2010 Internal Revenue Service

Transcription

1 Sign Here Paid Preparer Use Only U.S. Income Tax Return for an S Corporation Do not file this form unless the corporation has filed or is OMB No Form 2S attaching Form 2553 to elect to be an S corporation. Department of the Treasury 2 Internal Revenue Service See separate instructions. For calendar year 2 or tax year beginning, 2, ending, 2 A S election effective date Name D Employer identification number ROBIN CENTER CHIROPRACTIC B TYPE Business activity code Number, street, and room or suite no. If a P.O. box, see instructions. E Date incorporated number (see instructions) OR 464 LAKELAND AVE NORTH PRINT City or town, state, and ZIP code F Total assets (see instructions) C Check if Sch. M-3 attached ROBBINSDALE MN $,565 G Is the corporation electing to be an S corporation beginning with this tax year? Yes X No If "Yes," attach Form 2553 if not already filed H Check if: () Final return (2) Name change (3) Address change (4) Amended return (5) S election termination or revocation I Enter the number of shareholders who were shareholders during any part of the tax year... Caution. Include only trade or business income and expenses on lines a through 2. See the instructions for more information. Income a Gross receipts or sales 399,435 bless returns and allowances c Bal c 2 Cost of goods sold (Schedule A, line 8) Gross profit. Subtract line 2 from line c Net gain (loss) from Form 49, Part II, line (attach Form 49) , , Total income (loss). Add lines 3 through ,583 Compensation of officers... 24, 8 Salaries and wages (less employment credits)... 8,44 9 Repairs and maintenance... 9,224 Bad debts... 5 Other income (loss) (see instructions - attach statement)... STATEMENT # 5 Deduc- Rents... 3,888 tions 2 Taxes and licenses... ATT_STL 2,345 (see 3 Interest instructions for 5 Depletion (Do not deduct oil and gas depletion.) Depreciation not claimed on Schedule A or elsewhere on return (attach Form 4562)... 4,2 limita- 6 Advertising... 6 tions) Pension, profit-sharing, etc., plans...,33 8 Employee benefit programs Other deductions (attach statement)... STATEMENT # ,599 2 Total deductions. Add lines through ,688 2 Ordinary business income (loss). Subtract line 2 from line , a Excess net passive income or LIFO recapture tax (see instructions)... 22a b Tax from Schedule D (Form 2S)... 22b c Add lines 22a and 22b (see instructions for additional taxes)... 22c 23 a 2 estimated tax payments and 29 overpayment credited to a Tax b Tax deposited with Form b and c Credit for federal tax paid on fuels (attach Form 436)... 23c Payd Add lines 23a through 23c... 23d ments 24 Estimated tax penalty (see instructions). Check if Form 222 is attached Amount owed. If line 23d is smaller than the total of lines 22c and 24, enter amount owed Overpayment. If line 23d is larger than the total of lines 22c and 24, enter amount overpaid Enter amount from line 26 Credited to 2 estimated tax Refunded 2 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. ALEX CHERNYAVSKY For Paperwork Reduction Act Notice, see separate instructions. May the IRS discuss this return Signature of officer Date Title Print/Type preparer's name Preparer's signature Date Check if PTIN self-employed Firm's name Abercrombie Accounting Firm's EIN Firm's address Phone no. PRESIDENT with the preparer shown below (see instructions)? Yes No Nels Larsen CPA P Currell Blvd Ste 2 Woodbury MN 5525 (65)39-22 X Form 2S (2)

2 Schedule A Schedule K ROBIN CENTER CHIROPRACTIC Cost of Goods Sold (see instructions) Form 2S (2) Page 2 Inventory at beginning of year 2 Purchases 2 3 Cost of labor 3 4 Additional section 263A costs (attach statement) 4 5 Other costs (attach statement) 5 6 Total. Add lines through 5 6 Inventory at end of year 8 Cost of goods sold. Subtract line from line 6. Enter here and on page, line 2 8 9a Check all methods used for valuing closing inventory: (i) Cost as described in Regulations section.4-3 (ii) Lower of cost or market as described in Regulations section.4-4 (iii) Other (Specify method used and attach explanation.) b Check if there was a writedown of subnormal goods as described in Regulations section.4-2(c)... c Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 9)... d If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO... 9d e If property is produced or acquired for resale, do the rules of section 263A apply to the corporation?... Yes No f Was there any change in determining quantities, cost, or valuations between opening and closing inventory?... Yes No If "Yes," attach explanation. Schedule B Other Information (see instructions) Yes No Check accounting method: a X Cash b Accrual c Other (specify) 2 See the instructions and enter the: a Business activity SERVICES b Product or service CHIROPRACTIC 3 At the end of the tax year, did the corporation own, directly or indirectly, 5% or more of the voting stock of a domestic corporation? (For rules of attribution, see section 26(c).) If "Yes," attach a statement showing: (a) name and employer identification number (EIN), (b) percentage owned, and (c) if % owned, was a qualified subchapter S subsidiary election made?... X 4 Has this corporation filed, or is it required to file, Form 898, Material Advisor Disclosure Statement, to provide information on any reportable transaction?... 5 Check this box if the corporation issued publicly offered debt instruments with original issue discount... X If checked, the corporation may have to file Form 828, Information Return for Publicly Offered Original Issue Discount Instruments. 6 If the corporation: (a) was a C corporation before it elected to be an S corporation or the corporation acquired an asset with a basis determined by reference to the basis of the asset (or the basis of any other property) in the hands of a C corporation and (b) has net unrealized built-in gain in excess of the net recognized built-in gain from prior years, enter the net unrealized built-in gain reduced by net recognized built-in gain from prior years (see instructions... $ Enter the accumulated earnings and profits of the corporation at the end of the tax year. $ 8 Are the corporation's total receipts (see instructions) for the tax year and its total assets at the end of the tax year less than $25,? If "Yes," the corporation is not required to complete Schedules L and M-... X 9 During the tax year, was a qualified subchapter S subsidiary election terminated or revoked? If "Yes," see instructions... X Total amount Shareholders' Pro Rata Share Items b Qualified dividends... 5b b... 8c Type Ordinary business income (loss) (page, line 2) 2 Net rental real estate income (loss) (attach Form 8825) 2 I 3a Other gross rental income (loss) 3a n b Expenses from other rental activities (attach statement) 3b c c Other net rental income (loss). Subtract line 3b from line 3a 3c o m 4 Interest income 4 e 5 Dividends: a Ordinary dividends 5a (L o 6 Royalties 6 s Net short-term capital gain (loss) (attach Schedule D (Form 2S)) s) 8a Net long-term capital gain (loss) (attach Schedule D (Form 2S)) 8a b Collectibles (28%) gain (loss) c Unrecaptured section 25 gain (attach statement) 9 Net section 23 gain (loss) (attach Form 49) 9 Other income (loss) (see instructions) 9,895 Form 2S (2)

3 ROBIN CENTER CHIROPRACTIC Form 2S (2) Page 3 Shareholders' Pro Rata Share Items (continued) Total amount Section 9 deduction (attach Form 4562)... 2a Contributions... STATEMENT # 9 2a Deductions b Investment interest expense... 2b,339 c Section 59(e)(2) expenditures () (2) Amount 2c(2) d Other deductions (see instructions) Type 2d 3a Low-income housing credit (section 42(j)(5))... 3a Type... b Low-income housing credit (other)... 3b c Qualified rehabilitation expenditures (rental real estate) (attach Form 3468)... 3c Credits d Other rental real estate credits (see instructions)... Type 3d e Other rental credits (see instructions)... Type 3e f Alcohol and cellulosic biofuel fuels credit (attach Form 648)... 3f g Other credits (see instructions)... Type 3g 4a Name of country or U.S. possession b Gross income from all sources... 4b c Gross income sourced at shareholder level... 4c Foreign gross income sourced at corporate level d Passive category... 4d e General category... 4e f Other (attach statement)... 4f Deductions allocated and apportioned at shareholder level Foreign g Interest expense... 4g Trans- h Other... 4h actions Deductions allocated and apportioned at corporate level to foreign source income i Passive category... 4i j General category... 4j k Other (attach statement)... 4k Other information l Total foreign taxes (check one): Paid Accrued... 4l m Reduction in taxes available for credit (attach statement)... 4m n Other foreign tax information (attach statement)... 5a Post-986 depreciation adjustment... 5a (2,25) Alternative b Adjusted gain or loss... 5b Minimum c Depletion (other than oil and gas)... 5c Tax (AMT) d Oil, gas, and geothermal properties-gross income... 5d Items e Oil, gas, and geothermal properties-deductions... 5e f Other AMT items (attach statement)... 5f 6a Tax-exempt interest income... 6a Items b Other tax-exempt income... 6b Affecting c Nondeductible expenses... 6c 2,8 Shareholder d Distributions (attach statement if required) (see instructions)... 6d 34,562 Basis e Repayment of loans from shareholders... 6e a Investment income... a Other b Investment expenses... b Information c Dividend distributions paid from accumulated earnings and profits... c d Other items and amounts (attach statement) Recon- ciliation 8 Income/loss reconciliation. Combine the amounts on lines through in the far right column. From the result, subtract the sum of the amounts on lines through 2d and 4I ,556 Form 2S (2)

4 Form 2S (2) Page 4 Schedule L Balance Sheets per Books Beginning of tax year End of tax year Assets (a) (b) (c) (d) Cash... 2a Trade notes and accounts receivable... b Less allowance for bad debts... ( ) ( ) 3 Inventories... 4 U.S. government obligations... 5 Tax-exempt securities (see instructions)... 6 Other current assets (attach statement)... Loans to shareholders... 8 Mortgage and real estate loans... 9 Other investments (attach statement)... a Buildings and other depreciable assets... 8,6 8,6 b Less accumulated depreciation... ( 54,22 ) 24,38 ( 64,932 ) a Depletable assets... 3,668 b Less accumulated depletion... ( ) ( ) 2 Land (net of any amortization)... 3 a Intangible assets (amortizable only)... b Less accumulated amortization... ( ) ( ) 4 Other assets (attach statement)... 5 Total assets... 25,433,565 Liabilities and Shareholders' Equity 6 Accounts payable... Mortgages, notes, bonds payable in less than year. 3,45 8 Other current liabilities (attach statement).. STATEMENT # 22 2,69 9 Loans from shareholders... 6,86 2 Mortgages, notes, bonds payable in year or more. 2 Other liabilities (attach statement) Capital stock Additional paid-in capital Retained earnings Adjustments to shareholders' equity (attach statement) 26 Less cost of treasury stock ( ) ( ) 2 Total liabilities and shareholders' equity Schedule M- Schedule M-2 ROBIN CENTER CHIROPRACTIC ,433,565 Reconciliation of Income (Loss) per Books With Income (Loss) per Return Note: Schedule M-3 required instead of Schedule M- if total assets are $ million or more-see instructions... Net income (loss) per books 5 Income recorded on books this year not 2 Income included on Schedule K, lines, 2, 3c, 4, included on Schedule K, lines through 5a, 6,, 8a, 9, and, not recorded on books (itemize): this year (itemize): a Tax-exempt interest $ 3 Expenses recorded on books this year not 6 Deductions included on Schedule K, included on Schedule K, lines through 2 and lines through 2 and 4l, not charged 4l (itemize): against book income this year (itemize): a Depreciation $ a Depreciation $ b Travel and entertainment $ 2,8 Add lines 5 and ,8 8 Income (loss) (Schedule K, line 8). 4 Add lines through 3... Line 4 less line... Analysis of Accumulated Adjustments Account, Other Adjustments Account, and Shareholders' Undistributed Taxable Income Previously Taxed (see instructions) (a) Accumulated (b) Other adjustments (c) Shareholders' undistributed adjustments account account taxable income previously taxed... 8,469 2 Balance at beginning of tax year Ordinary income from page, line Other additions... 4 Loss from page, line 2... ( ) 5 Other reductions... STATEMENT # 3 ( 3,426 ) ( ) 6 Combine lines through ,235 Distributions other than dividend distributions. 33,235 8 Balance at end of tax year. Subtract line from line 6.,53 (2,3) (54,234) (,5) 89,556 89,556 (54,234) 9,895 Form 2S (2)

5 Final K- Amended K- OMB No Shareholder's Share of Current Year Income, 2 Part III For calendar year 2, or tax Deductions, Credits, and Other Items Department of the Treasury year beginning, 2 Ordinary business income (loss) 3 Credits Internal Revenue Service ending, 2 9,895 2 Net rental real estate income (loss) Schedule K- (Form 2S) Shareholder's Share of Income, Deductions, Credits, etc. A B Part I See page 2 of form and separate instructions. Information About the Corporation Corporation's employer identification number Corporation's name, address, city, state, and ZIP code ROBIN CENTER CHIROPRACTIC 3 4 5a Other net rental income (loss) Interest income Ordinary dividends 5b Qualified dividends 4 6 Foreign transactions 464 LAKELAND AVE NORTH ROBBINSDALE MN Royalties Net short-term capital gain (loss) C IRS Center where corporation filed return OGDEN Part II Information About the Shareholder 8a 8b Net long-term capital gain (loss) Collectibles (28%) gain (loss) D E Shareholder's identifying number Shareholder's name, address, city, state, and ZIP code ALEX CHERNYAVSKY 8c 9 Unrecaptured section 25 gain Net section 23 gain (loss) Other income (loss) 5 Alternative minimum tax (AMT) items 4324 SHORELINE DRIVE A (2,25) ROBBINSDALE MN F Shareholder's percentage of stock ownership for tax year. % F o r I R S Section 9 deduction 6 2 Other deductions Items affecting shareholder basis C 2,8 A,339 D 34,562 U s e O n l y Other information * See attached statement for additional information. For Paperwork Reduction Act Notice, see Instructions for Form 2S. Schedule K- (Form 2S) 2

6 Schedule K- (Form 2S) 2 Page 2 This list identifies the codes used on Schedule K- for all shareholders and provides summarized reporting information for shareholders who file Form 4. For detailed reporting and filing information, see the separate Shareholder's Instructions for Schedule K- and the instructions for your income tax return. Code Report on. Ordinary business income (loss). Determine whether the income (loss) is M Credit for increasing research passive or nonpassive and enter on your return as follows: activities Report on N Credit for employer social Passive loss security and Medicare taxes Form 8846, line 5 Passive income Schedule E, line 28, column (g) O Backup withholding Form 4, line 6 Nonpassive loss Schedule E, line 28, column (h) P Other credits Nonpassive income Schedule E, line 28, column (j) 4. Foreign transactions 2. Net rental real estate income (loss) A Name of country or U.S. 3. possession Other net rental income (loss) B Gross income from all sources Net income Schedule E, line 28, column (g) C Gross income sourced at Form 6, Part I Net loss shareholder level 4. Interest income Form 4, line 8a Foreign gross income sourced at corporate level 5a. Ordinary dividends Form 4, line 9a D Passive category E General category 5b. Qualified dividends Form 4, line 9b F Other Form 6, Part I 6. Royalties Schedule E, line 4 Deductions allocated and apportioned at shareholder level. Net short-term capital gain (loss) Schedule D, line 5, column (f) G Interest expense Form 6, Part I H Other Form 6, Part I 8a. Net long-term capital gain (loss) Schedule D, line 2, column (f) Deductions allocated and apportioned at corporate level to foreign source 8b. Collectibles (28%) gain (loss) 28% Rate Gain Worksheet, line 4 income (Schedule D instructions) I Passive category 8c. Unrecaptured section 25 gain J General category Form 6, Part I 9. Net section 23 gain (loss) K Other Other information. Other income (loss) L Total foreign taxes paid Form 6, Part II Code M Total foreign taxes accrued Form 6, Part II A Other portfolio income (loss) N Reduction in taxes available for B Involuntary conversions credit Form 6, line 2 C Sec. 256 contracts & straddles Form 68, line O Foreign trading gross receipts Form 883 D Mining exploration costs recapture See Pub. 535 P Extraterritorial income exclusion Form 883 E Other income (loss) Q Other foreign transactions. Section 9 deduction 5. Alternative minimum tax (AMT) items A Post-986 depreciation adjustment 2. Other deductions See the B Adjusted gain or loss A Cash contributions (5%) Shareholder's C Depletion (other than oil & gas) B Cash contributions (3%) Instructions and D Oil, gas, & geothermal - gross income C Noncash contributions (5%) the Instructions for E Oil, gas, & geothermal - deductions D Noncash contributions (3%) See the Shareholder's Form 625 F Other AMT items E Capital gain property to a 5% Instructions organization (3%) 6. Items affecting shareholder basis F Capital gain property (2%) A Tax-exempt interest income Form 4, line 8b G Contributions (%) B Other tax-exempt income H Investment interest expense Form 4952, line C Nondeductible expenses I Deductions - royalty income Schedule E, line 8 D Distributions See the Shareholder's J Section 59(e)(2) expenditures E Repayment of loans from Instructions K Deductions - portfolio (2% floor) Schedule A, line 23 shareholders L Deductions - portfolio (other) Schedule A, line 28. Other information M Preproductive period expenses A Investment income Form 4952, line 4a N Commercial revitalization deduction B Investment expenses Form 4952, line 5 from rental real estate activities See Form 8582 Instructions C Qualified rehabilitation expenditures O Reforestation expense deduction (other than rental real estate) P Domestic production activities D Basis of energy property information See Form 893 Instructions E Recapture of low-income housing Q Qualified production activities income Form 893, line b credit (section 42(j)(5)) Form 86, line 8 R Employer's Form W-2 wages Form 893, line F Recapture of low-income housing S Other deductions credit (other) Form 86, line 8 G Recapture of investment credit See Form Credits H Recapture of other credits A Low-income housing credit (section I Look-back interest - completed 42(j)(5)) from pre-28 buildings long-term contracts See Form 869 B Low-income housing credit (other) from J Look-back interest - income forecast pre-28 buildings method See Form 8866 C Low-income housing credit (section K Dispositions of property with 42(j)(5)) from post-2 buildings Form 8586, line section 9 deductions D Low-income housing credit (other) L Recapture of section 9 from post-2 buildings Form 8586, line deduction E Qualified rehabilitation M Section 453(I)(3) information expenditures (rental real estate) See the Shareholder's N Section 453A(c) information F Other rental real estate credits Instructions O Section 26(b) information G Other rental credits P Interest allocable to production See the Shareholder's H Undistributed capital gains credit Form 4, line, box a expenditures Instructions I Alcohol and cellulosic biofuel fuels Q CCF nonqualified withdrawals credit Form 648, line 8 R Depletion information - oil and gas J Work opportunity credit Form 5884, line 3 S Amortization of reforestation K Disabled access credit costs L Empowerment zone and renewal T Section 8(i) information community employment credit Form 8844, line 3 U Other information N

7 Form 4562 Department of the Treasury Internal Revenue Service (99) Name(s) shown on return Depreciation and Amortization (Including Information on Listed Property) See separate instructions. Attach to your tax return. Business or activity to which this form relates 2 ROBIN CENTER CHIROPRACTIC FORM 2S Part I Election To Expense Certain Property Under Section 9 Note: If you have any listed property, complete Part V before you complete Part I. Maximum amount (see the instructions) 2 Total cost of section 9 property placed in service (see instructions) Threshold cost of section 9 property before reduction in limitation (see instructions) Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter Dollar limitation for tax year. Subtract line 4 from line. If zero or less, enter --. If married filing separately, see instructions (a) Description of property (b) Cost (business use only) (c) Elected cost... OMB No Attachment Sequence No. Identifying number 6 Listed property. Enter the amount from line 29 8 Total elected cost of section 9 property. Add amounts in column (c), lines 6 and Tentative deduction. Enter the smaller of line 5 or line Carryover of disallowed deduction from line 3 of your 29 Form Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 2 Section 9 expense deduction. Add lines 9 and, but do not enter more than line Carryover of disallowed deduction to 2. Add lines 9 and, less line 2. 3 Note: Do not use Part II or Part III below for listed property. Instead, use Part V. Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.) 4 Special depreciation allowance for qualified property (other than listed property) placed in service during the tax year (see instructions) Property subject to section 68(f)() election Other depreciation (including ACRS)... 6 (Do not include listed property.) (See instructions.) Part III Part IV MACRS Depreciation Section A MACRS deductions for assets placed in service in tax years beginning before If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here... 9a b c d e f g h i 2a b c Section B - Assets Placed in Service During 2 Tax Year Using the General Depreciation System (a) Classification of property (b) Month and (c) Basis for depreciation year placed in (business/investment use (d) Recovery service only-see instructions) period (e) Convention (f) Method (g) Depreciation deduction 3-year property 5-year property -year property -year property 5-year property 2-year property 25-year property 25 yrs. S/L Residential rental 2.5 yrs. MM S/L property 2.5 yrs. MM S/L Nonresidential real 39 yrs. MM S/L property MM S/L Section C - Assets Placed in Service During 2 Tax Year Using the Alternative Depreciation System Class life S/L 2-year 2 yrs. S/L 4-year 4 yrs. MM S/L (See instructions.) Summary Listed property. Enter amount from line Total. Add amounts from line 2, lines 4 through, lines 9 and 2 in column (g), and line 2. Enter here and on the appropriate lines of your return. Partnerships and S corporations - see instructions For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs For Paperwork Reduction Act Notice, see separate instructions. 8,26 2,496,2 Form 4562 (2)

8 Part V Part VI ROBIN CENTER CHIROPRACTIC Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for Form 4562 (2) Page 2 24a Do you have evidence to support the business/investment use claimed? Yes No 24b If "Yes," is the evidence written? Yes No 28 Add amounts in column (h), lines 25 through 2. Enter here and on line 2, page Add amounts in column (i), line 26. Enter here and on line, page Section B - Information on Use of Vehicles 34 Was the vehicle available for personal use Yes No Yes No Yes No Yes No Yes No Yes No during off-duty hours? Was the vehicle used primarily by a more than 5% owner or related person? Is another vehicle available for personal use? Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees 3 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by Yes No your employees? Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or % or more owners Do you treat all use of vehicles by employees as personal use?... 4 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received?... 4 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.)... Note: If your answer to 3, 38, 39, 4, or 4 is "Yes," do not complete Section B for the covered vehicles. 42 entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable. Section A - Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.) (c) (e) (i) (a) (b) Business/ (d) (f) (g) (h) Basis for depreciation Elected Type of property (list Date placed investment Cost or other basis Recovery Method/ Depreciation (business/investment section 9 vehicles first) in service use period Convention deduction percentage use only) cost 25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 5% in a qualified business use (see instructions) Property used more than 5% in a qualified business use: Van 2863 % 3, 3, 5 2 DB-HY 2,496 % % 2 Property used 5% or less in a qualified business use: % S/L- % S/L- % S/L- Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. 3 Total business/investment miles driven during the year (do not include commuting miles) 3 Total commuting miles driven during the year 32 Total other personal (noncommuting) miles driven 33 Total miles driven during the year. Add lines 3 through Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions). Amortization (a) Description of costs Amortization of costs that begins during your 2 tax year (see instructions):.... (a) (b)... (c) Vehicle Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6 (b) (c) (d) (e) (f) Amortization Date amortization Amortizable amount Code section Amortization for this year period or begins percentage (d) 2,496 (e) (f) 43 Amortization of costs that began before your 2 tax year Total. Add amounts in column (f). See the instructions for where to report Form 4562 (2)

9 MINNESOTA REVENUE S Corporation Return 2 Tax year beginning --2, ending Name of corporation Federal ID number Minnesota tax ID Print or type ROBIN CENTER CHIROPRACTIC Current street address 464 LAKELAND AVE NORTH Final return (see Composite Financial Qualified Subchapter Qualified business partici- Initial instructions., pg. 4) income tax institution S Subsidiary pating in a JOBZ zone return S corporation taxes (place an X in all that apply): Round amounts to nearest whole dollar federal Schedule D taxes passive income LIFO recapture... (enclose computation) 2 Minimum fee from M8A, line 2 (see M8A instructions, pg. 9)... 2 (enclose M8A) 3 Composite income tax for nonresident shareholders... 3 (enclose Schedules KS) 4 Minnesota income tax withheld for nonresident shareholders. If you received Form AWC from a shareholder, check box:.. 4 (enclose Forms AWC) Tax 5 Add lines through and 6 Employer transit pass credit not passed through to shareholders, credits limited to the sum of lines and 2 above (enclose Schedule ETP)... 6 Subtract line 6 from line 5 8 Minnesota Nongame Wildlife Fund donation (see instructions, pg. 4). This will reduce your refund or increase your tax Add lines and Enterprise zone credit not passed through to shareholders (enclose Schedule EPC)... Job Opportunity Building Zone jobs credit not passed through to shareholders (enclose Schedule JOBZ)... 2 Credit for tuberculosis testing on cattle (see instructions, pg. 5) Estimated tax and/or extension payments made for Add lines through Tax due. If line 9 is more than line 4, subtract line 4 from line Penalty (see instructions, pg. 5)... 6 Interest (see instructions, pg. 5)... 8 Additional charge for underpayment of estimated tax (attach Schedule EST) 8 Refund 9 AMOUNT DUE. If you entered an amount on line 5, add lines 5 through 8. or Payment method: Electronic (see inst., pg. 2), or Check (attach Form PV4)... 9 amount 2 Overpayment. If line 4 is more than the sum of lines due 9 and 8, subtract line 9 and line 8 from line Former name, if changed since 29 return: City State Zip code Number of enclosed Number of Schedules KS: shareholders: ROBBINSDALE MN Place an X in all that apply: Amount of line 2 to be credited to your 2 estimated tax 2 22 REFUND. Subtract line 2 from line To have your refund direct deposited, enter the following. Otherwise, you will receive a check. Account type: Routing number Account number (use an account not assoc. with any foreign banks) Checking Savings M8 2 Signatures Signature of officer Date Daytime phone I authorize the MN Dept. of Revenue to discuss this tax return with the person below. Print name of officer address for correspondence, if desired This address belongs to: ALEX CHERNYAVSKY Employee Paid preparer Other Paid preparer's signature Date Daytime phone Preparer's PTIN Include a complete copy of federal Form 2S, Schedules K and K-, and other federal schedules Mail to: Minnesota S Corporation Income Tax, Mail Station, St. Paul, MN P434698

10 MINNESOTA REVENUE Apportionment and Minimum Fee 2 If you conducted all your business in Minnesota during the tax year, complete columns A and B. Enter B B2 B3 QSSS designated filer. on line 8. S corporation name ROBIN CENT If you're a qualified business participating in a JOBZ FEIN zone in Minnesota and all your property and payroll Minnesota tax ID are within the zone, you are exempt from the minimum fee. Enter zero on line 2 below and on line 2 A of Form M8. Total in and outside Minnesota In Minnesota In Minnesota In Minnesota M8A 2 Property ratio Payroll ratio Sales ratio... Average inventory 2 Average tangible property (at original cost) Average land owned/used (at original cost) Financial institutions only: average intangible property (see inst., pg. 8) 4 5 Capitalized rents (gross rents x 8) 5 6 Total property (add lines - 5; if Col. A is zero, see inst., pg. ).. 6 Minnesota property factor (divide each line 6B amount by line 6A; carry to five decimal places) 8 Property factor weight Weighted ratio for PROPERTY (multiply line by line 8) 9 Payroll/officer's compensation (if Col. A is zero, see inst., pg. ). Minnesota payroll factor (divide each line B amount by line A; carry to five decimal places)... 2 Payroll factor weight Weighted ratio for PAYROLL (multiply line by line 2) 3 4 Sales or receipts (if a financial institution or if Col. A is zero, see inst., pg. ) Minnesota sales factor (divide each line 4B amount by line 4A; carry to five decimal places) Sales factor weight Apportion- ment/ Minimum fee Weighted ratio for SALES (multiply line 5 by line 6) 8 APPORTIONMENT FACTOR (Add lines 9, 3 and in each column OR if you conduct all activity in Minnesota, enter. on line 8) Minimum fee calculation (read instructions, pg. 9) 9 Adjustments (see instructions, pg. 9) 9 2 Add lines 6,, 4 and Minimum fee (see table below) 2 Add line 2 amounts and enter on Form M8, line If the amount Enter this amount If the amount Enter this amount on line 2 is: on line 2: on line 2 is: on line 2: less than $5, $ $5,, to $9,999,999 $, $5, to $999,999 $ $,, to $9,999,999 $2, $,, to $4,999,999 $3 $2,, or more $5,

11 4562 For your records only. Do Not Mail to Minnesota. Depreciation and Amortization Form (Including Information on Listed Property) (Rev. /5) Note: Minnesota does not allow any additional depreciation benefits provided by I.R.C. Section 2 68(k) and 4L. Minnesota See separate instructions. Name(s) shown on return Business or activity to which this form relates Identification number ROBIN CENTER CHIROPRACTIC FORM 2S Part I Election To Expense Certain Tangible Property Under Section 9 Maximum amount. See IRS instructions for a higher limit for certain businesses 2 Total cost of IRC Section 9 property placed in service (see IRS instructions) Threshold cost of IRC Section 9 property before reduction in limitation Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter Dollar limitation for tax year. Subtract line 4 from line. If zero or less, enter --. If married filing separately, see IRS instructions a b c d e f g h i Part IV 2a b c Note: If you have any listed property, complete Part V before you complete Part I. 3-year property 5-year property -year property -year property 5-year property 2-year property 25-year property 25 yrs. S/L Residential rental 2.5 yrs. MM S/L property 2.5 yrs. MM S/L Nonresidential real 39 yrs. MM S/L property MM S/L Section C - Assets Placed in Service During 2 Tax Year Using the Alternative Depreciation System Class life S/L 2-year 2 yrs. S/L 4-year 4 yrs. MM S/L Summary... (a) Description of property (b) Cost (business use only) (c) Elected cost... Listed property. Enter the amount from line Total elected cost of IRC Section 9 property. Add amounts in column (c), lines 6 and Tentative deduction. Enter the smaller of line 5 or line Carryover of disallowed deduction from line 3 of your 29 Form Business income limitation. Enter the smaller of business income (not less than zero) or line IRC Section 9 expense deduction. Add lines 9 and, but do not enter more than line Carryover of disallowed deduction to 2. Add lines 9 and, less line Note: Do not use Part II or Part III below for listed property. Instead, use Part V. Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) 4 Special depreciation allowance for qualified property (other than listed property) placed in Not allowed for service during the tax year... 4 MINNESOTA purposes 5 Property subject to IRC Section 68(f)() election Other depreciation (including ACRS)... 6 Part III MACRS Depreciation (Do not include listed property.) Section A MACRS deductions for assets placed in service in tax years beginning before If you are electing under IRC Section 68(i)(4) to group any assets placed in service during the tax year into one or more general asset accounts, check here... Section B - Assets Placed in Service During 2 Tax Year Using the General Depreciation System (a) Classification of property (b) Month and (c) Basis for depreciation (d) Recovery (e) Convention (f) Method (g) Depreciation deduction year placed in (business/investment use period service only-see instructions)... 2 Listed property. Enter amount from line Total. Add amounts from line 2, lines 4 through, lines 9 and 2 in column (g), and line 2 Enter here and on the appropriate lines of your return For assets shown above and placed in service during the current year, enter the portion of the basis attributable to IRC Section 263A costs

12 Part VI ROBIN For CENTER your CHIROPRACTIC records only. Do not Mail to Minnesota Form 4562 (2) Page 2 Part V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable. Section A - Depreciation and Other Information (Caution: See IRS instructions for limits for passenger automobiles.) 24a Do you have evidence to support the business/investment use claimed? Yes No 24b If "Yes," is the evidence written? Yes No Add amounts in column (h), lines 25 through 2. Enter here and on line 2, page Add amounts in column (i), line 26. Enter here and on line, page Section B - Information on Use of Vehicles 34 Was the vehicle available for personal use Yes No Yes No Yes No Yes No Yes No Yes No during off-duty hours? Was the vehicle used primarily by a more than 5% owner or related person? Is another vehicle available for personal use? (a) (b) (c) (d) (e) (f) (g) (h) (i) Type of property (list Date placed in Business/ Cost or other Basis for depreciation Recovery Method/ Depreciation Elected vehicles first) service investment basis (business/investment period Convention deduction section 9 use percentage use only) cost Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 5% in a qualified business use: Property used more than 5% in a qualified business use: % % % Property used 5% or less in a qualified business use: % S/L- % S/L- % S/L- Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. 3 Total business/investment miles driven (a) (b) (c) (d) (e) (f) during the year (do not include commuting Vehicle Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6 miles Total commuting miles driven during the year Total other personal (noncommuting) miles driven Total miles driven during the year. Add lines 3 through Amortization Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons. Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See IRS instructions for vehicles used by corporate officers, directors, or % or more owners Do you treat all use of vehicles by employees as personal use? Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? Do you meet the requirements concerning qualified automobile demonstration use? Note: If your answer to 3, 38, 39, 4, or 4 is "Yes," do not complete Section B for the covered vehicles. (a) Description of costs (b) Date amortization begins Amortization of costs that begins during your 2 tax year: (c) Amortizable amount... (d) Code section 25 (e) Amortization period or percentage Not Allowed for Minnesota Purposes VAN DBHY Yes (f) Amortization for this year No Amortization of costs that began before your 2 tax year Total. Add amounts in column (f) 44