Form 20c - Schedule Ab - Add-Back Form - 2012 Page 2
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1
2
3
42012
1200052C1283
Schedule
Alabama Department of Revenue
AB
Add-Back Form
ADOR
(Form 20C)
Taxpayer Name
99-9999999
01-01
12
12-31
12
TAXPAYER
TAXPAYER
FOR THE
, 20
through
, 20
NAME:
FEIN:
TAX PERIOD
Related member is defined to include a corporation, association, disregarded entity, or subchapter K entity (Alabama Code section 40-18-1(13) and (15)). Disregarded entities and subchapter K
entities are related members separate and apart from their owner. A column must be completed for each recipient related member.
Recipient related member who received interest/intangible income from the taxpayer:
Related Member 1
Related Member 2
Related Member 3
Related Member 4
11-1111111
22-2222222
33-3333333
44-4444444
1 a. Recipient related member FEIN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1a
BCA Corp
CAB Corp
DEF Corp
EFG Corp
b. Recipient related member name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
10,000
0
1,000,000
100,000,000
2 List the intangible expense amounts paid to the recipient related member. . . . . . . . . . . . . . . .
2
0
50,000,000
25,000,000
125,000,000
3 List the interest expense amounts paid to the recipient related member. . . . . . . . . . . . . . . . . .
3
10,000
50,000,000
26,000,000
225,000,000
4 Total intangible/interest expenses paid (total lines 2 and 3).. . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
To determine the exempt amount of intangible/interest expense, complete the applicable section(s) below.
5 Exemption related to §40-18-35(b)(1):
GA,PA,TX,FL,LA
a. Jurisdiction(s) where recipient related member income is “subject to tax”: . . . . . . . . . . . . .
5a
0
0
26,000,000
0
b. Amount of Line 4 expense not added back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5b
c. Recipient related member’s corresponding intangible/interest income allocated to
0
0
0
0
jurisdiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5c
0
0
26,000,000
0
d. Adjusted intangible/interest amount (Line 5b minus Line 5c). . . . . . . . . . . . . . . . . . . . . . . . .
5d
0
0
97
0
e. Recipient related member’s total apportionment percentage in the above jurisdiction(s). .
5e
%
%
%
%
0
0
25,220,000
0
f. Adjusted interest/intangible amount (multiply Line 5d by Line 5e).. . . . . . . . . . . . . . . . . . . .
5f
0
0
25,220,000
0
g. Add Line 5c and Line 5f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5g
6 Exemption related to §40-18-35(b)(2) and §40-18-35(b)(4) – Amount of Line 4
0
0
0
125,000,000
expense not added back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
NOTE: For Section 7, 8, 9, and 10 the receipts of a disregarded entity/subchapter K entity, which may be a related entity in and unto itself, may not be combined with receipts of its owner for purposes of this schedule.
10,000
50,000,000
0
0
7 Exemption related to §40-18-35(b)(3) – Amount of Line 4 expense not added back. . . . . . .
7
10,000
0
0
0
8 Recipient related member receipts by category: a. Intangible receipts . . . . . . . . . . . . . . . . . .
8a
0
50,000,000
0
0
b. lnterest receipts . . . . . . . . . . . . . . . . . . . .
8b
Sales
15,000
0
0
0
9 a.
9a
Net gain Income
0
60,000,000
0
0
b.
9b
0
250,000,000
0
0
Other Income
c.
9c
0
1,000,000
0
0
d.
9d
0
0
0
0
e.
9e
0
0
0
0
10 a. If either Lines 8a or 8b are greater than Lines 9a, 9b, 9c, 9d or 9e, enter zero. . . . . . . . . .
10a
10,000
50,000,000
0
0
b. If Lines 9a, 9b, 9c, 9d or 9e are greater than Lines 8a or 8b, enter amount from Line 7. .
10b
10,000
50,000,000
25,220,000
125,000,000
11 Exempt Amount. Enter the greater of Lines 5g, 6, 10a or 10b.. . . . . . . . . . . . . . . . . . . . . . . . . .
11
12 Total Intangible/Interest expenses paid to all related members. (Sum all Line 4 for
301,010,000
all related members from all pages, enter here and on Form 20C, Schedule A, Line 6a). . . .
12
Attach additional pages as needed and enter the totals of Lines 4 and Lines 11 for all
related members from all pages on Page 1, Line 12 and 13.
13 Total Exempt Amount. (Sum line 11 for all related members from all pages and enter
200,230,000
this amount on Form 20C, Schedule A, Line 6b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
In order to qualify for the exemption presented in §40-18-35(b)(3), Line 10b must be greater than zero and an
Corporate Officer
informed corporate officer must sign the statement below, executed under penalty of perjury. With respect to the
transaction(s) giving rise to the related member’s interest/intangible expenses and costs, including both the direct
Signature
interest/intangible expense transaction(s) between the taxpayer and the related member and any prior
CFO
3/15/13
organizational restructuring transaction(s) that facilitated such direct interest/intangible expense transactions, tax
Title
Date
avoidance (which included the avoidance of a meaningful amount of Alabama tax) was not a principal motivating
factor.
THIS FORM MUST BE ATTACHED TO FORM 20C.
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