Form 1041-A — Form 1041-A — U.S. Information Return Trust

(Rev. September 2018)

Department of the Treasury Internal Revenue Service

U.S. Information Return Trust Accumulation of Charitable Amounts

Go to www.irs.gov/Form1041A for the latest information.

For calendar year 20

OMB No. 1545-0094

Name of trust Employer identification number

Name of trustee

Number, street, and room or suite no. (or P.O. box)

City or town, state, and ZIP code

Part I Income and Deductions (See the instructions for Form 1041 or Form 5227.) If total income is $25,000 or less, skip lines 1–8 and enter total income on line 9.

1 Interest income . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Business income or (loss) (attach Schedule C or C-EZ (Form 1040)) . . . . . . . . 3 4 Capital gain or (loss) (attach Schedule D (Form 1041)) . . . . . . . . . . . . 4 5 Rents, royalties, partnerships, other estates and trusts, etc. (attach Schedule E (Form 1040)) 5 6 Farm income or (loss) (attach Schedule F (Form 1040)) . . . . . . . . . . . . 6 7 Ordinary gain or (loss) (attach Form 4797) . . . . . . . . . . . . . . . . 7 8 Other income (state type of income) 8 9 Total income (combine lines 1 through 8) . . . . . . . . . . . . . . . . 9

10 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Charitable deduction (itemize by charitable purpose; include payee’s name and address) 12 13 Trustee fees . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Attorney, accountant, and return preparer fees . . . . . . . . . . . . . . . 14 15 Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . 15

Part II Distributions of Income Set Aside for Charitable Purposes (see instructions)

Part III Distributions of Principal for Charitable Purposes (see instructions)

Form 1041-A (Rev. 9-2018) Page 2

Balance Sheets (see instructions). If line 9, page 1, is $25,000 or less, complete only lines 38, 42,

Part IV and 45 (see instructions).

Assets	Assets	Assets	Assets	Assets	Assets	Assets	Assets	(a)Beginning-of- Year Book Value	(a)Beginning-of- Year Book Value	(b)End-of-Year Book Value	(b)End-of-Year Book Value

25
Cash—non-interest bearing .
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26
Savings and temporary cash investments .
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27aAccounts receivable .
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27a
**b **Less: allowance for doubtful accounts
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27b
28aNotes and loans receivable .
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28a
**b **Less: allowance for doubtful accounts
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28b
29
Inventories for sale or use
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30
Prepaid expenses and deferred charges
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31
Investments—U.S. and state government obligations (attach schedule)
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32
Investments—corporate stock (attach schedule) .
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33
Investments—corporate bonds (attach schedule) .
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34 aInvestments—land, buildings, and equipment: basis .
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34a
**b **Less: accumulated depreciation
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34b
35
Investments—other (attach schedule)
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36aLand, buildings, and equipment: basis
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36a
**b **Less: accumulated depreciation
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36b
37
Other assets (describe▶
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38
Total assets(add lines 25 through 37) .
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Liabilities
39
Accounts payable and accrued expenses .
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40
Mortgages and other notes payable (attach schedule) .
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41
Other liabilities (describe▶
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42
Total liabilities(add lines 39 through 41)
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Net Assets
43
Trust principal or corpus .
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44
Undistributed income and profits .
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45
Total net assets (add lines 43 and 44)
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46
Total liabilities and net assets(add lines 42 and 45)
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Part IV and 45 (see instructions).

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	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	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	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	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	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	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	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	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	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	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	Paid Preparer Use Only	Print/Type preparer’s name	Preparer’s signature	Preparer’s signature	Preparer’s signature	Preparer’s signature	Date	Date	Check if self-employed	Check if self-employed	PTIN
Paid Preparer Use Only	Paid Preparer Use Only	Firm’s name▶	Firm’s name▶	Firm’s name▶	Firm’s name▶	Firm’s name▶	Firm’s name▶	Firm’s name▶	Firm’s EIN▶	Firm’s EIN▶	Firm’s EIN▶
Paid Preparer Use Only	Paid Preparer Use Only	Firm’s address▶	Firm’s address▶	Firm’s address▶	Firm’s address▶	Firm’s address▶	Firm’s address▶	Firm’s address▶	Phone no.	Phone no.	Phone no.

Form 1041-A (Rev. 9-2018) Page 3

Section references are to the Internal Revenue Code unless otherwise noted. Future Developments

For the latest information about developments related to Form 1041-A and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form1041A . What’s New

The Tax Cuts and Jobs Act of 2017 (P.L. 115-97) amended section 641(c)(2). As a result, electing small business trusts (ESBTs) are no longer subject to the charitable information reporting requirements under section 6034 and do not file Form 1041-A. Reminder

Split-interest trusts as described in section 4947(a)(2) don’t file Form 1041-A. These types of trusts file Form 5227, Split-Interest Trust Information Return, which meets the section 6034 filing requirements.

Specific Instructions¶