, line 1b of Form 5227 for a CRAT or Part VI, line 7 of Form 5227 for a 

CRUT, check here ▶ and attach an explanation. 

Part IV Current Distributions (charitable lead trusts or pooled income funds only) (see instructions) 

1 Enter the amount required to be paid to private beneficiaries for 2021 . . . . . . . . . . ▶

Part V Assets and Donor Information (Section 664 trust or charitable lead trust only) 

1 Is this the initial return or were additional assets contributed to the trust in 2021? . . . . . . . . . Yes No 

If “Yes,” complete the schedule below. 

If “No,” complete only column (a) of the schedule below. 

(a) 

Name and address of donor 

(b) 

Description of each asset donated 

(c) 

FMV of each 

asset on date of donation 

(d) 

Date of donation 

2a 

2b 

2c 

3 Attachment total . . . . . . . . . . . . . . . 

4 Total . . . . . . . . . . . . . . . . . . . . ▶ 

5 For charitable remainder trusts: If this was the final year, was an early termination agreement signed 

by all parties to the trust? . . . . . . . . . . . . . . . . . . . . . . . . Yes No N/A 

If “Yes,” attach a copy of the signed agreement. 

Form 5227 (2021)