For calendar year 2012 or other tax year beginning. See separate instructions. Name of organization ( Check box if name changed and see instructions.

Transcription

1 Form 990-T Department of the Treasury Internal Revenue Service A Check box if address changed Exempt Organization Business Income Tax Return (and proxy tax under section 0(e)) For calendar year 2012 or other tax year beginning, 2012, and ending, 20. See separate instructions. Name of organization ( Check box if name changed and see instructions.) B Exempt under section LICR FUND, INC. X 01( C )( ) Print Number, 1-70 street, and room or suite no. If a P.O. box, see instructions. or 408(e) 220(e) Type 408A 0(a) TIRD AVENUE - 28T FLOOR 29(a) C Book value of all assets at end of year F City or town, state, and ZIP code Group exemption number (see instructions) OMB No wx Open to Public Inspection for 01(c)() Organizations Only D Employer identification number (Employees' trust, see instructions.) E Unrelated business activity codes (see instructions.) G Check organization type 01(c) corporation 01(c) trust 401(a) trust Other trust Describe the organization's primary unrelated business activity. _ I During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? Yes No If "Yes," enter the name and identifying number of the parent corporation. J The books are in care of Telephone number Part I Unrelated Trade or Business Income (A) Income (B) Expenses (C) Net 1a Gross receipts or sales b Less returns and allowances c Balance 1c 2 Cost of goods sold (Schedule A, line 7) 2 4a b c Part II X _ Gross profit. Subtract line 2 from line 1c Capital gain net income (attach Schedule D) Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797) Capital loss deduction for trusts Income (loss) from partnerships and S corporations (attach statement) Rent income (Schedule C) Unrelated debt-financed income (Schedule E) _ Interest, annuities, royalties, and rents from controlled organizations (Schedule F) _ Investment income of a section 01(c)(7), (9), or (17) organization (Schedule G) Exploited exempt activity income (Schedule I) Advertising income (Schedule J) Other income (see instructions; attach statement) Total. Combine lines through 12 _ 4a 4b 4c ,227,7. -1,227,7. Deductions Not Taken Elsewhere (see instructions for limitations on deductions) (except for contributions, deductions must be directly connected with the unrelated business income) Compensation of officers, directors, and trustees (Schedule K) Salaries and wages Repairs and maintenance Bad debts Interest (attach statement) Taxes and licenses Charitable contributions (see instructions for limitation rules) Depreciation (attach Form 42) Less depreciation claimed on Schedule A and elsewhere on return Depletion _ a _ ATTACMENT _ Contributions to deferred compensation plans Employee benefit programs Excess exempt expenses (Schedule I) Excess readership costs (Schedule J) Other deductions (attach statement) Total deductions. Add lines 14 through 28 NEW YORK, NY Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 1 Net operating loss deduction (limited to the amount on line 0) INVESTMENTS XING CEN Unrelated business taxable income before specific deduction. Subtract line 1 from line 0 Specific deduction (generally $1,000, but see line instructions for exceptions) Unrelated business taxable income. Subtract line from line 2. If line is greater than line 2, enter the smaller of zero or line 2 4 JSA For Paperwork Reduction Act Notice, see instructions. Form 990-T (2012) 2E CR 777 V 12-7F 24,2. 24,2. -1,22,00. ATC 1-1,22, b 27 ATTACMENT , X 1. 29,01. -1,47,2. -1,47,2. 1, ,47,2. Page 1

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6 LICR FUND, INC Form 990-T (2012) Page Schedule C - Rent Income (From Real Property and Personal Property Leased With Real Property) (see instructions) 1. Description of property (1) (2) () (4) (a) From personal property (if the percentage of rent for personal property is more than 10% but not more than 0%) 2. Rent received or accrued (b) From real and personal property (if the percentage of rent for personal property exceeds 0% or if the rent is based on profit or income) (a) Deductions directly connected with the income in columns 2(a) and 2(b) (attach statement) (1) (2) () (4) Total Total _ (c) Total income. Add totals of columns 2(a) and 2(b). Enter here and on page 1, Part I, line, column (A) Schedule E - Unrelated Debt-Financed Income (see instructions) (1) (2) () (4) (1) (2) () (4) 1. Description of debt-financed property 4. Amount of average acquisition debt on or allocable to debt-financed property (attach statement). Average adjusted basis of or allocable to debt-financed property (attach statement) 2. Gross income from or allocable to debt-financed property. Column 4 divided by column % % % % (b) Total deductions. Enter here and on page 1, Part I, line, column (B). Deductions directly connected with or allocable to debt-financed property (a) Straight line depreciation (attach statement) 7. Gross income reportable (column 2 x column ) Enter here and on page 1, Part I, line 7, column (A). Totals _ Total dividends-received deductions included in column 8 Schedule F - Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions) Exempt Controlled Organizations 1. Name of controlled organization 2. Employer identification number. Net unrelated income (loss) (see instructions) 4. Total of specified payments made. Part of column 4 that is included in the controlling organization's gross income (b) Other deductions (attach statement) 8. Allocable deductions (column x total of columns (a) and (b)) Enter here and on page 1, Part I, line 7, column (B).. Deductions directly connected with income in column (1) (2) () (4) Nonexempt Controlled Organizations (1) (2) () (4) Totals JSA 7. Taxable Income 8. Net unrelated income (loss) (see instructions) 9. Total of specified payments made 10. Part of column 9 that is included in the controlling organization's gross income Add columns and 10. Enter here and on page 1, Part I, line 8, column (A). 11. Deductions directly connected with income in column 10 Add columns and 11. Enter here and on page 1, Part I, line 8, column (B). Form 990-T (2012) 2E CR 777 V 12-7F Page

7 Form 990-T (2012) Page 4 Schedule G - Investment Income of a Section 01(c)(7), (9), or (17) Organization (see instructions). Deductions 4. Set-asides. Total deductions 1. Description of income 2. Amount of income directly connected (attach statement) and set-asides (col. (attach statement) plus col. 4) (1) (2) () (4) Totals Enter here and on page 1, Part I, line 9, column (A). Schedule I - Exploited Exempt Activity Income, Other Than Advertising Income (see instructions) (1) (2) () (4) 1. Description of exploited activity Totals LICR FUND, INC Gross unrelated business income from trade or business Enter here and on page 1, Part I, line 10, col. (A).. Expenses directly connected with production of unrelated business income Enter here and on page 1, Part I, line 10, col. (B). 4. Net income (loss) from unrelated trade or business (column 2 minus column ). If a gain, compute cols. through 7. Schedule J - Advertising Income (see instructions) Income From Periodicals Reported on a Consolidated Basis Part I. Gross income from activity that is not unrelated business income. Expenses attributable to column Enter here and on page 1, Part I, line 9, column (B). 7. Excess exempt expenses (column minus column, but not more than column 4). Enter here and on page 1, Part II, line Name of periodical 2. Gross advertising income. Direct advertising costs 4. Advertising gain or (loss) (col. 2 minus col. ). If a gain, compute cols. through 7.. Circulation income. Readership costs 7. Excess readership costs (column minus column, but not more than column 4). (1) (2) () (4) Totals (carry to Part II, line ()) Part II Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns 2 through 7 on a line-by-line basis.) 1. Name of periodical 2. Gross advertising income. Direct advertising costs 4. Advertising gain or (loss) (col. 2 minus col. ). If a gain, compute cols. through 7.. Circulation income. Readership costs 7. Excess readership costs (column minus column, but not more than column 4). (1) (2) () (4) Totals from Part I Totals, Part II (lines 1-) Enter here and on page 1, Part I, line 11, col. (A). Enter here and on page 1, Part I line 11, col. (B). Schedule K - Compensation of Officers, Directors, and Trustees (see instructions) 1. Name 2. Title. Percent of time devoted to business (1) % (2) % () % (4) % Total. Enter here and on page 1, Part II, line 14 JSA Enter here and on page 1, Part II, line Compensation attributable to unrelated business Form 990-T (2012) 2E CR 777 V 12-7F Page 7

8 Form 42 Department of the Treasury Internal Revenue Service Name 1 Alternative Minimum Tax - Corporations OMB No Attach to the corporation's tax return. wx Information about Form 42 and its separate instructions is at Employer identification number Note: See the instructions to find out if the corporation is a small corporation exempt from the alternative minimum tax (AMT) under section (e). Taxable income or (loss) before net operating loss deduction 2 Adjustments and preferences: a Depreciation of post-198 property b Amortization of certified pollution control facilities _ c Amortization of mining exploration and development costs _ d Amortization of circulation expenditures (personal holding companies only) e Adjusted gain or loss f Long-term contracts g Merchant marine capital construction funds h Section 8(b) deduction (Blue Cross, Blue Shield, and similar type organizations only) i Tax shelter farm activities (personal service corporations only) j Passive activities (closely held corporations and personal service corporations only) k Loss limitations l Depletion m Tax-exempt interest income from specified private activity bonds n Intangible drilling costs _ o Other adjustments and preferences SEE ATTACMENT _ 4 Pre-adjustment alternative minimum taxable income (AMTI). Combine lines 1 through 2o _ 4 Adjusted current earnings (ACE) adjustment: a ACE from line 10 of the ACE worksheet in the instructions _ 4a b Subtract line from line 4a. If line exceeds line 4a, enter the difference as a negative amount (see instructions) _ 4b c Multiply line 4b by 7% (.7). Enter the result as a positive amount 4c 7 d e 8 a b c LICR FUND, INC Enter the excess, if any, of the corporation's total increases in AMTI from prior year ACE adjustments over its total reductions in AMTI from prior year ACE adjustments (see instructions). Note: You must enter an -1,44,97. amount on line 4d (even if line 4b is positive) _ 4d ACE adjustment. $ If line 4b is zero or more, enter the amount from line 4c _ If line 4b is less than zero, enter the smaller of line 4c or line 4d as a negative amount % Combine lines and 4e. If zero or less, stop here; the corporation does not owe any AMT Alternative tax net operating loss deduction (see instructions) SEE ATTACMENT Alternative minimum taxable income. Subtract line from line. If the corporation held a residual interest in a REMIC, see instructions Exemption phase-out (if line 7 is $10,000 or more, skip lines 8a and 8b and enter -0- on line 8c): _ Subtract $10,000 from line 7 (if completing this line for a member of a controlled group, see instructions). If zero or less, enter -0-8a Multiply line 8a by 2% (.2) _ 8b Exemption. Subtract line 8b from $40,000 (if completing this line for a member of a controlled group, see instructions). If zero or less, enter -0- Subtract line 8c from line 7. If zero or less, enter -0- Multiply line 9 by 20% (.20) _ Alternative minimum tax foreign tax credit (AMTFTC) (see instructions) Tentative minimum tax. Subtract line 11 from line 10 _ Regular tax liability before applying all credits except the foreign tax credit NONE NONE Alternative minimum tax. Subtract line 1 from line 12. If zero or less, enter -0-. Enter here and on _ Form 1120, Schedule J, line, or the appropriate line of the corporation's income tax return _ For Paperwork Reduction Act Notice, see separatee instructions. Form 42 (2012) 1 2a 2b 2c 2d 2e 2f 2g 2h 2i 2j 2k 2l 2m 2n 2o 4e 7 8c ,47,2. 22, ,44,97. -1,44,97. -1,44,97. 40,000. NONE NONE NONE NONE JSA 2X Page 8

9 LICR FUND, INC Adjusted Current Earnings (ACE) Worksheet See ACE Worksheet Instructions. _ NONE _ 1 Pre-adjustment AMTI. Enter the amount from line of Form ACE depreciation adjustment: a AMT depreciation 2a b ACE depreciation: (1) Post-199 property 2b(1) (2) Post-1989, pre-1994 property 2b(2) () Property described in sections 18(f)(1) through _ () Pre-1990 MACRS property 2b() (4) Pre-1990 original ACRS property 2b(4) (4) 2b() () Other property 2b() (7) Total ACE depreciation. Add lines 2b(1) through 2b() 2b(7) c ACE depreciation adjustment. Subtract line 2b(7) from line 2a2c _ Inclusion in ACE of items included in earnings and profits (E&P): a Tax-exempt interest income a b Death benefits from life insurance contracts b c All other distributions from life insurance contracts (including surrenders) c d Inside buildup of undistributed income in life insurance contracts _ d e Other items (see Regulations sections 1.(g)-1(c)()(iii) through (ix) for a partial list) _ e 4 Disallowance of items not deductible from E&P: a Certain dividends received 4a b Dividends paid on certain preferred stock of public utilities that are deductible under section 247 4b c Dividends paid to an ESOP that are deductible under section 404(k) 4c d Nonpatronage dividends that are paid and deductible under section 182(c) _ 4d e Other items (see Regulations sections 1.(g)-1(d)()(i) and (ii) for a partial list) 4e Other adjustments based on rules for figuring E&P: a Intangible drilling costs a b Circulation expenditures b c Organizational expenditures c d LIFO inventory adjustments d e Installment sales e Disallowance of loss on exchange of debt pools _ 7 7 Acquisition expenses of life insurance companies for qualified foreign contracts 8 8 Depletion _ 9 Basis adjustments in determining gain or loss from sale or exchange of pre-1994 property 10 Adjusted current earnings. Combine lines 1, 2c, f, 4f, and f through 9. Enter the result here and on line 4a of Form 42 f Total increase to ACE from inclusion in ACE of items included in E&P. Add lines a through e f f Total increase to ACE because of disallowance of items not deductible from E&P. Add lines 4a through 4e 4f f Total other E&P adjustments. Combine lines a through e f Keep for Your Records NONE NONE ,44,97. NONE -1,44,97. JSA 2X Page 9

10 SCEDULE D (Form 1120) Capital Gains and Losses OMB No Attach to Form 1120, 1120-C, 1120-F, 1120-FSC, 1120-, 1120-IC-DISC, 1120-L, 1120-ND, 1120-PC, 1120-POL, 1120-REIT, 1120-RIC, 1120-SF, or certain Forms 990-T. Department of the Treasury Internal Revenue Service Information about Schedule D (Form 1120) and its separate instructions is at wx Name Employer identification number LICR FUND, INC Part I Short-Term Capital Gains and Losses - Assets eld One Year or Less Complete Form 8949 before completing line 1, 2, or. This form may be easier to complete if you round off cents to whole dollars. 1 Short-term totals from all Forms 8949 with box A checked in Part I. 2 Short-term totals from all Forms 8949 with box B checked in Part I. (d) Proceeds (sales price) from Form(s) 8949, Part I, line 2, column (d) (e) Cost or other basis from Form(s) 8949, Part I, line 2, column (e) (g) Adjustments to gain or loss from Form(s) 8949, Part I, line 2, column (g) (h) Gain or (loss). Subtract column (e) from column (d) and combine the result with column (g) Short-term totals from all Forms 8949 with box C checked 4 7 in Part I. Short-term capital gain from installment sales from Form 22, line 2 or 7 Short-term capital gain or (loss) from like-kind exchanges from Form 8824 Unused capital loss carryover (attach computation) _ Net short-term capital gain or (loss). Combine lines 1 through in column h Part II Long-Term Capital Gains and Losses - Assets eld More Than One Year Complete Form 8949 before completing line 8, 9, or 10. This form may be easier to complete if you round off cents to whole dollars. (d) Proceeds (sales price) from Form(s) 8949, Part II, line 4, column (d) (e) Cost or other basis from Form(s) 8949, Part II, line 4, column (e) 4 7 (g) Adjustments to gain or loss from Form(s) 8949, Part II, line 4, column (g) 11. ( ) 11. (h) Gain or (loss). Subtract column (e) from column (d) and combine the result with column (g) 8 Long-term totals from all Forms 8949 with box A checked in Part II. 9 Long-term totals from all Forms 8949 with box B checked in Part II. 10 Long-term totals from all Forms 8949 with box C checked in Part II. 11 Enter gain from Form 4797, line 7 or 9 12 Long-term capital gain from installment sales from Form 22, line 2 or 7 1 Long-term capital gain or (loss) from like-kind exchanges from Form Capital gain distributions (see instructions) 1 Net long-term capital gain or (loss). Combine lines 8 through 14 in column h Part III Summary of Parts I and II _ Enter excess of net short-term capital gain (line 7) over net long-term capital loss (line 1) Net capital gain. Enter excess of net long-term capital gain (line 1) over net short-term capital loss (line 7) Add lines 1 and 17. Enter here and on Form 1120, page 1, line 8, or the proper line on other returns Note. If losses exceed gains, see Capital losses in the instructions ,24. 22, , ,24. 24,2. For Paperwork Reduction Act Notice, see the Instructions for Form Schedule D (Form 1120) (2012) JSA 2C Page 10

11 Form 8949 Department of the Treasury Internal Revenue Service Name(s) shown on return LICR FUND, INC Sales and Other Dispositions of Capital Assets OMB No Information about Form 8949 and its separate instructions is at wx Attachment File with your Schedule D to list your transactions for lines 1, 2,, 8, 9, and 10 of Schedule D. Sequence No. 12A Social security number or taxpayer identification number Most brokers issue their own substitute statement instead of using Form 1099-B. They also may provide basis information (usually your cost) to you on the statement even if it is not reported to the IRS. Before you check Box A, B, or C below, determine whether you received any statement(s) and, if so, the transactions for which basis was reported to the IRS. Brokers are required to report basis to the IRS for most stock you bought in 2011 or later. Part I Short-Term. Transactions involving capital assets you held one year or less are short-term. For long-term transaction, see page 2. You must check Box A, B, or C below. Check only one box. If more than one box applies for your short-term transactions, complete a separate Form 8849, page 1, for each applicable box. If you have more short-term transactions than will fit on this page for one or more of the boxes, complete as many forms with the same box checked as you need. X 1 (A) Short-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (B) Short-term transactions reported on Form(s) 1099-B showing basis was not reported to the IRS (C) Short-term transactions not reported to you on Form 1099-B (a) Description of property (Example: 100 sh. XYZ Co.) (b) Date acquired (Mo., day, yr.) (c) Date sold or disposed (Mo., day, yr.) (d) Proceeds (sales price) (see instructions) (e) Cost or other basis. See the Note below and see Column (e) in the separate instructions Adjustment, if any, to gain or loss. If you enter an amount in column (g), enter a code in column (f). See the separate instructions. (f) Code(s) from instructions (g) Amount of adjustment (h) Gain or (loss). Subtract column (e) from column (d) and combine the result with column (g) FROM PASS-TROUG Totals. Add the amounts in columns (d), (e), (g), and (h) (subtract negative amounts). Enter each total here and include on your Schedule D, line 1 (if Box A above is checked), line 2 (if Box B above is checked), or line (if Box C above is checked) 11. Note. If you checked Box A above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment. For Paperwork Reduction Act Notice, see your tax return instructions. JSA 2X Form 8949 (2012) Page 11

12 Form 8949 (2012) Attachment Sequence No. 12A Page 2 Name(s) shown on return. (Name and SSN or taxpayer identification no. not required if shown on other side.) Social security number or taxpayer identification number LICR FUND, INC Most brokers issue their own substitute statement instead of using Form 1099-B. They also may provide basis information (usually your cost) to you on the statement even if it is not reported to the IRS. Before you check Box A, B, or C below, determine whether you received any statement(s) and, if so, the transactions for which basis was reported to the IRS. Brokers are required to report basis to the IRS for most stock you bought in 2011 or later. Part II Long-Term. Transactions involving capital assets you held more than one year are long-term. For short-term transactions, see page 1. You must check Box A, B, or C below. Check only one box. If more than one box applies for your long-term transactions, complete a separate Form 8849, page 2, for each applicable box. If you have more long-term transactions than will fit on this page for one or more of the boxes, complete as many forms with the same box checked as you need. X (A) Long-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (B) Long-term transactions reported on Form(s) 1099-B showing basis was not reported to the IRS (C) Long-term transactions not reported to you on Form 1099-B (a) Description of property (Example: 100 sh. XYZ Co.) (b) Date acquired (Mo., day, yr.) (c) Date sold or disposed (Mo., day, yr.) (d) Proceeds (sales price) (see instructions) (e) Cost or other basis. See the Note below and see Column (e) in the separate instructions Adjustment, if any, to gain or loss. If you enter an amount in column (g), enter a code in column (f). See the separate instructions. (f) Code(s) from instructions (g) Amount of adjustment (h) Gain or (loss). Subtract column (e) from column (d) and combine the result with column (g) FROM PASS-TROUG 2,24. 4 Totals. Add the amounts in columns (d), (e), (g), and (h) (subtract negative amounts). Enter each total here and include on your Schedule D, line 8 (if Box A above is checked), line 9 (if Box B above is checked), or line 10 (if Box C above is checked) 2,24. Note. If you checked Box A above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment. For Paperwork Reduction Act Notice, see your tax return instructions. JSA 2X Form 8949 (2012) Page 12

13 Form 800 Department of the Treasury Internal Revenue Service (99) Name(s) shown on return General Business Credit OMB No Information about Form 800 and its separate instructions is at wx Attachment Attach to your tax return. Sequence No. 22 Identifying number LICR FUND, INC Part I Current Year Credit for Credits Not Allowed Against Tentative Minimum Tax (TMT) (See instructions and complete Part(s) III before Parts I and II) _ 1 General business credit from line 2 of all Parts III with box A checked 1 2 Passive activity credits from line 2 of all Parts III with box B checked 2 Enter the applicable passive activity credits allowed for 2012 (see instructions) 4 Carryforward of general business credit to Enter the amount from line 2 of Part III with box C checked. See instructions for statement to attach 4 Carryback of general business credit from 201. Enter the amount from line 2 of Part III with box D checked (see instructions) Add lines 1,, 4, and Part II Allowable Credit 7 Regular tax before credits: Individuals. Enter the amount from Form 1040, line 44, or Form 1040NR, line 42 $ Corporations. Enter the amount from Form 1120, Schedule J, Part I, line 2; or the applicable line of your return _ 7 ( $ Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G, lines 1a and 1b; or the amount from the applicable line of your return _ 7 8 Alternative minimum tax: Individuals. Enter the amount from Form 21, line _ Corporations. Enter the amount from Form 42, line 14 ( _ $ Estates and trusts. Enter the amount from Schedule I (Form 1041), line _ 7 9 Add lines 7 and 8 _ Foreign tax credit _ 10a b Certain allowable credits (see instructions) 10b c Add lines 10a and 10b 10a 11 Net income tax. Subtract line 10c from line 9. If zero, skip lines 12 through 1 and enter -0- on line 1a c Net regular tax. Subtract line 10c from line 7. If zero or less, enter Enter 2% (.2) of the excess, if any, of line 12 over $2,000 (see instructions) _ 1 14 Tentative minimum tax: Individuals. Enter the amount from Form 21, line ( $ Corporations. Enter the amount from Form 42, line Estates and trusts. Enter the amount from Schedule I (Form 1041), line Enter the greater of line 1 or line 14 1a Subtract line 1 from line 11. If zero or less, enter -0- b c Reserved 17a Enter the smaller of line or line 1a b c C corporations: See the line 17a instructions if there has been an ownership change, acquisition, or reorganization. Reserved Reserved For Paperwork Reduction Act Notice, see separate instructions. Form 800 (2012) 1 1a 1b 1c 17a 17b 17c JSA 2X Page 1

14 Form 800 (2012) LICR FUND, PageINC Part II Allowable Credit (Continued) Note. If you are not required to report any amounts on lines 22 or 24 below, skip lines 18 through 2 and enter -0- on line Multiply line 14 by 7% (.7) (see instructions) _ Enter the greater of line 1 or line 18 Subtract line 19 from line 11. If zero or less, enter -0- _ Subtract line 17a from line 20. If zero or less, enter -0- _ Combine the amounts from line of all Parts III with box A, C, or D checked _ Passive activity credit from line of all Parts III with box B checked 2 Enter the applicable passive activity credit allowed for 2012 (see instructions) Add lines 22 and 24 _ Empowerment zone and renewal community employment credit allowed. Enter the smaller of line 21 or line 2 _ Subtract line 1 from line 11. If zero or less, enter -0- _ Add lines 17a and 2 _ Subtract line 28 from line 27. If zero or less, enter -0- _ Enter the general business credit from line of all Parts III with box A checked _ Enter the total eligible small business credit from line of all Parts III with box E checked Passive activity credits from line of all Parts III with box B checked and line of all Parts III with box F checked _ 2 Enter the applicable passive activity credits allowed for 2012 (see instructions) _ Carryforward of business credit to Enter the amount from line of Part III with box C checked and line of Part III with box G checked. See instructions for statement to attach Carryback of business credit from 201. Enter the amount from line of Part III with box D checked and line of Part III with box checked (see instructions) Add lines 0, 1,, 4, and 7 Enter the smaller of line 29 or line 8 Credit allowed for the current year. Add lines 28 and 7. Report the amount from line 8 (if smaller than the sum of Part I, line, and Part II, lines 2 and, see instructions) as indicated below or on the applicable line of your return: Individuals. Form 1040, line, or Form 1040NR, line 0 ( _ $ Corporations. Form 1120, Schedule J, Part I, line c Estates and trusts. Form 1041, Schedule G, line 2b Form 800 (2012) JSA 2X Page 14

15 Form 800 (2012) Page Name(s) shown on return Identifying number LICR FUND, INC Part III General Business Credits or Eligible Small Business Credits (see instructions) Complete a separate Part III for each box checked below. (see instructions) A B C D I General Business Credit From a Non-Passive Activity General Business Credit From a Passive Activity General Business Credit Carryforwards General Business Credit Carrybacks E F G Eligible Small Business Credit From a Non-Passive Activity Eligible Small Business Credit From a Passive Activity Eligible Small Business Credit Carryforwards Eligible Small Business Credit Carrybacks If you are filing more than one Part III with box A, B, E, or F checked, complete and attach first an additional Part III combining amounts from all Parts III with box A, B, E, or F checked. Check here if this is the consolidated Part III X (a) Description of credit Note. On any line where the credit is from more than one source, a separate Part III is needed for each pass-through entity. 1a Investment (Form 48, Part II only) (attach Form 48) 1a b Reserved _ 1b c Increasing research activities (Form 7) 1c d Low-income housing (Form 88, Part I only) 1d e Disabled access (Form 882) (see instructions for limitation) _ 1e f Renewable electricity, refined coal, and Indian coal production (Form 88)_ 1f g Indian employment (Form 884) 1g h Orphan drug (Form 8820) _ 1h i New markets (Form 8874) _ 1i j Small employer pension plan startup costs (Form 8881) (see instructions for limitation) _ 1j k Employer-provided child care facilities and services (Form 8882) (see l m n o p q r s t u v w x y z aa bb zz 2 4a b c d e f g h i j z instructions for limitation) _ Biodiesel and renewable diesel fuels (attach Form 884) Low sulfur diesel fuel production (Form 889)_ Distilled spirits (Form 890) Nonconventional source fuel (Form 8907) Energy efficient home (Form 8908) Energy efficient appliance (Form 8909) Alternative motor vehicle (Form 8910) _ Alternative fuel vehicle refueling property (Form 8911) Reserved _ Mine rescue team training (Form 892) _ Agricultural chemicals security (Form 891) (see instructions for limitation) Employer differential wage payments (Form 892) Carbon dioxide sequestration (Form 89) Qualified plug-in electric drive motor vehicle (Form 89) Qualified plug-in electric vehicle (Form 884, Part I only) New hire retention (Form 884-B) General credits from an electing large partnership (Schedule K-1 (Form 10-B)) Other _ Add lines 1a through 1zz and enter here Enter the amount from Form 8844 _ Investment (Form 48, Part III) (attach Form 48) Work opportunity (Form 884) _ Alcohol and cellulosic biofuel fuels (Form 478) Low-income housing (Form 88, Part II) Renewable electricity, refined coal, and Indian coal production (Form 88) Employer social security and Medicare taxes paid on certain employee tips (Form 884) Qualified railroad track maintenance (Form 8900) Small employer health insurance premiums (Form 8941) Reserved Reserved Other Add lines 4a through 4z and enter here Add lines 2,, and 1k 1l 1m 1n 1o 1p 1q 1r 1s 1t 1u 1v 1w 1x 1y 1z 1aa 1bb 1zz 2 4a 4b 4c 4d 4e 4f 4g 4h 4i 4j 4z (b) If claiming the credit from a pass-through entity, enter the EIN _ (c) Enter the appropriate amount JSA Form 800 (2012) 2X Page 1

16 Form 800 (2012) Page Name(s) shown on return Identifying number LICR FUND, INC Part III General Business Credits or Eligible Small Business Credits (see instructions) Complete a separate Part III for each box checked below. (see instructions) A B C D I X General Business Credit From a Non-Passive Activity General Business Credit From a Passive Activity General Business Credit Carryforwards General Business Credit Carrybacks E F G Eligible Small Business Credit From a Non-Passive Activity Eligible Small Business Credit From a Passive Activity Eligible Small Business Credit Carryforwards Eligible Small Business Credit Carrybacks If you are filing more than one Part III with box A, B, E, or F checked, complete and attach first an additional Part III combining amounts from all Parts III with box A, B, E, or F checked. Check here if this is the consolidated Part III (a) Description of credit Note. On any line where the credit is from more than one source, a separate Part III is needed for each pass-through entity. 1a Investment (Form 48, Part II only) (attach Form 48) 1a b Reserved _ 1b c Increasing research activities (Form 7) 1c d Low-income housing (Form 88, Part I only) 1d e Disabled access (Form 882) (see instructions for limitation) _ 1e f Renewable electricity, refined coal, and Indian coal production (Form 88)_ 1f g Indian employment (Form 884) 1g h Orphan drug (Form 8820) _ 1h i New markets (Form 8874) _ 1i j Small employer pension plan startup costs (Form 8881) (see instructions for limitation) _ 1j k Employer-provided child care facilities and services (Form 8882) (see l m n o p q r s t u v w x y z aa bb zz 2 4a b c d e f g h i j z instructions for limitation) _ Biodiesel and renewable diesel fuels (attach Form 884) Low sulfur diesel fuel production (Form 889)_ Distilled spirits (Form 890) Nonconventional source fuel (Form 8907) Energy efficient home (Form 8908) Energy efficient appliance (Form 8909) Alternative motor vehicle (Form 8910) _ Alternative fuel vehicle refueling property (Form 8911) Reserved _ Mine rescue team training (Form 892) _ Agricultural chemicals security (Form 891) (see instructions for limitation) Employer differential wage payments (Form 892) Carbon dioxide sequestration (Form 89) Qualified plug-in electric drive motor vehicle (Form 89) Qualified plug-in electric vehicle (Form 884, Part I only) New hire retention (Form 884-B) General credits from an electing large partnership (Schedule K-1 (Form 10-B)) Other _ Add lines 1a through 1zz and enter here Enter the amount from Form 8844 _ Investment (Form 48, Part III) (attach Form 48) Work opportunity (Form 884) _ Alcohol and cellulosic biofuel fuels (Form 478) Low-income housing (Form 88, Part II) Renewable electricity, refined coal, and Indian coal production (Form 88) Employer social security and Medicare taxes paid on certain employee tips (Form 884) Qualified railroad track maintenance (Form 8900) Small employer health insurance premiums (Form 8941) Reserved Reserved Other Add lines 4a through 4z and enter here Add lines 2,, and 1k 1l 1m 1n 1o 1p 1q 1r 1s 1t 1u 1v 1w 1x 1y 1z 1aa 1bb 1zz 2 4a 4b 4c 4d 4e 4f 4g 4h 4i 4j 4z (b) If claiming the credit from a pass-through entity, enter the EIN _ (c) Enter the appropriate amount JSA Form 800 (2012) 2X Page 1

17 Form 800 (2012) Page Name(s) shown on return Identifying number LICR FUND, INC Part III General Business Credits or Eligible Small Business Credits (see instructions) Complete a separate Part III for each box checked below. (see instructions) A B C D I X General Business Credit From a Non-Passive Activity General Business Credit From a Passive Activity General Business Credit Carryforwards General Business Credit Carrybacks E F G Eligible Small Business Credit From a Non-Passive Activity Eligible Small Business Credit From a Passive Activity Eligible Small Business Credit Carryforwards Eligible Small Business Credit Carrybacks If you are filing more than one Part III with box A, B, E, or F checked, complete and attach first an additional Part III combining amounts from all Parts III with box A, B, E, or F checked. Check here if this is the consolidated Part III (a) Description of credit Note. On any line where the credit is from more than one source, a separate Part III is needed for each pass-through entity. 1a Investment (Form 48, Part II only) (attach Form 48) 1a b Reserved _ 1b c Increasing research activities (Form 7) 1c d Low-income housing (Form 88, Part I only) 1d e Disabled access (Form 882) (see instructions for limitation) _ 1e f Renewable electricity, refined coal, and Indian coal production (Form 88)_ 1f g Indian employment (Form 884) 1g h Orphan drug (Form 8820) _ 1h i New markets (Form 8874) _ 1i j Small employer pension plan startup costs (Form 8881) (see instructions for limitation) _ 1j k Employer-provided child care facilities and services (Form 8882) (see l m n o p q r s t u v w x y z aa bb zz 2 4a b c d e f g h i j z instructions for limitation) _ Biodiesel and renewable diesel fuels (attach Form 884) Low sulfur diesel fuel production (Form 889)_ Distilled spirits (Form 890) Nonconventional source fuel (Form 8907) Energy efficient home (Form 8908) Energy efficient appliance (Form 8909) Alternative motor vehicle (Form 8910) _ Alternative fuel vehicle refueling property (Form 8911) Reserved _ Mine rescue team training (Form 892) _ Agricultural chemicals security (Form 891) (see instructions for limitation) Employer differential wage payments (Form 892) Carbon dioxide sequestration (Form 89) Qualified plug-in electric drive motor vehicle (Form 89) Qualified plug-in electric vehicle (Form 884, Part I only) New hire retention (Form 884-B) General credits from an electing large partnership (Schedule K-1 (Form 10-B)) Other _ Add lines 1a through 1zz and enter here Enter the amount from Form 8844 _ Investment (Form 48, Part III) (attach Form 48) Work opportunity (Form 884) _ Alcohol and cellulosic biofuel fuels (Form 478) Low-income housing (Form 88, Part II) Renewable electricity, refined coal, and Indian coal production (Form 88) Employer social security and Medicare taxes paid on certain employee tips (Form 884) Qualified railroad track maintenance (Form 8900) Small employer health insurance premiums (Form 8941) Reserved Reserved Other Add lines 4a through 4z and enter here Add lines 2,, and 1k 1l 1m 1n 1o 1p 1q 1r 1s 1t 1u 1v 1w 1x 1y 1z 1aa 1bb 1zz 2 4a 4b 4c 4d 4e 4f 4g 4h 4i 4j 4z (b) If claiming the credit from a pass-through entity, enter the EIN _ (c) Enter the appropriate amount JSA Form 800 (2012) 2X Page 17

18 Form 800 (2012) Page Name(s) shown on return Identifying number LICR FUND, INC Part III General Business Credits or Eligible Small Business Credits (see instructions) Complete a separate Part III for each box checked below. (see instructions) A B C D I X General Business Credit From a Non-Passive Activity General Business Credit From a Passive Activity General Business Credit Carryforwards General Business Credit Carrybacks E F G Eligible Small Business Credit From a Non-Passive Activity Eligible Small Business Credit From a Passive Activity Eligible Small Business Credit Carryforwards Eligible Small Business Credit Carrybacks If you are filing more than one Part III with box A, B, E, or F checked, complete and attach first an additional Part III combining amounts from all Parts III with box A, B, E, or F checked. Check here if this is the consolidated Part III (a) Description of credit Note. On any line where the credit is from more than one source, a separate Part III is needed for each pass-through entity. 1a Investment (Form 48, Part II only) (attach Form 48) 1a b Reserved _ 1b c Increasing research activities (Form 7) 1c d Low-income housing (Form 88, Part I only) 1d e Disabled access (Form 882) (see instructions for limitation) _ 1e f Renewable electricity, refined coal, and Indian coal production (Form 88)_ 1f g Indian employment (Form 884) 1g h Orphan drug (Form 8820) _ 1h i New markets (Form 8874) _ 1i j Small employer pension plan startup costs (Form 8881) (see instructions for limitation) _ 1j k Employer-provided child care facilities and services (Form 8882) (see l m n o p q r s t u v w x y z aa bb zz 2 4a b c d e f g h i j z instructions for limitation) _ Biodiesel and renewable diesel fuels (attach Form 884) Low sulfur diesel fuel production (Form 889)_ Distilled spirits (Form 890) Nonconventional source fuel (Form 8907) Energy efficient home (Form 8908) Energy efficient appliance (Form 8909) Alternative motor vehicle (Form 8910) _ Alternative fuel vehicle refueling property (Form 8911) Reserved _ Mine rescue team training (Form 892) _ Agricultural chemicals security (Form 891) (see instructions for limitation) Employer differential wage payments (Form 892) Carbon dioxide sequestration (Form 89) Qualified plug-in electric drive motor vehicle (Form 89) Qualified plug-in electric vehicle (Form 884, Part I only) New hire retention (Form 884-B) General credits from an electing large partnership (Schedule K-1 (Form 10-B)) Other _ Add lines 1a through 1zz and enter here Enter the amount from Form 8844 _ Investment (Form 48, Part III) (attach Form 48) Work opportunity (Form 884) _ Alcohol and cellulosic biofuel fuels (Form 478) Low-income housing (Form 88, Part II) Renewable electricity, refined coal, and Indian coal production (Form 88) Employer social security and Medicare taxes paid on certain employee tips (Form 884) Qualified railroad track maintenance (Form 8900) Small employer health insurance premiums (Form 8941) Reserved Reserved Other Add lines 4a through 4z and enter here Add lines 2,, and 1k 1l 1m 1n 1o 1p 1q 1r 1s 1t 1u 1v 1w 1x 1y 1z 1aa 1bb 1zz 2 4a 4b 4c 4d 4e 4f 4g 4h 4i 4j 4z (b) If claiming the credit from a pass-through entity, enter the EIN _ (c) Enter the appropriate amount JSA Form 800 (2012) 2X Page 18

19 Form 800 (2012) Page Name(s) shown on return Identifying number LICR FUND, INC Part III General Business Credits or Eligible Small Business Credits (see instructions) Complete a separate Part III for each box checked below. (see instructions) A B C D I X General Business Credit From a Non-Passive Activity General Business Credit From a Passive Activity General Business Credit Carryforwards General Business Credit Carrybacks E F G Eligible Small Business Credit From a Non-Passive Activity Eligible Small Business Credit From a Passive Activity Eligible Small Business Credit Carryforwards Eligible Small Business Credit Carrybacks If you are filing more than one Part III with box A, B, E, or F checked, complete and attach first an additional Part III combining amounts from all Parts III with box A, B, E, or F checked. Check here if this is the consolidated Part III (a) Description of credit Note. On any line where the credit is from more than one source, a separate Part III is needed for each pass-through entity. 1a Investment (Form 48, Part II only) (attach Form 48) 1a b Reserved _ 1b c Increasing research activities (Form 7) ATC 1c d Low-income housing (Form 88, Part I only) 1d e Disabled access (Form 882) (see instructions for limitation) _ 1e f Renewable electricity, refined coal, and Indian coal production (Form 88)_ 1f g Indian employment (Form 884) 1g h Orphan drug (Form 8820) _ 1h i New markets (Form 8874) _ 1i j Small employer pension plan startup costs (Form 8881) (see instructions for limitation) _ 1j k Employer-provided child care facilities and services (Form 8882) (see l m n o p q r s t u v w x y z aa bb zz 2 4a b c d e f g h i j z instructions for limitation) _ Biodiesel and renewable diesel fuels (attach Form 884) Low sulfur diesel fuel production (Form 889)_ Distilled spirits (Form 890) Nonconventional source fuel (Form 8907) Energy efficient home (Form 8908) Energy efficient appliance (Form 8909) Alternative motor vehicle (Form 8910) _ Alternative fuel vehicle refueling property (Form 8911) Reserved _ Mine rescue team training (Form 892) _ Agricultural chemicals security (Form 891) (see instructions for limitation) Employer differential wage payments (Form 892) Carbon dioxide sequestration (Form 89) Qualified plug-in electric drive motor vehicle (Form 89) Qualified plug-in electric vehicle (Form 884, Part I only) New hire retention (Form 884-B) General credits from an electing large partnership (Schedule K-1 (Form 10-B)) Other _ Add lines 1a through 1zz and enter here Enter the amount from Form 8844 _ Investment (Form 48, Part III) (attach Form 48) Work opportunity (Form 884) _ Alcohol and cellulosic biofuel fuels (Form 478) Low-income housing (Form 88, Part II) Renewable electricity, refined coal, and Indian coal production (Form 88) Employer social security and Medicare taxes paid on certain employee tips (Form 884) Qualified railroad track maintenance (Form 8900) Small employer health insurance premiums (Form 8941) Reserved Reserved Other Add lines 4a through 4z and enter here Add lines 2,, and 1k 1l 1m 1n 1o 1p 1q 1r 1s 1t 1u 1v 1w 1x 1y 1z 1aa 1bb 1zz 2 4a 4b 4c 4d 4e 4f 4g 4h 4i 4j 4z (b) If claiming the credit from a pass-through entity, enter the EIN _ (c) Enter the appropriate amount JSA Form 800 (2012) 2X Page 19