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1120S2012
U.S. Income Tax Return for an S Corporation
SignHere
PaidPreparerUse Only
Do not file this form unless the corporation has filed or is
attaching Form 2553 to elect to be an S corporation.
Information about Form 1120S and its separate instructions is at www.irs.gov/form1120s.
DA
TYPEB E
OR
PRINT F
C
G
H (1) (2) (3) (4) (5)
I
1 a 1a
b 1b
c 1c
2 2
3 3
Inc
om
e
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 131414
15 15
16 16
17 17
18 18
19 19
20 20
De
du
cti
on
s
21 21
22 a 22a
b 22b
c 22c
23 a 23a
b 23b
c 23c
d 23d
24 24
Tax
an
d P
ay
me
nts
25 25
26 26
27 Refunded 27
For Paperwork Reduction Act Notice, see separate instructions.
OMB No. 1545-0130
For calendar year 2012 or tax year beginning , 2012, ending , 20
$
Is the corporation electing to be an S corporation beginning with this tax year? Yes No If "Yes," attach Form 2553 if not already filed
Check if: Final return Name change Address change Amended return S election termination or revocation
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 1a through 21. See the instructions for more information.
Gross receipts or sales
Returns and allowances
Balance. Subtract line 1b from line 1a
Cost of goods sold (attach Form 1125-A)
Gross profit. Subtract line 2 from line 1c
Net gain (loss) from Form 4797, line 17 (attach Form 4797)
Other income (loss) (see instructions - attach statement)
Total income (loss). Add lines 3 through 5
Compensation of officers
Salaries and wages (less employment credits)
Repairs and maintenance
Bad debts
Rents
Taxes and licenses
InterestDepreciation not claimed on Form 1125-A or elsewhere on return (attach Form 4562)
Depletion (Do not deduct oil and gas depletion.)
Advertising
(se
e in
stru
ctio
ns
for
limita
tion
s)
Pension, profit-sharing, etc., plans
Employee benefit programs
Other deductions (attach statement)
Total deductions. Add lines 7 through 19
Ordinary business income (loss). Subtract line 20 from line 6
Excess net passive income or LIFO recapture tax (see instructions)
Tax from Schedule D (Form 1120S)
Add lines 22a and 22b (see instructions for additional taxes)
2012 estimated tax payments and 2011 overpayment credited to 2012
Tax deposited with Form 7004
Credit for federal tax paid on fuels (attach Form 4136)
Add lines 23a through 23c
Estimated tax penalty (see instructions). Check if Form 2220 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 2013 estimated tax
Form 1120S (2012)
Employer identification number
Form
Department of the Treasury
Internal Revenue Service
NameS election effective date
Number, street, and room or suite no. If a P.O. box, see instructions.Business activity code Date incorporatednumber (see instructions)
City or town, state, and ZIP code Total assets (see instructions)
Check if Sch. M-3attached
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to May the IRS discuss this returnthe best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on
with the preparer shown belowall information of which preparer has any knowledge.
(see instructions)? Yes No
TitleSignature of officer Date
Print/Type preparer's name Date PTINPreparer's signature Check if
self-employed
Firm's name Firm's EIN
Firm's address Phone no.
EEA
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05-21-2007 ROBIN CENTER CHIROPRACTIC 26-0214535
4064 LAKELAND AVE NORTH 05-21-2007621339
ROBBINSDALE MN 55422 44,655X
1
429,904
429,904
429,904
429,90412,00074,1825,052
29,491ATT_STL 19,818
1,96915,366
17,575
Statement #2 165,242340,69589,209
XALEX CHERNYAVSKY PRESIDENT
Laurel St John CPA 03-13-2013 P00962456Abercrombie Accounting7582 Currell Blvd Ste 211Woodbury MN 55125 (651)739-2020
Schedule B Other Information1 a b Yes No
c
2
3
4
a
b
5 a
(i)
(ii)
b
(i)
(ii)
6
7
8
9
10
a
b
11
12
13 a
b
Form 1120S (2012) Page 2
(see instructions)
Check accounting method: Cash Accrual
Other (specify)
See the instructions and enter the:
a Business activity b Product or service
At any time during the tax year, was any shareholder of the corporation a disregarded entity, a trust, an estate, or a
nominee or similar person?
At the end of the tax year, did the corporation:
Own directly 20% or more, or own, directly or indirectly, 50% or more of the total stock issued and outstanding of any
foreign or domestic corporation? For rules of constructive ownership, see instructions. If "Yes," complete (i) through (v)
below
Own directly an interest of 20% or more, or own, directly or indirectly, an interest of 50% or more in the profit, loss, or
capital in any foreign or domestic partnership (including an entity treated as a partnership) or in the beneficial interest of a
trust? For rules of constructive ownership, see instructions. If "Yes," complete (i) through (v) below
At the end of the tax year, did the corporation have any outstanding shares of restricted stock?
If "Yes," complete lines (i) and (ii) below.
Total shares of restricted stock
Total shares of non-restricted stock
At the end of the tax year, did the corporation have any outstanding stock options, warrants, or similar instruments?
If "Yes," complete lines (i) and (ii) below.
Total shares of stock outstanding at the end of the tax year
Total shares of stock outstanding if all instruments were executed
Has this corporation filed, or is it required to file, Form 8918, Material Advisor Disclosure Statement, to provide
information on any reportable transaction?
Check this box if the corporation issued publicly offered debt instruments with original issue discount
If checked, the corporation may have to file Form 8281, Information Return for Publicly Offered Original Issue Discount
Instruments.
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. $
Does the corporation satisfy both of the following conditions?
The corporation's total receipts (see instructions) for the tax year were less than $250,000
The corporation's total assets at the end of the tax year were less than $250,000
If "Yes," the corporation is not required to complete Schedules L and M-1.
During the tax year, did the corporation have any non-shareholder debt that was canceled, was forgiven, or had the
terms modified so as to reduce the principal amount of the debt?
If "Yes," enter the amount of principal reduction $
During the tax year, was a qualified subchapter S subsidiary election terminated or revoked? If "Yes," see instructions
Did the corporation make any payments in 2012 that would require it to file Form(s) 1099?
If "Yes," did the corporation file or will it file all required Forms 1099?
Form 1120S (2012)
(v)(ii) (iii) (iv)
(i)
(iv) (v)(i) (iii)
If Percentage in (iv) is 100%, Enter theEmployer Identification Number Country of Percentage of Stock
Name of Corporation Date (if any) a Qualified Subchapter S(if any) Incorporation Owned
Subsidiary Election Was Made
(ii) Employer Identification Number Country of Maximum Percentage Owned in Profit,Name of Entity Type of Entity
(if any) Organization Loss, or Capital
EEA
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ROBIN CENTER CHIROPRACTIC 26-0214535
X
SERVICES CHIROPRACTIC
X
X
X
Alt
ern
ativ
e
(AM
T)
Item
sM
inim
um
Tax
Schedule K Shareholders' Pro Rata Share Items Total amount
11 1
2 2
3a 3a
b 3b
c 3c
4 4
5 5a
5b
6 6
7 7
Inc
om
e (
Lo
ss
)
8a 8a
b 8b
c 8c
9 9
10 10
11 11
12a 12a
b 12b
c (1) (2)
Ded
uct
ion
s
12dd13a 13a
b 13b
c 13c
d 13d
e 13e
Cre
dit
s
f 13f
g 13g
14a
b 14b
c 14c
d 14d
e 14e
f 14f
g 14g
h 14h
i 14i
Fo
reig
n T
ran
sact
ion
j 14j
k 14k
l 14l
m 14m
n
15a 15a
b 15b
c 15c
d 15d
e 15e
f 15f
16a 16a
b 16b
c 16c
Ba
sis
d 16d
Sh
areh
old
er
e 16eIte
ms
Aff
ect
ing
Form 1120S (2012) Page 3
Ordinary business income (loss) (page 1, line 21)
Net rental real estate income (loss) (attach Form 8825)
Other gross rental income (loss)
Expenses from other rental activities (attach statement)
Other net rental income (loss). Subtract line 3b from line 3a
Interest income
Dividends: a Ordinary dividends
b Qualified dividends
Royalties
Net short-term capital gain (loss) (attach Schedule D (Form 1120S))
Net long-term capital gain (loss) (attach Schedule D (Form 1120S))
Collectibles (28%) gain (loss)
Unrecaptured section 1250 gain (attach statement)
Net section 1231 gain (loss) (attach Form 4797)
Other income (loss) (see instructions) Type
Section 179 deduction (attach Form 4562)
Charitable contributions
Investment interest expense
Section 59(e)(2) expenditures Type Amount
Other deductions (see instructions) Type
Low-income housing credit (section 42(j)(5))
Low-income housing credit (other)
Qualified rehabilitation expenditures (rental real estate) (attach Form 3468)
Other rental real estate credits (see instructions) Type
Other rental credits (see instructions) Type
Alcohol and cellulosic biofuel fuels credit (attach Form 6478)
Other credits (see instructions) Type
Name of country or U.S. possession
Gross income from all sources
Gross income sourced at shareholder level
Foreign gross income sourced at corporate level
Passive category
General category
Other (attach statement)
Deductions allocated and apportioned at shareholder level
Interest expense
Other
Deductions allocated and apportioned at corporate level to foreign source income
Passive category
General category
Other (attach statement)
Other information
Total foreign taxes (check one): Paid Accrued
Reduction in taxes available for credit (attach statement)
Other foreign tax information (attach statement)
Post-1986 depreciation adjustment
Adjusted gain or loss
Depletion (other than oil and gas)
Oil, gas, and geothermal properties-gross income
Oil, gas, and geothermal properties-deductions
Other AMT items (attach statement)
Tax-exempt interest income
Other tax-exempt income
Nondeductible expenses
Distributions (attach statement if required) (see instructions)
Repayment of loans from shareholders
Form 1120S (2012)
12c(2)
EEA
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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ROBIN CENTER CHIROPRACTIC 26-0214535
89,20927,504
2,168
(1,505)
3,830109,247
Schedule K
Schedule L
Total amount
17 a 17a
b 17b
c 17c
d
18
18
Balance Sheets per Books
Assets (a) (b) (c) (d)
1
2 a
b
3
4
5
6
7
8
9
10 a
b
11 a
b
12
13 a
b
14
15
Liabilities and Shareholders' Equity
16
17
18
19
20
21
22
23
24
25
26
27
Form 1120S (2012) Page 4
Shareholders' Pro Rata Share Items (continued)
Investment income
Investment expenses
Dividend distributions paid from accumulated earnings and profits
Other items and amounts (attach statement)
Income/loss reconciliation. Combine the amounts on lines 1 through 10 in the far right
column. From the result, subtract the sum of the amounts on lines 11 through 12d and 14I
Beginning of tax year End of tax year
Cash
Trade notes and accounts receivable
Less allowance for bad debts ( ) ( )
Inventories
U.S. government obligations
Tax-exempt securities (see instructions)
Other current assets (attach statement)
Loans to shareholders
Mortgage and real estate loans
Other investments (attach statement)
Buildings and other depreciable assets
Less accumulated depreciation ( ) ( )
Depletable assets
Less accumulated depletion ( ) ( )
Land (net of any amortization)
Intangible assets (amortizable only)
Less accumulated amortization ( ) ( )
Other assets (attach statement)
Total assets
Accounts payable
Other current liabilities (attach statement)
Loans from shareholders
Other liabilities (attach statement)
Capital stock
Additional paid-in capital
Retained earnings
Less cost of treasury stock ( ) ( )
Total liabilities and shareholders' equity
Form 1120S (2012)
Oth
erIn
form
atio
nR
eco
n-
cilia
tio
n
Mortgages, notes, bonds payable in less than 1 year
Mortgages, notes, bonds payable in 1 year or more
Adjustments to shareholders' equity (attach statement)
EEA
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ROBIN CENTER CHIROPRACTIC 26-0214535
114,545
(1,331) (2,094)
10,811 33,524
79,496 90,76173,002 6,494 77,536 13,225
15,974 44,655
Statement #22 15,843 Statement #22 22,785
0 21,739
31 31
100 100
15,974 44,655
Schedule M-1 Reconciliation of Income (Loss) per Books With Income (Loss) per Return
Schedule M-2
1 5
2
a
3 6
a a
b
7
4 8
Analysis of Accumulated Adjustments Account, Other Adjustments Account, and Shareholders'
1
2
3
4
5
6
7
8
Form 1120S (2012) Page 5
Note. Schedule M-3 required instead of Schedule M-1 if total assets are $10 million or more-see instructions
Net income (loss) per books
Tax-exempt interest $
Expenses recorded on books this year not Deductions included on Schedule K,
included on Schedule K, lines 1 through 12 and lines 1 through 12 and 14l , not charged
14l (itemize): against book income this year (itemize):
Depreciation $ Depreciation $
Travel and entertainment $
Add lines 5 and 6
Add lines 1 through 3
Undistributed Taxable Income Previously Taxed (see instructions)
(a) Accumulated (b) Other adjustments (c) Shareholders' undistributedadjustments account account taxable income previously taxed
Balance at beginning of tax year
Ordinary income from page 1, line 21
Other additions
Loss from page 1, line 21 ( )
Other reductions ( ) ( )
Combine lines 1 through 5
Distributions other than dividend distributions
Form 1120S (2012)
Income recorded on books this year not included
Income included on Schedule K, lines 1, 2, 3c, 4, on Schedule K, lines 1 through 10 (itemize):
5a, 6, 7, 8a, 9, and 10, not recorded on books this
year (itemize):
Income (loss) (Schedule K, line 18). Line 4 less line 7
Balance at end of tax year. Subtract line 7 from line 6
EEA
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.
.
ROBIN CENTER CHIROPRACTIC 26-0214535
110,715
3,830
3,830114,545 114,545
16389,209
Statement #29 27,504
Statement #30 5,998110,878109,247
1,631
Fo
r IR
S U
se O
nly
2012
671112
Shareholder's Share of Income, Deductions,Credits, etc.
Schedule K-1Part III(Form 1120S)
Part I Information About the Corporation
Part II Information About the Shareholder
Shareholder's Share of Current Year Income,
Deductions, Credits, and Other Items
%
* See attached statement for additional information.
1 13
2
3See page 2 of form and separate instructions.
4
A
5a
B
5b 14
6
7
C 8a
8b
8cD
9E
10 15
F
11 16
12
17
For Paperwork Reduction Act Notice, see Instructions for Form 1120S. Schedule K-1 (Form 1120S) 2012
Final K-1 Amended K-1 OMB No. 1545-0130
For calendar year 2012, or taxDepartment of the Treasury Ordinary business income (loss) Creditsyear beginning , 2012Internal Revenue Service
ending , 20
Net rental real estate income (loss)
Other net rental income (loss)
Interest income
Corporation's employer identification number
Ordinary dividends
Corporation's name, address, city, state, and ZIP code
Qualified dividends Foreign transactions
Royalties
Net short-term capital gain (loss)
IRS Center where corporation filed return Net long-term capital gain (loss)
Collectibles (28%) gain (loss)
Unrecaptured section 1250 gainShareholder's identifying number
Net section 1231 gain (loss)Shareholder's name, address, city, state, and ZIP code
Other income (loss) Alternative minimum tax (AMT) items
Shareholder's percentage of stockownership for tax year
Section 179 deduction Items affecting shareholder basis
Other deductions
Other information
IRS.gov/form1120S
EEA
. . . . . . . . . .
89,209
27,504
26-0214535
ROBIN CENTER CHIROPRACTIC
4064 LAKELAND AVE NORTH
ROBBINSDALE MN 55422
E-FILE
560-61-4710
ALEX CHERNYAVSKY
7650 28TH ST SE A (1,505)BUFFALO MN 55313
100.00000
2,168 C 3,830
D 109,247
This list identifies the codes used on Schedule K-1 for all shareholders and provides summarized reporting information for shareholders whofile Form 1040. For detailed reporting and filing information, see the separate Shareholder's Instructions for Schedule K-1 and theinstructions for your income tax return.
Page 2
1. Ordinary business income (loss). M
N
OP
14. Foreign transactions
A2. Net rental real estate income (loss)
3. Other net rental income (loss) B
C
4. Interest income
D5a. Ordinary dividendsE
5b. Qualified dividends F
6. Royalties
G7. Net short-term capital gain (loss)H
8a. Net long-term capital gain (loss)
8b. Collectibles (28%) gain (loss)
IJ8c. Unrecaptured section 1250 gainK
9. Net section 1231 gain (loss)
10. Other income (loss) LMNA
BOCPDQE
15. Alternative minimum tax (AMT) items11. Section 179 deduction
A12. Other deductions B
A CB DC ED FE
16. Items affecting shareholder basis
AFBGCHDIEJ
KL 17. Other informationM
AN
BC
OP
DE
Q
R FS
G13. Credits H
A I
B J
C K
D L
E MN
F O
G PHI Q
RJ SK
L T
U
N
Schedule K-1 (Form 1120S) 2012
Code Report on
Determine whether the income (loss) is Credit for increasing researchpassive or nonpassive and enter on your return as follows: activities
Credit for employer socialReport onSee the Shareholder's Instructionssecurity and Medicare taxesPassive loss See the Shareholder's Instructions
Backup withholdingPassive income Schedule E, line 28, column (g)Other creditsNonpassive loss Schedule E, line 28, column (h)
Nonpassive income Schedule E, line 28, column (j)
Name of country or U.S.See the Shareholder's InstructionspossessionGross income from all sources Form 1116, Part I
Net income Schedule E, line 28, column (g) Gross income sourced atNet loss See the Shareholder's Instructions shareholder level
Form 1040, line 8a Foreign gross income sourced at corporate level
Passive categoryForm 1040, line 9aGeneral category Form 1116, Part I
Form 1040, line 9b Other
Schedule E, line 4 Deductions allocated and apportioned at shareholder level
Interest expense Form 1116, Part ISchedule D, line 5Other Form 1116, Part I
Schedule D, line 12Deductions allocated and apportioned at corporate level to foreign source
28% Rate Gain Worksheet, line 4 income
(Schedule D instructions) Passive category
General categorySee the Shareholder's Instructions Form 1116, Part IOther
See the Shareholder's InstructionsOther information
Total foreign taxes paid Form 1116, Part II
Total foreign taxes accruedCode Form 1116, Part IIReduction in taxes available forOther portfolio income (loss) See the Shareholder's Instructionscredit Form 1116, line 12Involuntary conversions See the Shareholder's InstructionsForeign trading gross receipts Form 8873Sec. 1256 contracts & straddles Form 6781, line 1Extraterritorial income exclusion Form 8873Mining exploration costs recapture See Pub. 535Other foreign transactions See the Shareholder's InstructionsOther income (loss) See the Shareholder's Instructions
See the Shareholder's InstructionsPost-1986 depreciation adjustment
See theAdjusted gain or loss
Shareholder'sCash contributions (50%) Depletion (other than oil & gas)Instructions andCash contributions (30%) Oil, gas, & geothermal - gross incomethe Instructions forNoncash contributions (50%) Oil, gas, & geothermal - deductions
See the Shareholder's Form 6251Noncash contributions (30%) Other AMT itemsInstructionsCapital gain property to a 50%
organization (30%)Tax-exempt interest income Form 1040, line 8bCapital gain property (20%)Other tax-exempt incomeContributions (100%)Nondeductible expensesInvestment interest expense Form 4952, line 1
See the Shareholder'sDistributionsDeductions - royalty income Schedule E, line 19InstructionsRepayment of loans fromSection 59(e)(2) expenditures See the Shareholder's Instructions
shareholdersDeductions - portfolio (2% floor) Schedule A, line 23Deductions - portfolio (other) Schedule A, line 28Preproductive period expenses See the Shareholder's Instructions
Investment income Form 4952, line 4aCommercial revitalization deduction
Investment expenses Form 4952, line 5from rental real estate activities See Form 8582 instructions
Qualified rehabilitation expendituresReforestation expense deduction See the Shareholder's Instructions
(other than rental real estate) See the Shareholder's InstructionsDomestic production activities
Basis of energy property See the Shareholder's Instructionsinformation See Form 8903 instructions
Recapture of low-income housingQualified production activities income Form 8903, line 7b credit (section 42(j)(5)) Form 8611, line 8Employer's Form W-2 wages Form 8903, line 17 Recapture of low-income housingOther deductions See the Shareholder's Instructions credit (other) Form 8611, line 8
Recapture of investment credit See Form 4255
Recapture of other credits See the Shareholder's InstructionsLow-income housing credit (section Look-back interest - completed42(j)(5)) from pre-2008 buildings long-term contracts See Form 8697Low-income housing credit (other) from Look-back interest - income forecastpre-2008 buildings method See Form 8866Low-income housing credit (section Dispositions of property with
See the Shareholder's42(j)(5)) from post-2007 buildings section 179 deductions
InstructionsLow-income housing credit (other) Recapture of section 179from post-2007 buildings deductionQualified rehabilitation expenditures Section 453(I)(3) information(rental real estate) Section 453A(c) informationOther rental real estate credits Section 1260(b) informationOther rental credits Interest allocable to production
See the Shareholder'sUndistributed capital gains credit Form 1040, line 71, box a expenditures
InstructionsAlcohol and cellulosic biofuel fuels CCF nonqualified withdrawalscredit Depletion information - oil and gasWork opportunity credit Amortization of reforestationSee the Shareholder's Disabled access credit Instructions costsEmpowerment zone and renewal Section 108(i) informationcommunity employment credit Other information
EEA
Line 17 Line 19 Line 20a Line 21Description Type
Income/Loss 4797 Pass-thru Net
Totals
8825 K-1 Rental Real Estate Activity 2012
EIN/SSN
K1_8825~.LD
Shareholder/Partner Name Ownership percentage
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ALEX CHERNYAVSKY 100 560-61-4710
4064 LAKELAND AVE NROBBINSDALE MN 55422 4 COMMERCIAL 27,504
27,504 27,504
Depreciation and Amortization45622012(Including Information on Listed Property)
179
Part I Election To Expense Certain Property Under Section 179
Part II Special Depreciation Allowance and Other Depreciation
Part III MACRS Depreciation
Part IV Summary
See separate instructions. Attach to your tax return.
1 1
2 2
3 3
4 4
5
5
6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14
14
15 15
16 16
Section A
17 17
18
Section B - Assets Placed in Service During 2012 Tax Year Using the General Depreciation System
19a
b
c
d
e
f
g
h
i
Section C - Assets Placed in Service During 2012 Tax Year Using the Alternative Depreciation System
20a
b
c
21 21
22
22
23
23
For Paperwork Reduction Act Notice, see separate instructions.
OMB No. 1545-0172Form
AttachmentSequence No.
Note: If you have any listed property, complete Part V before you complete Part I.
Maximum amount (see instructions)
Total cost of section 179 property placed in service (see instructions)
Threshold cost of section 179 property before reduction in limitation (see instructions)
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0-
Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see instructions
Listed property. Enter the amount from line 29
Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7
Tentative deduction. Enter the smaller of line 5 or line 8
Carryover of disallowed deduction from line 13 of your 2011 Form 4562
Business income limitation. Enter the smaller of business income (not less than zero) or line 5
Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11
Carryover of disallowed deduction to 2013. Add lines 9 and 10, less line 12
Note: Do not use Part II or Part III below for listed property. Instead, use Part V.
(Do not include listed property.) (See instructions.)
Special depreciation allowance for qualified property (other than listed property) placed in service
during the tax year (see instructions)
Property subject to section 168(f)(1) election
Other depreciation (including ACRS)
(Do not include listed property.) (See instructions.)
MACRS deductions for assets placed in service in tax years beginning before 2012
If you are electing to group any assets placed in service during the tax year into one or more general
asset accounts, check here
3-year property
5-year property
7-year property
10-year property
15-year property
20-year property
25-year property 25 yrs. S/L
Residential rental 27.5 yrs. MM S/L
property 27.5 yrs. MM S/L
Nonresidential real 39 yrs. MM S/L
property MM S/L
Class life S/L
12-year 12 yrs. S/L
40-year 40 yrs. MM S/L
(See instructions.)
Listed property. Enter amount from line 28
Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. 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
Form 4562 (2012)
Identifying number
(a) (b) (c)
(b) (c)(d)
(a) (e) (f) (g)
Department of the TreasuryInternal Revenue Service (99)
Name(s) shown on return Business or activity to which this form relates
Description of property Cost (business use only) Elected cost
(see instructions)
Month and year Basis for depreciationRecoveryplaced in (business/investment useClassification of property Convention Method Depreciation deductionperiodservice only-see instructions)
EEA
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ROBIN CENTER CHIROPRACTIC FORM 1120S 26-0214535
500,00024,265
2,000,0000
500,000
COMPUTER 869 869MASSAGE CHAIRS 1,299 1,299
2,1682,168
128,7132,168
11,049
3,765
11,048 5 MQ 200 DB 552
15,366
Part V Listed Property
Part VI Amortization
24a Yes No Yes No
25
25
26
27
28 28
29 29
Section B - Information on Use of Vehicles
30
31
32
33
34 Yes No Yes No Yes No Yes No Yes No Yes No
35
36
Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees
37 Yes No
38
39
40
41
42
43 43
44 44
Form 4562 (2012) Page 2
(Include automobiles, certain other vehicles, 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 the instructions for limits for passenger automobiles.)
24b If "Yes," is the evidence written?
Special depreciation allowance for qualified listed property placed in service during
the tax year and used more than 50% in a qualified business use (see instructions)
Property used more than 50% in a qualified business use:
%
%
%
Property used 50% or less in a qualified business use:
% S/L-
% S/L-
% S/L-
Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1
Add amounts in column (i), line 26. Enter here and on line 7, page 1
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.
Total business/investment miles driven during
the year (do not include commuting miles)
Total commuting miles driven during the year
Total other personal (noncommuting)
miles driven
Total miles driven during the year. Add
lines 30 through 32
Was the vehicle available for personal
use 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?
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).
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 the instructions for vehicles used by corporate officers, directors, or 1% 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? (See instructions.)
Note: If your answer to 37, 38, 39, 40, or 41 is "Yes," do not complete Section B for the covered vehicles.
Amortization of costs that begins during your 2012 tax year (see instructions):
Amortization of costs that began before your 2012 tax year
Total. Add amounts in column (f). See the instructions for where to report
Form 4562 (2012)
(c) (e) (i)(a) (b) (d) (f) (g) (h)
(a) (b) (c) (d) (e) (f)
(e)(b) (c) (d) (f)(a)
Do you have evidence to support the business/investment use claimed?
Business/ Basis for depreciationType of property (list Date placed Cost or other basis Recovery Method/ Depreciation Elected section 179
investment use (business/investmentvehicles first) in service period Convention deduction cost
percentage use only)
Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6
AmortizationDate amortization Amortizable amount Code section Amortization for this year
period orDescription of costs beginspercentage
EEA
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ROBIN CENTER CHIROPRACTIC 26-0214535
VAN 20080630 100 13,000 13,000
Sales of Business Property47972012(Also Involuntary Conversions and Recapture Amounts
Under Sections 179 and 280F(b)(2))
27
Part I Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From Other
Part II
Than Casualty or Theft - Most Property Held More Than 1 Year (see instructions)
Ordinary Gains and Losses (see instructions)
Attach to your tax return.Information about Form 4797 and its separate instructions is at www.irs.gov/form4797.
1
1
2
3 3
4 4
5 5
6 6
7 7
8 8
9
9
10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18
a
18a
b 18b
For Paperwork Reduction Act Notice, see separate instructions.
Form
Enter the gross proceeds from sales or exchanges reported to you for 2012 on Form(s) 1099-B or 1099-S (or
substitute statement) that you are including on line 2, 10, or 20 (see instructions)
Gain, if any, from Form 4684, line 39
Section 1231 gain from installment sales from Form 6252, line 26 or 37
Section 1231 gain or (loss) from like-kind exchanges from Form 8824
Gain, if any, from line 32, from other than casualty or theft
Combine lines 2 through 6. Enter the gain or (loss) here and on the appropriate line as follows:
Partnerships (except electing large partnerships) and S corporations. Report the gain or (loss) following theinstructions for Form 1065, Schedule K, line 10, or Form 1120S, Schedule K, line 9. Skip lines 8, 9, 11, and 12 below.
Individuals, partners, S corporation shareholders, and all others. If line 7 is zero or a loss, enter the amount fromline 7 on line 11 below and skip lines 8 and 9. If line 7 is a gain and you did not have any prior year section 1231losses, or they were recaptured in an earlier year, enter the gain from line 7 as a long-term capital gain on theSchedule D filed with your return and skip lines 8, 9, 11, and 12 below.
Nonrecaptured net section 1231 losses from prior years (see instructions)
Subtract line 8 from line 7. If zero or less, enter -0-. If line 9 is zero, enter the gain from line 7 on line 12 below. If line
9 is more than zero, enter the amount from line 8 on line 12 below and enter the gain from line 9 as a long-term
capital gain on the Schedule D filed with your return (see instructions)
Ordinary gains and losses not included on lines 11 through 16 (include property held 1 year or less):
Loss, if any, from line 7 ( )
Gain, if any, from line 7 or amount from line 8, if applicable
Gain, if any, from line 31
Net gain or (loss) from Form 4684, lines 31 and 38a
Ordinary gain from installment sales from Form 6252, line 25 or 36
Ordinary gain or (loss) from like-kind exchanges from Form 8824
Combine lines 10 through 16
For all except individual returns, enter the amount from line 17 on the appropriate line of your return and skip lines a
and b below. For individual returns, complete lines a and b below:
If the loss on line 11 includes a loss from Form 4684, line 35, column (b)(ii), enter that part of the loss here. Enter the part
of the loss from income-producing property on Schedule A (Form 1040), line 28, and the part of the loss from property
used as an employee on Schedule A (Form 1040), line 23. Identify as from "Form 4797, line 18a." See instructions
Redetermine the gain or (loss) on line 17 excluding the loss, if any, on line 18a. Enter here and on Form 1040, line 14
Form 4797 (2012)
Identifying number
(e) (f)(a) (b) (c) (d) (g) Gain or (loss)
OMB No. 1545-0184
Department of the Treasury AttachmentInternal Revenue Service (99) Sequence No.
Name(s) shown on return
Depreciation Cost or otherDescription Date acquired Date sold Gross allowed or basis, plus
allowable since improvements and Subtract (f) from theof property sales price(yr., mo., day) (yr., mo., day)acquisition expense of sale sum of (d) and (e)
EEA
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ROBIN CENTER CHIROPRACTIC 26-0214535
VAN 2008063020121108 13,000 13,000
A
B
C
D
A B C D
8825 Rental Real Estate Income and Expenses of aPartnership or an S Corporation
Properties
( )
See instructions.Attach to Form 1065, Form 1065-B, or Form 1120S.
1
Rental Real Estate Income
2 2
Rental Real Estate Expenses
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15
15
16
16
17
17
18 a 18a
b 18b
19
19
20 a
20a
b
21 21
For Paperwork Reduction Act Notice, see instructions.
OMB No. 1545-1186
Show the type and address of each property. For each rental real estate property listed, report the number of days rented at fair
rental value and days with personal use. See instructions. See page 2 to list additional properties.
Physical address of each property - street, city, Type - Enter code 1-8;Fair Rental Days Personal Use Days
state, ZIP code see page 2 for list
Gross rents
Advertising
Auto and travel
Cleaning and maintenance
Commissions
Insurance
Legal and other professional fees
Interest
Repairs
Taxes
Utilities
Wages and salaries
Depreciation (see instructions)
Other (list)
Total expenses for each property.
Add lines 3 through 15
Income or (Loss) from each
property. Subtract line 16 from line 2
Total gross rents. Add gross rents from line 2, columns A through H
Total expenses. Add total expenses from line 16, columns A through H
Net gain (loss) from Form 4797, Part II, line 17, from the disposition of property from rental real
estate activities
Net income (loss) from rental real estate activities from partnerships, estates, and trusts in which
this partnership or S corporation is a partner or beneficiary (from Schedule K-1)
Identify below the partnerships, estates, or trusts from which net income (loss) is shown on line 20a.
Attach a schedule if more space is needed:
(1) Name (2) Employer identification number
Net rental estate income (loss). Combine lines 18a through 20a. Enter the result here and on:
Form 1065 or 1120S: Schedule K, line 2, or
Form 1065-B: Part I, line 4
Form 8825 (12-2010)
Employer identification number
Form
(Rev. December 2010)
Department of the Treasury
Internal Revenue Service
Name
EEA
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ROBIN CENTER CHIROPRACTIC 26-0214535
4064 LAKELAND AVE NROBBINSDALE MN 55422
4COMMERCIAL
365
27,504
27,50427,504
27,504
2012Taxes and Licenses Attachment
Taxes and Licenses Form 1120S Page 1, Line 12
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
Note: This information does not transmit to the IRS with e-filed returns.
Including with a paper filed return is optional.
State income taxes
State franchise taxes
City income taxes
City franchise taxes
Local property taxes
Intangible property taxes
Payroll taxes
Less: credit from Form 8846
Foreign taxes paid
Occupancy taxes
Other miscellaneous taxes
Built in gains tax allocated to ordinary income
Licenses
Total to Form 1120S, Page 1, Line 12
S CORPORATION NAME EIN
ATT_STL.LD
ROBIN CENTER CHIROPRACTIC 26-0214535
10,848
8,970
19,818
Federal Supporting Statements 2012Name(s) as shown on return FEIN
STATMENT.LD
FORM 1120S LINE 19
PG01
ROBIN CENTER CHIROPRACTIC 26-0214535
Statement #2
DESCRIPTION AMOUNTACCOUNTING 7,508AUTOMOBILE AND TRUCK EXPENSE 6,532BANK CHARGES 1,792DUES AND SUBSCRIPTIONS 373EDUCATION AND TRAINING 1,541EQUIPMENT RENTAL/LEASE 16,828INSURANCE 6,14850% MEALS AND ENTERTAINMENT 3,831OFFICE EXPENSE 9,245OUTSIDE SERVICES/SUB CONTRACTORS 29,928POSTAGE/SHIPPING 1,175SUPPLIES 11,554TELEPHONE 6,417TRAVEL 968UNIFORMS 2,809UTILITIES 7,428BILLING SERVICE 50,803CREDIT CARD FEES 291STORAGE EXPENSE 71______________
____________________________TOTAL 165,242
STM22PG01
FORM 1120S, SCHEDULE L, LINE 18 OTHER CURRENT LIABILITIES
DESCRIPTION BEG OF YEAR END OF YEARUS BANK CC 3199 10,834 14,434AMEX CC 71008 1,930 6,840FEDERAL PAYROLL TAX 2,152 1,058STATE PAYROLL TAX 357 219MN CARE TAX 570 234___________ ___________
TOTAL 15,843 22,785___________ ______________________ ___________
Federal Supporting Statements 2012Name(s) as shown on return FEIN
STATMENT.LD
SCHEDULE M-2 LINE 3
PG01
ROBIN CENTER CHIROPRACTIC 26-0214535
Statement #29
DESCRIPTION AMOUNTNET RENTAL REAL ESTATE INCOME 27,504______________
____________________________TOTAL 27,504
SCHEDULE M-2 LINE 5PG01
Statement #30
DESCRIPTION AMOUNTALLOWED SECTION 179 EXPENSE 2,168NONDEDUCTIBLE EXPENSES 3,830______________
____________________________TOTAL 5,998
S Corporation Return 2012MINNESOTA REVENUE
2012 M8
ID 1121
or
Type
Round amounts to nearest whole dollar1
1
2 2
33
44
Tax 5 56and
6Credits
7 7
88
9 910
10
1111
12 12
13 13
1414
15 15
16 16
17 17
18 18
19Refund
or 19
Amount 20
Due 20
21 21
22 22
23
Signa-tures
Include a complete copy of federal Form 1120S, Schedules K and K-1, and other federal schedules
Tax year beginning , 2012, ending
Name of corporation Federal ID number Minnesota tax ID
Current street address Check if new address Former name, if changed since 2011 return:
City State Zip code Number of enclosed Number ofSchedules KS: shareholders:
S corporation taxes (place an X in all that apply):
federal Schedule D taxes passive income
LIFO recapture (enclose computation)
Minimum fee from M8A, line 21 (see M8A instructions, pg. 9) (enclose M8A)
Composite income tax for nonresident shareholders (enclose Schedules KS)
Minnesota income tax withheld for nonresident shareholders.(enclose Forms AWC)If you received Form AWC from a shareholder, check box:
Add lines 1 through 4Employer Transit Pass Credit not passed through to shareholders,
limited to the sum of lines 1 and 2 above (enclose Schedule ETP)
Subtract line 6 from line 5
Minnesota Nongame Wildlife Fund donation (see instructions, pg. 4).This will reduce your refund or increase your tax
Add lines 7 and 8
Enterprise Zone Credit not passed throughto shareholders (enclose Schedule EPC)
Job Opportunity Building Zone Jobs Credit not passedthrough to shareholders (enclose Schedule JOBZ)
Credit for tuberculosis testing on cattle (see instructions, pg. 5)
Estimated tax and/or extension payments made for 2012
Add lines 10 through 13
Tax due. If line 9 is more than line 14, subtract line 14 from line 9
Penalty (see instructions, pg. 5)
Interest (see instructions, pg. 5)
Additional charge for underpayment of estimated tax (attach Schedule EST)
AMOUNT DUE. If you entered an amount on line 15, add lines 15 through 18.
Payment method: Electronic (see inst., pg. 2), or Check (attach Form PV40)Overpayment. If line 14 is more than the sum of lines
9 and 18, subtract line 9 and line 18 from line 14
Amount of line 20 to be credited to your 2013 estimated tax
REFUND. Subtract line 21 from line 20
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
Mail to: Minnesota S Corporation Income Tax, Mail Station 1770, St. Paul, MN 55145-1770
Place an X in
all that apply:Initial Composite Financial Qualified Subchapter Qualified business partici- Out of business (see
return income tax institution S Subsidiary pating in a JOBZ zone instructions, pg. 4)
Signature of officer Date Daytime phone I authorize the MN Dept. ofRevenue to discuss this taxreturn with the person below.
This email address belongs to:Print name of officer Email address for correspondence, if desiredEmployee Paid preparer Other
Paid preparer's signature Date Daytime phone Preparer's PTIN
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01-01-2012 12-31-2012
ROBIN CENTER CHIROPRACTIC 26-0214535 8919549
4064 LAKELAND AVE NORTH
ROBBINSDALE MN 55422 1 1
0
100
100
100
100
0
10000
0
100X
0
00
X03-13-2013 763-746-1244
ALEX CHERNYAVSKY
03-13-2013 651-739-2020 P00962456
2012 M8AApportionment and Minimum Fee 2012
ID 1121
MINNESOTA REVENUE
B B B
A
Place an X in the box if you conduct all activity
in Minnesota, and enter 1.00000 on line 18.
1 1
2
2
3
3
44
5 5
6
6
7
7
8 8
9 9
1010
11
11
12 12
13 13
14
14
1515
1616
171718 APPORTIONMENT FACTOR
18
1919
2020
2121
Add line 21 amounts and enter on Form M8, line 2.
If the amount Enter this amount If the amount Enter this amount
on line 20 is: on line 21: on line 20 is: on line 21:
S corporation nameIf you're a qualified business participating in a JOBZ FEINzone in Minnesota and all your property and payroll Minnesota tax IDare within the zone, you are exempt from the mini-mum fee. Enter zero on line 21 below and on line 2of Form M8.
Average inventory
Average tangible property
(at original cost)
Average land owned/used
(at original cost)
Financial institutions only: averageintangible property (see inst., pg. 8)
Capitalized rents (gross rents x 8)
Total property (add lines 1 - 5;
if Col. A is zero, see inst., pg. 7)
Minnesota property factor (divide each
line 6B amount by line 6A; carry to five decimal places)
Property factor weight 0.035 0.035 0.035
Weighted ratio for PROPERTY (multiply line 7 by line 8)
Payroll/officer's compensation(if Col. A is zero, see inst., pg. 7)
Minnesota payroll factor (divide each
line 10B amount by line 10A; carry to five decimal places)
Payroll factor weight 0.035 0.035 0.035
Weighted ratio for PAYROLL (multiply line 11 by line 12)
Sales or receipts (if a financialinstitution or if Col. A is zero,see inst., pg. 7)
Minnesota sales factor (divide each
line 14B amount by line 14A; carry to five decimal places)
Sales factor weight 0.93 0.93 0.93
Weighted ratio for SALES (multiply line 15 by line 16)
(Add lines 9, 13 and 17 in each column OR if you conduct all
activity in Minnesota, enter 1.00000 on line 18)
Minimum fee calculation (read instructions, pg. 9)
Adjustments (see instructions, pg. 9)
Add lines 6, 10, 14 and 19
Minimum fee (see table below)
less than $500,000 $0 $5,000,000 to $9,999,999 $1,000
$500,000 to $999,999 $100 $10,000,000 to $19,999,999 $2,000
$1,000,000 to $4,999,999 $300 $20,000,000 or more $5,000
1 2 3
Total In andOutside Minnesota In Minnesota In Minnesota In Minnesota
Property
Ratio
Payroll
Ratio
Sales
Ratio
Apportion-
ment/
Minimum
Fee
QSSS designated filer
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X
ROBIN CENT26-02145358919549
0 0
85129 85129
0 0
00
370552 370552
455681 455681
1.00000
0.03500
86182 86182
1.00000
0.03500
457408 457408
1.00000
0.93000
1.00000
0
999271
100
MINNESOTA REVENUE
Shareholder's Share of Income, Credits and Modifications 2012
MNKS_SUM
Modifications to Federal Taxable Income
1 1
2 2
3
3
4
4
5 5
6
6
A 7l
7l8 8
sh 9a
9re 10 10ho 11 11l
12 12de 13 13rs 14 14
15 15
16 16
Relating to Alternative Minimum Tax
17 17
18 18
19 19
20 20
Minnesota Portion of Amounts From Federal Schedule K-1 (1120S)
21 21
22
N 22o 23n
23re 24 24s
25 25id 26 26e
27 27nt 28 28
29 29s
30ha 30r
31 31eh 32 32o
Composite Income Tax or Nonresident Withholdingld 33 33e 34r
34s35
35
Calculate lines 1-17 the same for all resident and nonresident shareholders. Calculate
lines 18-32 for nonresident shareholders only. Round amounts to the nearest whole dollar.
Interest income from non-Minnesota state and municipal bonds
State income tax deducted in arriving at ordinary or net rental income
Expenses deducted that are attributable to income not taxed by Minne-
sota (other than interest or mutual fund dividends from U.S. bonds)
If the S corporation elected section 179 expensing, enter the share-
holder's flow-through section 179 expensing for Minnesota purposes
100% of shareholder's pro rata share of federal bonus depreciation
Federal tax-exempt subsidies paid to employers for providing
prescription drug coverage for their retirees
Fines, fees and penalties deducted federally
as a trade or business expense
Addition due to federal changes not adopted by Minnesota
Interest from U.S. government bond obligations, minus any expenses
deducted on the federal return that are attributable to this income
JOBZ business and investment income exemptions
Subtraction due to federal changes not adopted by Minnesota
Employer transit pass credit
Enterprise zone credit
Credit for increasing research activities
Credit for historic structure rehabilitation & NPS project number:
Jobs credit for participating in a JOBZ zone
Intangible drilling costs
Gross income from oil, gas and geothermal properties
Deductions allocable to oil, gas and geothermal properties
Depletion
Minnesota source gross income
Ordinary Minnesota source income (loss)
from trade or business activities
Income (loss) from Minnesota rental real estate
and other Minnesota rental activities
Interest income
Ordinary dividends
Royalties
Net Minnesota short-term capital gain (loss)
Net Minnesota long-term capital gain (loss)
Section 1231 Minnesota net gain (loss)
Other Minnesota income (loss). (Describe type of income
or include separate sheet: )
Section 179 expense deduction apportionable to Minnesota ( )
S Corporation's MN apportionment factor (line 18 of M8A)
Minnesota source distributive income
Minnesota composite income tax paid by S corporation. If the
shareholder elected composite income tax
Minnesota income tax withheld for nonresident shareholder
not electing to file composite income tax. If the shareholder
completed and signed a Form AWC
1121
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ROBIN CENTER CHIROPRACTIC 26-0214535
11049
2012Minnesota KS Worksheet
Line 5(Keep for your records)
If you chose on your federal return the special depreciation allowance for certain qualified property, your shareholders must add back 80
percent of the bonus depreciation to Minnesota.
Follow the steps below to determine the shareholder's share of the amount that is required to be added back to Minnesota:
1 Add line 14 and line 25 of your federal Form 4562
2 Total of any bonus depreciation amounts passed through to the S corporation as a partner of a
partnership (from line 8 of Schedule KPC)
3 Add steps 1 and 2
4 Multiply step 3 by the shareholder's percentage of stock ownership
Enter the result from step 4 on line 5 of the shareholder's Schedule KS.
Shareholder's Name SSN
EIN
MNKS_BON.LD
Name of Corporation
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ALEX CHERNYAVSKY 560-61-4710
ROBIN CENTER CHIROPRACTIC 26-0214535
11049
11049
11049
45622012
Minnesota
Depreciation and AmortizationFor your records only. Do Not Mail to Minnesota.
Part I Election To Expense Certain Tangible Property Under Section 179
Part II Special Depreciation Allowance and Other Depreciation
Part III MACRS Depreciation
Part IV
Summary
1 1
2 2
3 3
4 4
5
5
6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 Not allowed for
14 MINNESOTA purposes
15 15
16 16
Section A
17 17
18
Section B - Assets Placed in Service During 2012 Tax Year Using the General Depreciation System
19a
b
c
d
e
f
g
h
i
Section C - Assets Placed in Service During 2012 Tax Year Using the Alternative Depreciation System
20a
b
c
21 21
22
22
23
23
Form(Including Information on Listed Property)
(Rev. 11/05)
See separate instructions.
Note: If you have any listed property, complete Part V before you complete Part I.
Maximum amount. See IRS instructions for a higher limit for certain businesses
Total cost of IRC Section 179 property placed in service (see IRS instructions)
Threshold cost of IRC Section 179 property before reduction in limitation
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0-
Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing
separately, see IRS instructions
Listed property. Enter the amount from line 29.
Total elected cost of IRC Section 179 property. Add amounts in column (c), lines 6 and 7
Tentative deduction. Enter the smaller of line 5 or line 8
Carryover of disallowed deduction from line 13 of your 2011 Form 4562
Business income limitation. Enter the smaller of business income (not less than zero) or line 5
IRC Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11
Carryover of disallowed deduction to 2013. Add lines 9 and 10, less line 12
Note: Do not use Part II or Part III below for listed property. Instead, use Part V.
(Do not include listed property.)
Special depreciation allowance for qualified property (other than listed property) placed in
service during the tax year
Property subject to IRC Section 168(f)(1) election
Other depreciation (including ACRS)
(Do not include listed property.)
MACRS deductions for assets placed in service in tax years beginning before 2012
If you are electing under IRC Section 168(i)(4) to group any assets placed in service during
the tax year into one or more general asset accounts, check here
3-year property
5-year property
7-year property
10-year property
15-year property
20-year property
25-year property 25 yrs. S/L
Residential rental 27.5 yrs. MM S/L
property 27.5 yrs. MM S/L
Nonresidential real 39 yrs. MM S/L
property MM S/L
Class life S/L
12-year 12 yrs. S/L
40-year 40 yrs. MM S/L
Listed property. Enter amount from line 28
Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21
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
(a) (b) (c) (d) (e) (f)
Note: Minnesota does not allow any additional depreciation benefits provided by I.R.C. Section
168(k) and 1400L.
Name(s) shown on return Business or activity to which this form relates Identification number
(a) Description of property (b) Cost (business use only) (c) Elected cost
Classification of property Month and Basis for depreciation Recovery Convention Method (g) Depreciation deductionyear placed in (business/investment use period
service only-see instructions)
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ROBIN CENTER CHIROPRACTIC FORM 1120S 26-0214535
2500024265
2000000
25000
COMPUTER 869 869MASSAGE CHAIRS 1299 1299
21682168
250002168
1770
22097 5 MQ 200 DB 1105
2875
For your records only. Do not Mail to Minnesota.Part V Listed Property
Part VI Amortization
24a Yes No Yes No
25
25
26
27
28 28
29 29
Section B - Information on Use of Vehicles
30
31
32
33
34 Yes No Yes No Yes No Yes No Yes No Yes No
35
36
Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees
Yes No
37
38
39
40
41
42
43 43
44 44
Form 4562 (2012) Page 2
(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.)
24b If "Yes," is the evidence written?
Special depreciation allowance for qualified listed property placed in service during the tax
year and used more than 50% in a qualified business use:
Property used more than 50% in a qualified business use:
%
%
%
Property used 50% or less in a qualified business use:
% S/L-
% S/L-
% S/L-
Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1
Add amounts in column (i), line 26. Enter here and on line 7, page 1
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.
Total business/investment miles driven
during the year (do not include commuting
miles
Total commuting miles driven during the year
Total other personal (noncommuting)
miles driven
Total miles driven during the year.
Add lines 30 through 32
Was the vehicle available for personal use
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?
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 1% 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 37, 38, 39, 40, or 41 is "Yes," do not complete Section B for the covered vehicles.
Amortization of costs that begins during your 2012 tax year:
Amortization of costs that began before your 2012 tax year
Total. Add amounts in column (f)
(a) (b) (c) (d) (e) (f) (g) (h) (i)
Not Allowed for
Minnesota Purposes
(a) (b) (c) (d) (e) (f)
(a) (b) (c) (d) (e) (f)AmortizationDescription of costs Date amortization Amortizable Code Amortization for
period orbegins amount section this yearpercentage
Do you have evidence to support the business/investment use claimed?
Business/Type of property (list Date placed in Cost or other Basis for depreciation Recovery Method/ Depreciation Electedinvestmentvehicles first) service basis (business/investment period Convention deduction section 179
useuse only) costpercentage
Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6
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ROBIN CENTER CHIROPRACTIC 26-0214535
VAN 20080630100 13000 13000 5 200DBHY
MINNESOTA REVENUE
Shareholder's Share of Income, Credits and Modifications 2012
ID 1121
2012 KS
Amended KS:
or
Type
Form M1 filers,
Modifications to Federal Taxable Income include on:
1 1
2 2
3
3
4
4
5 5
6
6Al 7l
7sh 8 8ar
9eh 9ol 10 10de
11 11rs
12 12
13 13
14 14
15
15
16 16
Relating to Alternative Minimum Tax
1717
1818
1919
20 20
S corporation: Complete and provide Schedule KS to each nonresident shareholder and Minnesota shareholder who has
adjustments to income.
Individual Estate Shareholder's percentage ofEntity of shareholderTrust Exempt Organization stock ownership for tax year: %(place an X in one box):
Calculate lines 1-20 the same for all resident and nonresident shareholders. Calculate
lines 21-35 for nonresident shareholders only. Round amounts to the nearest whole dollar.
Interest income from non-Minnesota state and municipal bonds M1M, line 4
State income tax deducted in arriving at ordinary or net rental income M1M, line 8Expenses deducted that are attributable to income not taxed by Minne-
sota (other than interest or mutual fund dividends from U.S. bonds) M1M, line 10If the S corporation elected section 179 expensing, enter the share-
holder's flow-through section 179 expensing for Minnesota purposes M1M, see line 7 inst.
100% of shareholder's pro rata share of federal bonus depreciation M1M, see line 6 inst.Federal tax-exempt subsidies paid to employers for providing
prescription drug coverage for their retirees M1M, line 11Fines, fees and penalties deducted federally
as a trade or business expense M1M, line 12
Addition due to federal changes not adopted by Minnesota M1M, line 16
Interest from U.S. government bond obligations, minus any expensesdeducted on the federal return that are attributable to this income M1M, line 18
JOBZ business and investment income exemptions M1M, line 32
Subtraction due to federal changes not adopted by Minnesota M1M, line 37
Employer Transit Pass Credit M1C, line 4
Enterprise Zone Credit M1B, line 6
Credit for increasing research activities M1B, line 1
Credit for historic structure rehabilita-
tion and enter NPS project number: M1B, line 3
Jobs Credit for participating in a JOBZ zone M1B, line 4
Intangible drilling costs Lines 17-20 are usedto compute M1MT,
Gross income from oil, gas and geothermal propertieslines 6 and 7. See
Deductions allocable to oil, gas and geothermal properties M1MT instructions fordetails.
Depletion
Continued next page
, 2012 and endingTax year beginningS corporation's federal ID number S corporation's Minnesota tax IDShareholder's federal ID or Social Security number
S corporation's name JOBZ ID number, if anyShareholder's name
AddressAddress
State Zip code City State Zip codeCity
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560-61-4710 260214535 8919549
ALEX CHERNYAVSKY ROBIN CENTER CHIROP
4064 LAKELAND AVE NORTH7650 28TH ST SE
BUFFALO MN 55313 ROBBINSDALE MN 55422X
100.00
11049
MINNESOTA REVENUE
ID 1121
2012 KS P2
Shareholder's Share of Income, Credits and Modifications 2012 (continued)
Minnesota Portion of Amounts From Federal Schedule K-1 (1120S)
21 21
22
22
23
23No 24 24nr
25 25es
26 26id
27e 27nt
28 28
S29 29h
a 30r
30eho 31 31ld 32 32er
Composite Income Tax or Nonresident Withholdings
33 33
3434
35
35
S corporations: Include this schedule and copies of federal Schedules K and K-1 when you file your Form M8.
Shareholders: Include this schedule when you file your Minnesota Form M1.
Minnesota source gross income information (see inst.)Ordinary Minnesota source income (loss)
from trade or business activities M1NR, line 6, col BIncome (loss) from Minnesota rental real estate
and other Minnesota rental activities M1NR, line 6, col B
Interest income M1NR, line 2, col B
Ordinary dividends M1NR, line 2, col B
Royalties M1NR, line 6, col B
Net Minnesota short-term capital gain (loss)M1NR, line 4, col B
Net Minnesota long-term capital gain (loss) M1NR, line 4, col B
Section 1231 Minnesota net gain (loss) M1NR, line 4 or 8, col BOther Minnesota income (loss). (Describe type of income
or include separate sheet: ) M1NR, line 8, col B
Section 179 expense deduction apportionable to Minnesota M1NR inst, line 6, col B
S corporation's Minnesota apportionment factor (line 18 of M8A) information only
If an amount is on line 35below, include line 33 onM1W, line 7, col. B.Minnesota source distributive income (see instructions)
Minnesota composite income tax paid by S corporation. If theshareholder elected composite income tax, mark an X in this box: composite income taxMinnesota income tax withheld for nonresident shareholdernot electing to file composite income tax. If the shareholder
completed and signed a Form AWC, mark an X in this box: M1W, line 7, col C
Shareholder's name Shareholder's Social Security number
S corporation's name S corporation's federal ID number S corporation's Minnesota ID number
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ALEX CHERNYAVSKY 560-61-4710
ROBIN CENTER CHIROPRACTIC 26-0214535 8919549