Form 355sc - Domestic Or Foreign Security Corporation Return

Schedule A. Balance Sheet as of

A. Beginning of Tax Year

B. End of Tax Year

Assets

11. Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

12. Federal and state government obligations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

13. Other current assets (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

14. Other investments (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

15. Buildings and other fixed depreciable assets (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . 5

5a. Less accumulated depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a

5b. Total. Subtract line 5a from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b

16. Land (net of any amortization) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

17. Intangible assets (amortizable only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

7a. Less accumulated amortization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a

7b. Total. Subtract line 7a from line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7b

18. Other assets (attach schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

19. Total assets. Add lines 1, 2, 3, 4, 5b, 6, 7b and 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Liabilities and Capital

10. Accounts Payable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11. Mortgages, notes, bonds payable in less than 1 year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12. Other current liabilities (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

13. Mortgages, notes, bonds payable in 1 year or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14. Other liabilities (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15. Capital stock: 15a. Preferred stock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15a

15b. Common stock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15b

16. Paid-in or capital surplus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

17. Retained earnings — Appropriated (attach statement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

18. Retained earnings — Unappropriated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19. Total liabilities and capital before treasury stock deduction. Add lines 10 through 18 . . . . . . 19

20. Cost of treasury stock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

21. Total liabilities and capital. Subtract line 20 from line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Ownership Information

11. At any time during the taxable year, was more than 50% of the voting stock:

(a) of another corporation owned by your corporation?

Yes

No.

(b) of your corporation owned by any single entity?

Yes

No.

(For rules of attribution, see Section 267(c) of the Internal Revenue Code.)

(If 1(a) or 1(b) is “Yes”, attach an ownership schedule. See instructions.)

12. At any time during the taxable year:

(a) Was any amount owed by your corporation during the taxable year?

Yes

No.

If “Yes”, enter amount $ _________________________________________

(b) Was any amount owed to your corporation during the taxable year?

Yes

No.

If “Yes”, enter amount $ _________________________________________

Note: “Amount owed” includes loans, accounts receivable and accounts payable.

Corporate Disclosure Schedule

Massachusetts requires all corporations to complete the following items:

¨$

11. Enter the amount for charitable contributions (U.S. Form 1120, 1120-A or 1120 RIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Enter the amount of the deduction for federal research expenses (included in U.S. 1120, 1120-A or 1120 RIC) allowed under

¨$

IRC Sec. 174, plus the credit for research allowed by IRC Sec 41 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter in line 3a the amounts of any accelerated depreciation (ACRS, MACRS or others) allowed as a federal deduction for the taxable year. In line 3b, enter depreciation for prop-

erty included in line 3a determined by using generally accepted accounting principles. Subtract line 3b from line 3a and enter the result in line 3c .

Buildings (other than

Pollution

Equipment

Rental Housing

Rental Housing)

Control Facilities

¨$

3a. Enter any accelerated depreciation taken federally for. . .

3b. Depreciation calculated according to generally

¨$

accepted accounting principles . . . . . . . . . . . . . . . . . . . . .

¨$