Form 5227 - Split-Interest Trust Information Return - 2017 Page 7
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77
Form 5227 (2017)
Page
Full name of trust
Employer identification number
NOT Open To Public Inspection
Schedule A—Distributions, Assets, and Donor Information
Part I-A
Accumulation Schedule (Section 664 trust only) (see the instructions)
Accumulations
(a) Ordinary income
(b) Capital gain (loss)
(c) Nontaxable income
Excluded
Accumulated
Excluded
Accumulated
Excluded
Accumulated
Net Investment Income (NII) Classification
Income
NII
Income
NII
Income
NII
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Total distributable income. Enter the amount from
line 29 .
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2a Total distributions for 2017:
b 2017 distributions from income
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3
Undistributed income at end of tax year. Subtract
line 2b from line 1 .
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Part I-B
Simplified Net Investment Income Calculation
(a) Accumulated NII
(b) Current Year NII
(c) Distributions
(d) Ending NII
4
Part II-A
Current Distributions Schedule (Section 664 trust only) (see the instructions)
(c)
(a)
(b)
Percentage of total unitrust amount
Name of recipient
Identifying number
payable (if applicable)
4a
%
b
%
c
%
Capital gains
(i)
(j)
(d)
(g)
(h)
Total (add cols.
Net investment
Ordinary Income
Nontaxable Income
Corpus
(e) Short-term
(f) Long-term
(d) through (h))
income
4a
b
c
Total
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.
▶
Part II-B
Current Distributions (charitable lead trusts or pooled income funds only) (see the instructions)
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Enter the amount required to be paid to private beneficiaries for 2017 .
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Part III
Assets and Donor Information (Section 664 trust or charitable lead trust only)
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Is this the initial return or were additional assets contributed to the trust in 2017? .
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Yes
No
If “Yes,” complete the schedule below.
If “No,” complete only column (a) of the schedule below.
(c)
(a)
(b)
(d)
Fair market value of each
Name and address of donor
Description of each asset donated
Date of donation
asset on date of donation
7a
7b
7c
7d Total .
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8
For charitable remainder trusts: If this was the final year, was an early termination agreement signed
Yes
No
N/A
by all parties to the trust?
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If “Yes,” attach a copy of the signed agreement.
5227
Form
(2017)
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