Michigan Department of Treasury                                                                                                                                         Attachment 3 
4894 (Rev. 03-22), Page 1 of 3 

2022 MICHIGAN Corporate Income Tax Schedule of Shareholders and Officers 
For all Corporations claiming the Small Business Alternative Credit 
Issued under authority of Public Act 38 of 2011. 
Taxpayer Name (If Unitary Business Group, Name of Designated Member)                                      Taxpayer or DM Federal Employer Identification Number (FEIN) 

Unitary Business Groups Only:  Name of Unitary Business Group Member Reporting on This Form               Member Federal Employer Identification Number (FEIN) 

PART 1:  QUALIFYING DATA           FOR THE            SMALL                  BUSINESS      ALTERNATIVE                            CREDIT         .  
Complete Part 2 and Part 3 before completing Part 1. See instructions for definition of active shareholder. 
1.  Compensation and director fees of active shareholders. Add amounts in Part 2, column L, for each active 
      shareholder. Enter here and on Form 4893, line 7 ................................................................................................. 1.                          00 
2.    Compensation and director fees of officers. Add amounts in Part 2, column L, for each officer who is not an 
      active shareholder. Enter here and on Form 4893, line 8.......................................................................................     2.                          00 

PART 2:   SHAREHOLDERS AND OFFICERS.  See instructions. 
3.  A                           B                                                          C              D                       E                         F           G 
                                                                                                          Enter                                                         % Stock from Col. F 
            Name of shareholder (including corporation, trust, partnership,                               (X) if                                                        less any attribution 
Identifying or family member who is a shareholder through attribution) or officer          FEIN or        an                      % Stock                % Stock with   between two active 
Number                          (Last, First, Middle)                              Social Security Number officer                 directly owned         attribution    shareholders 
                                                                                                                                                 %                    %              % 
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Percent of stock (not listed above) owned by shareholders (including through attribution)  ......................................                % 
who own less than 10% and receive no compensation or directors’ fees                                                              100            % 
                                                                                                          Total: 

+  0000 2022 18 01 27 7                                                                                                                                               Continue on Page 2 

2022 Form 4894, Page 2 of 3                                                 Taxpayer or DM FEIN 
                                                                            UBG Member FEIN 

PART 2:   SHAREHOLDERS AND OFFICERS — Continued 
3.  H       I                    J                 K                      L                              M                    N 
            Dividends                                                    Total compensation and director 
Identifying (used to determine   Salaries, wages   Employee insurance    fees for officers and/or share- Share of modified    Total shareholder/officer 
Number      active shareholders) and director fees plans, pensions, etc. holders.  Add columns J and K.  business income/loss income. Add columns L and M. 

If more space is needed to complete Part 2, include additional copies of Form 4894. Repeat the taxpayer name and FEIN at the top of every copy of 
page 1, and carry over the FEIN to the top of page 2. (See instructions.) 

IMPORTANT NOTE ON COMPLETING THIS FORM: If filing this form for a short-period return, or if reporting a part-year shareholder or officer: 
  •  Compensation, director fees, and dividends of each individual must be entered on this form as the actual amount received during the period. 
  • For purposes of determining the credit disqualifiers, compensation and director fees must be annualized. 
  •  For purposes of determining active shareholders, compensation, director fees, and dividends must be annualized. 

+  0000 2022 18 02 27 5                                                                                                       Continue on Page 3 

2022 Form 4894, Page 3 of 3 
                                                                                                         Taxpayer or DM FEIN 
                                                                                                                UBG Member FEIN 

PART 3:   LIST OF FAMILY MEMBERS AND THEIR CORRESPONDING RELATIONSHIPS 
Part          3 is used      to report  attributable  family relationships  between  individual  shareholders.  An  attributable  family  relationship        is defined  as  either   a   
spouse, parent, child, or grandchild. In Part 3, column O, list each individual shareholder from Part 2, using the same Identifying Number references 
from Part 2, column A. For each shareholder listed in column O: 
  •  If an attributable family relationship exists with another shareholder, report that other shareholder’s Identifying Number in the appropriate column, 
P through S. 
  •  If no attributable family relationship exists between the shareholder in column O and any other shareholder, enter “X” in column T. 
4.  O                           P                              Q                                   R                                      S                               T 
                                                                                                                                                                 Enter (X) if 
Identifying                                                                                                                                                      No Attributable 
Number                          Spouse                         Parent                              Child                            Grandchild                   Relationship 

If more space is needed to complete Part 3, include additional copies of Form 4894. Repeat the taxpayer name and FEIN at the top of every copy of 
page 1, and carry over the FEIN to the top of page 3. (See instructions.) 

+  0000 2022 18 03 27 3 

                                                                                Instructions for Form 4894  
                     Corporate Income Tax (CIT) Schedule of Shareholders and Officers 
                                      For all Corporations claiming the Small Business Alternative Credit  
Purpose                                                                                                            Tax Years Less Than 12 Months 
                                                                                                                          If the  reported       tax  year      is less  than  12  months, shareholders’                     
To      determine  eligibility of                  corporations            to qualify    for the                  
                                                                                                                   and officers’       allocated         income     must          be annualized      to determine  
Small Business               Alternative            Credit      (SBAC).         This form must be                                                                                                                                
                                                                                                                   eligibility  and reduction               percentage.          Where     those       same                 
included when filing                         CIT Small Business Alternative Credit 
                                                                                                                   amounts           are  reported on       SBAC       forms,      they    are     reported       on         
(Form 4893). 
                                                                                                                   forms      as actual, not         annualized,        amounts.        
Corporation means   a   taxpayer                          that       is required      or has elected          to   
                                                                                                                   NOTE:        If a shareholder owned              stock         for  less    than     the   entire    tax   
file              as a C Corporation under            the       Internal    Revenue       Code    (IRC).          
                                                                                                                   year      of the   corporation,      or an          officer     served      as an        officer    less  
Corporation  includes                            a Limited  Liability Company               that    has          
                                                                                                                   than the     entire      tax    year:    
elected          to be taxed federally                            as a C Corporation. 
                                                                                                                     •    For purposes             of determining        credit  disqualifiers and                credit          
Special Instructions for Unitary Business                                                                          reduction, compensation                   and    director      fees   must        be   annualized.             
Groups (UBGs)                                                                                                      The determination                    of credit disqualifiers        and     credit     reduction           is   
The      allocated  income  disqualifier                             is based    on  all items      paid           performed                         
                                                                                                                                       off-form.
or allocable                     to a shareholder      or officer          by   all  members           of the        •    For  purposes             of       determining             active       shareholders,              
UBG. All        items        paid              or allocable          to a single individual      must       be     compensation, director                 fees,  and    dividends           must          be annualized. 
combined when                calculating            this        disqualifier.                                      The    determination  of active                 shareholders                  is performed  off-
                                                                                                                   form. 
General Instructions                                                                                               Annualizing 
        If claiming the   SBAC,               complete          this  form  and      include     part     it as    Where annualization                 applies      (see  above       NOTE),           multiply       each    
of the      annual       return   report:   to                                                                     applicable amount               by  12    and    divide   the    result     by    the   number             of   
  •     Shareholder         and  corporate officer                     qualifications    for  the                  months      in the tax         year.     Generally,           a business counts              a month   if   
        SBAC;                                                                                                      the business        operated        for   more   than     half     the   days            of the month.    
                                                                                                                          If the tax  year       is less than  one  month,          consider         the  tax    year         to   
  •     Compensation  and  director fees                       of      active shareholders          and                 one     month      for  the   purposes           of the calculation.         
                                                                                                                   be
        all officers    for   the          computation   the   of           SBAC.     
                                                                                                                   Resources 
Officer  means  an officer                       of          a corporation including     all  of      the    
following:                                                                                                         For    guidance  in addition             to  these    instructions,          see  Revenue                      
                                                                                                                   Administrative            Bulletin  (RAB) 2020-26                  at        www.michigan. 
         (i) The       chairperson   the   of         board.                                                       gov/taxes. 
         (ii) The       president,            vice  president,            secretary,      ortreasurer of      
         the  corporation   board.   or                                                                            Line-by-Line Instructions 
         (iii) Persons       performing              similar          duties   and    responsibilities             Lines not       listed    are     explained      on  the    form.     
         to   persons  described in                 subparagraphs             (i)  and   (ii),  that             
                                                                                                                   Taxpayer Name and Account Number:                                         Enter  name and                  
         include,           ata minimum, major                  decision       making.    
                                                                                                                   account        number  as reported              on  page      1 of      the           CIT Annual 
Shareholder  means      a person who                           owns        outstanding      stock   in             Return  (Form  4891). Also,                  the  taxpayer        Federal        Employer                  
       a corporation              or is a member          of a business  entity  that files             as         Identification  Number  (FEIN) from                      the    top     of      page 1      must be            
       a corporation        for       federal      income      tax      purposes.  An individual                   repeated   the   in       proper      location   on     pages   and   2     3.   
        is considered       the       owner      of the        stock,      or the  equity  interest in      
                                                                                                                   UBGs:  Complete  one form                    for  each        member       that is  a                       
       a business entity      that           files     corporation     as a      for  federal    income           
                                                                                                                   standard  member  (i.e.,  not an                insurance         company          or      financial           
tax      purposes,  owned directly                   or        indirectly,    by   or  for  family                
                                                                                                                   institution).      Enter  the  Designated Member                        (DM)       name      in      the       
members      asdefined by      IRC §   318(a)(1).                          
                                                                                                                   Taxpayer           Name  field  and  the member                 to      whom the      schedule                 
      A family member                    , as  defined         by  IRC §      318(a)(1), includes                  applies on          the  line   below.    On     the   copy       filed   report   to      the   DM’s     
spouses, parents,             children              and  grandchildren.                                            data (if     applicable),         enter   the    DM’s     name       and      account         number           
                                                                                                                   on     each  line.  Also, the           DM’s    FEIN     and      the   member’s            FEIN          
NOTE:  Rules of                     attribution     in IRC           § 318(a)(1)      do not                 
                                                                                                                   from  the  top of      page 1      must  be  repeated in      the  proper  location  
differentiate  between   adult   an                    and   minor   a      child.     
                                                                                                                   on  pages   and   2       3.   
Outstanding stock                     means  all stock               of   record,  regardless       of       
                                                                                                                   PART   1:QUALIFYING DATA                            FOR         THE     SMALL                 
class,      value,  or  voting rights,               but       outstanding       stock   does    not         
                                                                                                                   BUSINESS ALTERNATIVE CREDIT 
include treasury             stock.           
                                                                                                                   NOTE: Parts       2 and      must3         be   completed           before     Part     1.   
All      attributable  family members                          of    persons    directly    owning               
stock during            the  tax       year        must      belisted in      Parts 2   and    3.                  NOTE:     If more than              one   Form    4894   included   is             for   filer,   a sum        
                                                                                                                   the  totals  for  lines 1      and 2      on  the  top  form. 
                                                                                                                                                                                                                         35 

Line  1: Add  compensation  and  director  fees  (column          L) of all                     this   numbering  system               is followed.   All  shareholders’ family         
active  shareholders and         enter  the  result  on     line       1 and  on  Form          members,   as  defined by        IRC                § 318(a)(1),  are considered        
4893,  line      7. Report  on  line      1 and  on  Form  4893,  line      7 actual,           shareholders  and  must      be listed      in Parts      2and    3.
not  annualized,  amounts. 
                                                                                                See   definitions  of officer,   shareholder,             family  member,   and         
An  active shareholder:                                                                         outstanding  stock      in the  general  instructions  for  this  form. 
  • Is      a shareholder of   the  corporation,    including        through                         If more  lines  are  needed  for  listing  the  shareholders  and  officers,  
    attribution,  AND                                                                           include  additional  copies            of this  form.    Complete the     taxpayer      
  • Owns   at  least        5 percent  of outstanding      stock,         including             name  and  account  number on             each   copy     (and  UBG   member                if
    through  attribution  (column              F = 5 percent      or more),  AND                applicable),  and  lines      3 and          4 as necessary.     If using  more  than  
  • Receives      at least  $10,000  in compensation,         director         fees,            one                                                                                    
                                                                                                      copy   of the form, continue the sequential numbering system 
    or  dividends  from the     business    (sum           of columns      I and          L =   for                                                                
                                                                                                    the Member Number   in columns     A, H, and O.
    $10,000      or more).     Important:  For  short-period returns                       or a Columns  B  and C:  Identify  each  shareholder and                     corporate       
    part-year   shareholder,  compensation, director                 fees,   and                officer   by  name and          Social  Security      number.  Corporations,            
    dividends      of each  individual  must      be annualized      to meet  this              Trusts,  and  Partnerships  should      be identified  using  the  FEIN. 
    requirement.  Perform  annualized  calculations  off-form. 
                                                                                                NOTE: Column C: An  individual                          or foreign  entity  that  does     
Line  2: Add  compensation  and  director  fees  (column          L) of all                     not   have      a Social  Security number             or  FEIN  may  enter  in          
corporate  officers  who  are  not  active  shareholders  and  enter  the                       Column      C “APPLD  FOR”  (an  abbreviation  for  “applied  for”)      or
result  on  line      2 and  on  Form  4893,  line      8. To  determine  which                 “FOREIGNUS”  (an  abbreviation  for  “foreign  filer”). 
officers  are  not  active  shareholders,  use  the  definition      of active                              E:  Enter  the percentage           of    outstanding   stock   each        
                                                                                                Column 
shareholders  under  line    1.                                                                                     or corporate  officer  owns  directly.          If a shareholder  
                                                                                                shareholder
PART   2: SHAREHOLDERS AND OFFICERS                                                             owned  stock  for             a period  less  than  the  corporation’s tax    year,        
Line  3 (Columns A through N):   In                 column      A, assign numbers               multiply   that  shareholder’s percentage             of   ownership    by  the            
(beginning   with  1)  to all   shareholders        and  officers         in order              number      of months  owned  and  divide  the  result  by  the  number  
of   percentage  of  stock ownership            (percentage   in  column       G),              of  months      in the  corporation’s  tax  year. 
starting  with  the  highest  percentage  first.  Repeat  this  numbering                       Taxpayers  must  account  for  100  percent      of the  stock.              If it is not  
in  Part      2, column    H,  and  Part        3, column  O.          It is essential  that    accounted  for,  processing      of the  return  may      be delayed. 

ATTRIBUTION  EXAMPLE: 
Larry David Stone               Husband of Betty Stone, Father of Mary Stone, Stepfather of Tammie Rock, Step Grandfather of Kathy Rock 
Betty Ann Stone                 Daughter of Bob Pebble, Wife of Larry Stone, Mother of Tammie Rock, Stepmother of Mary Stone, Grandmother of Kathy Rock 
Mary Elizabeth Stone            Daughter of Larry Stone, Stepdaughter of Betty Stone 
                                Daughter of Betty Stone, Stepdaughter of Larry Stone, Spouse of Steve Rock, Mother of Kathy Rock, Granddaughter of 
Tammie Marie Rock               Bob Pebble 
Steve Carl Rock                 Spouse of Tammie Rock, Father of Kathy Rock, Brother of Mike Rock 
Kathy Evelyn Rock               Daughter of Tammie and Steve Rock, Granddaughter of Betty Stone, Step Granddaughter of Larry Stone 
Mike Joseph Rock                Brother of Steve Rock 
Bob Kenneth Pebble              Father of Betty Stone, Grandfather of Tammie Rock 
Terry Robert Marble             Friend 

Part 2: Shareholders and officers - See instructions                                    Part 3: List of family members and their corresponding relationship type 
3.       A                                      B                                       4.      O        P               Q                R                S                T 
                 Name of shareholder (including corporation, trust, partnership,                                                                                      Check (X) if 
    Member       or family member who is a shareholder through attribution) or          Member                                                                      No Attributable 
    Number                      officer (Last, First, Middle)                           Number         Spouse            Parent           Child       Grandchild      Relationship 
     1           Stone, Larry David                                                           1      2                                  3 
     2           Stone, Betty Ann                                                             2      1               8                  4             6 
     3           Stone, Mary Elizabeth                                                        3                      1 
     4           Rock, Tammie Marie                                                           4      5               2                  6 
     5           Rock, Steve Carl                                                             5      4                                  6 
     6           Rock, Kathy Evelyn                                                           6                      4-5 
     7           Rock, Mike  Joseph                                                           7                                                                      X 
     8           Pebble, Bob Kenneth                                                          8                                         2             4 
     9           Marble, Terry Robert                                                         9                                                                      X 

36 

Column  F:  Enter  the percentage                      of  outstanding            stock     each               an   officer      or shareholder.      These  amounts  must be             annualized               
shareholder   owns,  including  through attribution                                     of ownership           when    determining disqualifiers,              but    should  be  reported         as                
from  family  members  under  IRC      § 318(a)(1).                                                            actual  amounts  on  this  form. 
Column  G:  When  reporting ownership                           of              a person  who              is  NOTE: All insurance              and    pension      payments          must      be included,  
an  active  shareholder, do             not  include              in Column      G any             stock       whether      or not    the  shareholder             or corporate      officer     worked               in
ownership   attributed to              this  person       from  another           active                       Michigan. 
shareholder.  See  definition      of active  shareholders      in the  Part      1
instructions.   For      the  purposes                 of determining       disqualification                   Column  M: Multiply  the  percentage      in column      G by  line      6 on  
from   the  SBAC, an             active   shareholder’s         share       of business                        Form  4893. 
income      is not  attributed      to another  active  shareholder.                                           UBGs   : Multiply         the   percentage        in  column            G by  the  sum of             
EXAMPLE:   In            this      case,    the  husband  and  daughter  are active                            lines  12,      26 and      29 from  the  CIT Data on UBG Members (Form  
shareholders because              their  total    compensation,              director       fees,     and      4897). 
dividends  from  the business                are  greater    than         $10,000         and   they           For Tax Years Less Than 12 Months: Shareholder compensation                                         
own  more  than  5%            of stock      (column        E).   The       wife  and  son  are                must      be annualized when         determining        disqualifiers,     but     should         be   
not   active  because  their  total compensation,                         director      fees,   and            reported      as actual amounts            on this form.  
dividends from       the  business            are  less    than   $10,000          (even      though        
they own      more   than  5%             of stock).                                                           PART   3: LIST           OF     FAMILY MEMBERS AND THEIR 
                                                                                                               CORRESPONDING  RELATIONSHIPS 
                                 Stock Percentage                                                              Columns      P through               S represent relationships            affected   by             
                  Column E                   Column F                           Column G                       attribution. 
Husband                                       100%                                 70%                         For   each  shareholder listed          in  Part    2,  column       A, enter       the               
                    40% 
  (active)                             (all shareholders)  (husband/wife/son)                                  corresponding          number  of the       shareholder’s         spouse,     parent,                 
     Wife                                     100%                                100%                         child,      or grandchild,      if any,  listed      in Part      2, column    A.
                    10% 
(inactive)                             (all shareholders)                 (all shareholders) 
                                                                                                                  If more     than    one  number      is entered  in boxes                    P through  S,         
     Son                                70% (husband/                              70%                                                                                                                              
                    20% 
(inactive)                                   wife/son)                (husband/wife/son)                       separate numbers with   adash.               For example,     if a family member 
                                                                                                               has three    children,     each      child’s   member      number          should     appear        
Daughter                                80% (husband/                              40%                         in  the  “Child”  column  with  dashes  separating  them  (“2-3-4”). 
                    30% 
  (active)                               wife/daughter)                   (wife/daughter) 
                                                                                                               Do  not  use         a dash      to imply   included      numbers  (such                  as “5-8”  
Column  I: Enter  total dividends                       received  by  each  shareholder                        meaning   “5  through 8”),             but  instead    include    each    member                    
during  the  tax  year  from  this  business  (used      to determine  active                                  number  (“5-6-7-8”).  Do  not  use  commas. 
shareholders).                                                                                                 EXAMPLE (SEE THE ATTRIBUTION EXAMPLE ON  
Column  J:  Enter  salaries, wages,                    and   director       fees that                          THE PREVIOUS PAGE): Kathy  Rock’s  (6)  parents      (4 and      5)
are   attributable to    each       shareholder           or corporate          officer.                       work  for  the  company.  Kathy  will  list  “4-5”      in column    Q.
Compensation   paid  by                   a professional  employer organization                                NOTE:   If     the  space provided            in  the  line             4 columns      is not  
to  the  officers             of a client   (if  the   client          is a corporation)           and      to adequate      to list all       of the corresponding       relationships,            include        a   
employees      of the    professional            employer  organization who                          are       separate  sheet      of paper  with  the  member  number  from  column  
assigned     or  leased        to and       perform  services for                       a client   must        O,   the  corresponding relationship,               and   the  number      of the                   
be  included      in determining             the   eligibility          of the    client       for   this      member(s)  with  that  relationship. 
credit. 
                                                                                                               Column  T:  Check           column            T for  each  shareholder  for whom                      
NOTE:     If      a shareholder          owned  stock  for less             than   the       entire            columns      P through      S are  blank (no           attributable       relationship                
tax year        of the  corporation,               or an  officer    served             as an   officer        exists). 
less   than  the  entire tax        year,    report    only    the     salaries,        wages               
and   director  fees attributable            while        serving    as an        officer                      Include completed Form 4894 as part of the tax return filing.                                     
or   shareholder.  These amounts                 must      be annualized           when                     
determining        disqualifiers,  but should               be  reported          as actual                 
amounts on      this  form.         
NOTE: All compensation                    must         be included, whether                     or not the   
shareholder      or corporate officer             worked           in Michigan. 
Column K:          Enter employee             insurance       payments             and      pensions        
that are  attributable              to each shareholder            or officer. 
NOTE: If      a shareholder owned                 stock      for less      than     the  entire tax         
year      of the  corporation,      or an         officer    served      as an            officer    less  
than   the   entire  tax year,         report    only     the  employee           insurance                  
payments, pensions,               etc.,  that  are     attributable          while       serving        as   

                                                                                                                                                                                                                37