Form 5227 Split-Interest Trust Information Return

OMB No. 1545-0196

Department of the Treasury

Internal Revenue Service © See separate instructions.

Full name of trust Employer identification number

Name of trustee Type of Entity

Charitable lead trust

Number, street, and room or suite no. (If a P.O. box, see page 3 of the instructions.) Charitable remainder annuity trust

described in section 664(d)(1)

City, state, and ZIP code

Charitable remainder unitrust

described in section 664(d)(2)

Pooled income fund described in

section 642(c)(5)

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

Yes No

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

1 Interest income 1

2a

Qualified dividends (see page 4 of the instructions) 

2a

3 Business income or (loss). Attach Schedule C or C-EZ (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

15 Other nontaxable income. List type and amount ©

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

17 Interest 17

18 Taxes (see page 5 of the instructions) 18

22

19

Total. Add lines 17 through 21 

If the trust is a section 664 trust, did it have unrelated business taxable income? If “Yes,” file Form 4720 

For Privacy Act and Paperwork Reduction Act Notice, see page 12 of the instructions. Cat. No. 13227T Form 5227 (2008)

C D

A

B

G

E Check applicable

boxes (see

instructions)

Initial return

Change in trustee’s ©

Part I

(1)

(2)

(3)

(4)

(5)

Final return Amended return

Name Address

b

Ordinary dividends (including qualified dividends) 

2b

Open to Public

Inspection

Section A—Ordinary Income

Section D—Deductions

19 Trustee fees 

20 Attorney, accountant, and return preparer fees 

21 Other allowable deductions. Attach schedule (see page 5 of the instructions) 

23 Charitable deduction 

20

21

22

23

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

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

b Subtract line 24a from line 8 

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

b Subtract line 25a from line 13 

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

b Subtract line 26a from line 16 

24a

24b

25a

25b

26a

26b

F Date the trust was created

2008
Form 5227 (2008) Page 2

Form 5227 (2008)

Schedule of Distributable Income (Section 664 trust only) See page 6 of the instructions

(b) Capital gains

(losses)

(c) Nontaxable

income

(a) Ordinary

income Accumulations

27 Undistributed income from prior tax years 

28 Current tax year net income (before distributions):

● In column (a), enter the amount from line 24b

● In column (c), enter the amount from line 26b

Part II

29 Total distributable income. Add lines 27 and 28 

Distributions of Principal for Charitable Purposes

30

b

c

Part III-A

31

a

Principal distributed in prior tax years for charitable purposes 

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 page 6 of

the instructions)

31a

31b

31c

30

32 Total. Add lines 30 through 31c 32

● In column (b), enter the amount from line 25b

35a

35b

35c

36 Add lines 35a through 35c 36

Accumulated Income Set Aside and Income Distributions for Charitable Purposes

(see page 6 of the instructions) Part III-B

(C)

Charitable purpose and description of assets distributed

(B)

Date of distribution

(A)

Payee’s name and address

b

c

a

33a Accumulated income set aside in prior tax years for which a deduction was claimed under 

section 642(c) 

b Enter the amount shown on line 23 

34 Add lines 33a and 33b

35 Distributions made during the tax year (see page 6 of the instructions):

33a

33b

34

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

or

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

the current tax year.

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

to the right.

37 Carryover. Subtract line 36 from line 34 37

(C)

Charitable purpose and description of assets distributed

(B)

Date of distribution

(A)

Payee’s name and address
Form 5227 (2008) Page 3

Form 5227 (2008)

Liabilities

51 Accounts payable and accrued expenses 51

53

52 Deferred revenue 

54

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

55

54 Mortgages and other notes payable. Attach schedule 

56

55 Other liabilities. Describe © 

57

56

58a

Total liabilities. Add lines 51 through 55 ©

Net Assets

59

57 Trust principal or corpus 

60

58a Undistributed income 

b Undistributed capital gains

c Undistributed nontaxable income 

59 Total net assets. Add lines 57 through 58c

60 Total liabilities and net assets. Add lines 56 and 59

58b

58c

52

Balance Sheet (see pages 6 through 8 of the instructions)

(c) FMV (see

instructions) Assets

38 Cash—non-interest-bearing 38

39 Savings and temporary cash investments 39

40a Accounts receivable 40a

b Less: allowance for doubtful accounts 40b

41

Receivables due from officers, directors, trustees, and other

disqualified persons (attach schedule) 

41

42a Other notes and loans receivable 42a

43 Inventories for sale or use 43

44 Prepaid expenses and deferred charges 44

45a

Investments—U.S. and state government obligations (attach

schedule) 

45a

47 Investments—other (attach schedule) 47

46a

Investments—land, buildings, and equipment:

basis (attach schedule) 

46a

b Less: accumulated depreciation 46b

48a Land, buildings, and equipment: basis 48a

b Less: accumulated depreciation 48b

49 Other assets. Describe © 49

50 Total assets. Add lines 38 through 49 (must equal line 60) © 50

(a) Beginning-ofYear Book Value

b Less: allowance for doubtful accounts 

Investments—corporate stock. Attach schedule 

Investments—corporate bonds. Attach schedule

b

c

42b

45b

45c

(b) End-of-Year

Book Value

Part IV
Form 5227 (2008) Page 4

Statements Regarding Activities (see page 8 of the instructions)

73 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? 73

74

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

4947(a)(2)(B)? 

74

71 Did the trustee change the method of determining the fair market value of the assets? Yes No

If “Yes,” attach an explanation.

72 Were any additional contributions received by the trust during 2008? Yes No

If “Yes,” be sure to complete all columns of line 7 in Schedule A, Part III.

Part VI-A

65a Enter the unitrust fixed percentage to be paid to the recipients 

68 Required unitrust distribution for 2008

69

69

Carryover of accumulated distribution deficiency (only for trusts that answered “Yes” on line 63).

Subtract line 68 from line 67b 

b Unitrust amount. Subtract line 56, column (c), from line 50, column (c), and mutiply the result by the 

percentage on line 65a. Do not enter less than -0- 

68

65a

65b

Form 5227 (2008)

%

If the answer is “Yes” on line 62 or line 63, go to line 66a. Otherwise, skip lines 66a through 67b 

and enter the line 65b amount on line 68.

66a Trust’s accounting income for 2008. Attach schedule 

b Enter the smaller of line 65b or line 66a here and on line 68. Skip lines 67a and 67b 

If the answer is “Yes” on line 62, go to line 66b. If the answer is “Yes” on line 63, skip line 66b

and go to line 67a.

67a Total accumulated distribution deficiencies from previous years (see page 8 of the instructions) 

b Add lines 65b and 67a 

If lines 67a and 67b are completed, enter the smaller of line 66a or line 67b on line 68.

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

66a

66b

67a

67b

70

Part V-B Charitable Remainder Unitrust (CRUT) Information (to be completed only by a section 664 CRUT)

See page 8 of the instructions

Yes No

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

1.664-3(a)(1)(i)(b)(1)? 

62

Yes No

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)? 

63

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

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

Charitable Remainder Annuity Trust (CRAT) Information (to be completed only by a section 

664 CRAT)

Part V-A

61a Enter the initial fair market value (FMV) of the property placed in the trust

b Enter the total annual annuity amounts for all recipients 

61a

61b
Form 5227 (2008) Page 5

If any answer is “Yes” to 79a(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 page 9

of the instructions)? 79b

If the answer is “Yes” to question 79a(4), does the trust claim exemption from the tax

because it maintained expenditure responsibility for the grant? (See page 9 of the

instructions.) 

c

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

Yes No

Organizations relying on a current Notice regarding disaster assistance, check here ©

80

a

b

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

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

a personal benefit contract? Yes No

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

If “Yes” to 80b, file Form 8870 (see page 9 of the instructions.)

80b

76 Does section 4947(b)(3)(A) or (B) apply? (See page 9 of the instructions.) 

77 Taxes on excess business holdings (section 4943):

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

any time during 2008? 

a

b If “Yes,” did the trust have excess business holdings in 2008 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? 77b

Use Schedule C, Form 4720, to determine if the trust had excess business holdings in 2008.

78 Taxes on investments that jeopardize charitable purposes (section 4944):

a Did the trust invest during 2008 any amount in a manner that would jeopardize its charitable purpose? 78a

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, 2008? 

b

78b

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

a During 2008, did the trust pay or incur any amount to:

(1)

(2)

(3)

(4)

(5)

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Provide for any purpose other than religious, charitable, scientific, literary, or

educational, or for the prevention of cruelty to children or animals? 

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)? 

Provide a grant to an individual for travel, study, or other similar purposes? 

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

on, directly or indirectly, any voter registration drive? 

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

N/A

N/A

Form 5227 (2008)

If any answer is “Yes” to 75a(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 page

9 of the instructions)? 

b

75b

Did the trust engage in a prior year in any of the acts described in 75a, other than excepted acts, that were 

not corrected before January 1, 2008? 

c

75c

Organizations relying on a current Notice regarding disaster assistance, check here ©

75 Self-dealing (section 4941):

a During 2008, did the trust (either directly or indirectly):

(1)

(2)

(3)

(4)

(5)

(6)

Part VI-B 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

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Engage in the sale or exchange, or leasing of property with a disqualified person? 

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

a disqualified person? 

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

Pay compensation to, or pay or reimburse the expenses of, a disqualified person? 

Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)? 

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.) 

b

If “Yes,” check the “N/A” box in questions 77 and 78.
Form 5227 (2008) Page 6

Section C—Pooled Income Funds

86 Enter the amount of contributions received during 2008 86

87 Enter the amount required to be distributed for 2008 to satisfy the remainder interest 87

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

undistributed 

88

88

89 Enter the amount of income required to be paid to the charitable remainder beneficiary for 2008 89

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 ©

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 page 10 of the instructions.) ©

90

91

Section D—Charitable Remainder Trusts

Form 5227 (2008)

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

Sign has any knowledge.

Here

Signature of trustee or officer representing trustee Date

Check if selfemployed

Date Preparer’s SSN or PTIN Preparer’s

signature

Paid

Preparer’s

Use Only Firm’s name (or yours

if self-employed),

address, and ZIP code

EIN

Phone no. ( )

©

©

©

©

c

94a

b

Was the trust instrument amended during the year? If “Yes,” attach a copy 

If this is the final return, were final distributions made according to the trust instrument? 

93

92 Is this the intial return? If “Yes,” attach a copy of the trust instrument Yes No

Yes No

Yes No

Yes No

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

(see instructions beginning on page 9)

Section A—All Trusts

81 Check this box if any of the split-interest trust’s income interests expired during 2008 ©

If 82 (above) is checked and this is not a final return, attach an explanation.

82

Part VII

Section B—Charitable Lead Trusts

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

paid for charitable purposes? Yes No

84 Enter the amount of any excess income required to be paid for charitable purposes for 2008 84

85 Enter the amount of annuity or unitrust payments required to be paid to charitable beneficiaries for 2008 85

Check this box if all of the split-interest trust’s income interests expired before 2008 ©

If “Yes,” did you complete line 31? 

If either line 94a or 94b is “No,” explain why ©

95 At any time during calendar year 2008, 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 beginning on page 10 for exceptions and filing requirements for Form TD F 90-22.1.

If “Yes,” enter the name of the foreign country ©
Form 5227 (2008) Page 7

Schedule A—Distributions, Assets, and Donor Information

Part I

Part II-B

Accumulation Schedule (Section 664 trust only) See page 10 of the instructions

Current Distributions (charitable lead trusts or pooled income funds only) See page 12 of the instructions

1

b

2a

Accumulations

(c)

Fair market value of each

asset on date of donation

(b)

Description of each asset donated

(a)

Name and address of donor

3

Total distributable income. Enter the amount from line 29

Total distributions for 2008:

2008 distributions from income

Undistributed income at end of tax year. Subtract line 2b from

line 1

Form 5227 (2008)

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

signed by all parties to the trust?

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

Yes No N/A

7d Total ©

7c

7b

7a

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

If “Yes,” complete the schedule below.

6 Is this the initial return or were additional assets contributed to the trust in 2008? Yes No

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

5 Enter the amount required to be paid to private beneficiaries for 2008 ©

Part II-A Current Distributions Schedule (Section 664 trust only) See instructions beginning on page 10

(c)

Percentage of total unitrust

amount payable (if applicable)

(b)

Identifying number

(a)

Name of recipient

4a

%

c

4a

b

c

Total

b

%

%

(d)

Ordinary

Income

Capital gains

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

(g)

Nontaxable Income

(h)

Corpus

(i)

Total (add cols.

(d) through (h)

(a)

Ordinary income

(b)

Capital gain (loss)

(c)

Nontaxable income

NOT Open To Public Inspection

Full name of trust Employer identification number

If Part II-A, Total, column (i) does not agree with line 61b of Form 5227 for a CRAT or line 68 of Form 5227 for a CRUT, check

here © and attach an explanation.

(d)

Date of donation