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Form 1125-E (Rev. October 2016) Department of the Treasury Internal Revenue Service

Compensation of Officers
▶ Attach to Form 1120, 1120-C, 1120-F, 1120-REIT, 1120-RIC, or 1120S.
Information about Form 1125-E and its separate instructions is at www.irs.gov/form1125e.
OMB No. 1545-0123
Name(s) shown on return
 
  Name Employer identification number
 
A
Corporate Alternative Minimum Tax (CAMT) and Base Erosion Anti-Abuse Tax (BEAT). Are you both (a) an “applicable corporation” within the meaning of section 59(k)(1) for the CAMT, and (b) an “applicable taxpayer” within the meaning of section 59A(e) for the BEAT? See instructions . . . . . . . Yes   ▢ No   ▢
(a) Name of officer (b) Social security number
(see instructions)
(c) Percent of
time devoted to
business
Percent of stock owned (f) Amount of
compensation
(d) Common (e) Preferred
 
1  
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
 
 
 
 
 
 
 
 % 
 
 
 % 
 
 
 % 
 
 
2
Total compensation of officers
2
 
 
3
Compensation of officers claimed on Form 1125-A or elsewhere on return
3
 
 
4
Subtract line 3 from line 2. Enter the result here and on Form 1120, page 1, line 12 or the appropriate line of your tax return
4
 
 
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 55989C
Form 1125-E (Rev. 10-2016)

Warning: This information is for informational purposes only and should not be used for official tax matters. Use the official Form 1125-E and instructions, generally found at: https://www.irs.gov/forms-instructions. Rely on this information at your own risk. Visit https://www.irs.gov/forms-instructions for official IRS information. Consult with a tax professional.

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