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4                                                                                                                                                                           4
5  K-1            FROM SP       Schedule of WV Partner/Shareholder/Member/Beneficiary                                                                                       5
6                                                                                                                                                                           6
   REV10-22                            Income, Loss, Modification, Credits, and Withholding                                                          2023
7                                            TAXABLE YEAR OF ORGANIZATION                                                                                                   7
8                                                                                                                                                                           8
9  BEGINNING                                          ENDING                                                                                                                9
10                           MM        DD        YYYY                                                                                       MM DD        YYYY             10
11 ORGANIZATION NAME (please type or print)           NAME OF PARTNER/SHAREHOLDER/MEMBER/BENEFICIARY                                                                      11
12                                                                                                                                                                        12
13                                                                                                                                                                        13
14 STREET or POST OFFICE BOX                          STREET or POST OFFICE BOX                                                                                           14
15                                                                                                                                                                        15
16                                                                                                                                                                        16
17 CITY                                STATE ZIP      CITY                                                                                     STATE ZIP                  17
18                                                                                                                                                                        18
19                                                                                                                                                                        19
20 WV IDENTIFICATION NUMBER            FEIN           FEIN/SSN                                                                                 WV IDENTIFICATION NUMBER   20
21                                                                                                                                                                        21
22                                                                                                                                                                        22
23 CHECK ONE:                          WITHHOLDING                                                                                                                        23
24                                                                                                                                                                        24
                                       1. Income subject to withholding  for nonresident  as reported  on 
25       S Corporation                       organization’s S Corporation,  Partnership or Fiduciary Return                                    $                        .00 25
26                                                                                                                                                                        26
                                       2.  Amount of West Virginia  tax withheld  (see instructions)
27       Limited Liability Company                                                                                                             $                        .00 27
28                                                                                                                                                                        28
                                                      PERCENTAGE OF OWNERSHIP
29       Partnership         Fiduciary                                                                                                                                  % 29
30                                                                                                                                                                        30
31                                                                                                                                                                        31
   DISTRIBUTIVE SHARE
32 INCOME                                                                                                                                                                 32
33                                                                                                                                                                        33
34 1. Distributive pro rata share of income allocable to West Virginia...........................................                        1                              .00 34
35 ADDITIONS                                                                                                                                                              35
36                                                                                                                                                                        36
   2. Interest or dividend income on federal obligations which is exempt from federal tax but 
37 subject to state tax............................................................................................................      2                              .00 37
38                                                                                                                                                                        38
   3. Interest or dividend income on state and local bonds other than bonds from West Virginia 
39 sources.............................................................................................................................. 3                              .00 39
40                                                                                                                                                                        40
   4. Interest on money borrowed  to purchase bonds  earning  income  exempt from West 
41 Virginia tax......................................................................................................................... 4                              .00 41
42                                                                                                                                                                        42
   5. Any amount not included  in federal income that was an eligible  contribution  for the 
43 Neighborhood Investment Program Tax Credit .................................................................                          5                              .00 43
44                                                                                                                                                                        44
45 6. Other Income deducted from federal adjusted gross income but subject to state tax......                                            6                              .00 45
46 SUBTRACTIONS                                                                                                                                                           46
47                                                                                                                                                                        47
   7. Interest or dividends received on United State or West Virginia obligations included in 
48 federal adjusted gross income but exempt from state tax.................................................                              7                              .00 48
49                                                                                                                                                                        49
50 8. Refunds of state and local income taxes received and reported as income to the IRS....                                             8                              .00 50
51                                                                                                                                                                        51
   9. Other income included  into federal adjusted gross income but excluded from state 
52 income tax.........................................................................................................................   9                              .00 52
53                                                                                                                                                                        53
54 10. Allowance for governmental obligations secured by residential property ........................                                   10                             .00 54
55                                                                                                                                                                        55
56                                                                                                                                                                        56
57                                                                                                                                                                        57
58                                                                                                                                                                        58
59                                                                                                                                                                        59
60                                                                                                                                                                        60
61                                                                                                                                                                        61
62                                                                                                                                                                        62
63      *B54022301W*                                                                                                                                                      63
        B54022301W
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   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980
4                                                                                                                                                     4
5                                                                                                                                                     5
6      NAME                                                                                                                        FEIN               6
7                                                                                                                                                     7
8                                                                                                                                                     8
   CREDITS ALLOCABLE TO PARTNER/SHAREHOLDER/MEMBER
9                                                                                                                                                     9
10 11. Economic Opportunity Tax Credit ...............................................................................          11            .00 10
11                                                                                                                                                    11
12 12. High Technology Manufacturing Business ..................................................................                12            .00 12
13                                                                                                                                                    13
14 13. Environmental Agricultural Equipment Tax Credit .......................................................                  13            .00 14
15                                                                                                                                                    15
16 14. WV Neighborhood Investment Program Credit ..........................................................                     14            .00 16
17                                                                                                                                                    17
18 15. Apprentice Training Tax Credit ...................................................................................       15            .00 18
19                                                                                                                                                    19
20 16. Alternative Fuel Tax Credit .........................................................................................    16            .00 20
21                                                                                                                                                    21
22 17. Historic Rehabilitated Buildings Tax Credit ................................................................             17            .00 22
23                                                                                                                                                    23
24 18. West Virginia Military Incentive Tax Credit ................................................................             18            .00 24
25                                                                                                                                                    25
26 19. Farm to Food Bank Tax Credit ...................................................................................         19            .00 26
27                                                                                                                                                    27
28 20. Post-Coal Mine Site Business Credit ........................................................................             20            .00 28
29                                                                                                                                                    29
30 21. Downstream Natural Gas Manufacturing Investment Tax Credit ..............................                                21            .00 30
31                                                                                                                                                    31
32 22. Natural Gas Liquids .................................................................................................... 22            .00 32
33                                                                                                                                                    33
34 23. Donation or Sale of Vehicle to Charitable Organizations ...........................................                      23            .00 34
35                                                                                                                                                    35
36 24. Small Arms And Ammunition Manufacturers Credit ...................................................                       24            .00 36
37                                                                                                                                                    37
38 25. WV Jumpstart Savings Program Credit for Employer contribution .............................                              25            .00 38
39                                                                                                                                                    39
40 26. Capital Investment in Child-Care Property Tax Credit .................................................                   26            .00 40
41                                                                                                                                                    41
42 27. Operating Costs of Child Care Property Tax Credit ....................................................                   27            .00 42
43                                                                                                                                                    43
44 28. Industrial Advancement Act Tax Credit  .......................................................................           28            .00 44
45                                                                                                                                                    45
46 29. West Virginia Film Industry Investment Tax Credit ....................................................                   29            .00 46
47                                                                                                                                                    47
48 30. Build WV Tax Credit  ................................................................................................    30            .00 48
49                                                                                                                                                    49
   ADDITIONAL INFORMATION
50                                                                                                                                                    50
51 _________________________________________________________________________________________                                                          51
52                                                                                                                                                    52
  ___________________________________________________________________________________________
53                                                                                                                                                    53
54 ___________________________________________________________________________________________ 54
55                                                                                                                                                    55
  ___________________________________________________________________________________________
56                                                                                                                                                    56
57 ___________________________________________________________________________________________ 57
58                                                                                                                                                    58
  ___________________________________________________________________________________________
59                                                                                                                                                    59
60                                                                                                                                                    60
61                                                                                                                                                    61
62                                                                                                                                 *B54022302W*       62
63                                                                                                                                 B54022302W         63
   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980

                          WEST VIRGINIA SCHEDULE K-1

GENERAL

The partners, members, or shareholders of any pass-through entity are liable for tax on their share of the income, whether 
or not distributed, and must include their share on the individual income tax return.

West Virginia Schedule K-1 provides a reporting mechanism for a Pass-through entity to report the distributive share of 
gains, losses, modifications and credits of owners (i.e. partners, shareholders, members, etc.) Additionally, it is the reporting 
mechanism for any withholding required to be performed on nonresident owners.

This form should be used for any owner that is not a “C” Corporation. The Schedule K-1C should be used for any owner 
that is a “C” Corporation.

WITHHOLDING

This section includes information concerning the entity reporting the information (including the name, address, identification 
number  and  type), information  concerning  the owner  to which  this information  statement relates (including  the name, 
address, and identification number) and a withholding statement.

Line 1 of this section should include the distributive share of income for a nonresident owner.

Line 2 of this section should include the amount withheld for the nonresident owner.

DISTRIBUTIVE SHARE

This section includes the owner’s distributive share of items of gain, loss, modification and credit applicable to the owner.

Line 1 of this section should include the distributive share of income for an owner regardless of source. 

Lines 2 through 10 reflect the distributive share of modifications available to the owner reported on the entity’s Schedule B.

Lines 11 through 30 reflect the distributive share of tax credits available to the owner reported on the entity’s Schedule 
PTE-100TC.

Report by Owners – The WV Schedule K-1 should be provided to all owners that are not “C” Corporations. All such owners 
must file a WV tax return that includes all WV Schedule K-1’s provided to the owner. Include your share of the partnership’s 
income or (loss), credits, deductions, etc., as shown by your Schedule K-1 on your West Virginia income tax return for the 
year in which the tax year of the entity ends.

SPECIAL RULE FOR PASS-THROUGH ENTITIES:

Pass-through entity owners of Pass-through entities should allocate income received from a pass-through entity unless 
such entities are engaged in a unitary business. If a unitary relationship exists, a pass-through entity owner of a Pass-
through entity may reapportion its WV income, including the appropriate factors of the subsidiary.

“FROM SP” CHECKED - INFORMATION ONLY K-1

When the entity listed in “Organization Name” submits the K-1 for information purposes, the entity must check the “From SP” 
box and include the “PARTNER/SHAREHOLDER/MEMBER/BENEFICIARY” on Schedule SP.