EFTA01116009.pdf

SCHEDULE B plAB No. 1545.0074 (Form 1040A or 1040) Interest and Ordinary Dividends Deportment of the Treasury ►Attach to Form 1040A or 1040. 2©13 Attachment internal Revenue &hence (991 ► Information about Schedule B (Form 1040A or 1040) and its instructions is at rnswirs.govIscheduleb. Sequence No. 08 Name(s) shown on return Your social security number LEON & DEBRA BLACK Part I 1 List name of payer. If any interest is from a seller-financed mortgage and the Amount buyer used the property as a personal residence, see instructions on back and list Interest this interest first. Also, show that buyers social security number and address ► (See instructions SEE RIDER ATTACHED - A 369,352 on back and the instructions for SEE RIDER ATTACHED - B 5 121 155 Form 1040A. or Form 1040. 1 line Ba.) Note. If you received a Form 1099-INT. Form 1099-0ID, or substitute statement from a brokerage firm. list the firm's name as the 2 Add the amounts on line 1 2 5,490507 payer and enter the total interest 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. shown on that Attach Form 8815 3 form. 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040. line 8a ► 4 5 490 507 Note. If line 4 is over $1.500. you must complete Part III. Amount Part II 5 List name of payer ► Ordinary Dividends (See instructions on back and the instructions for Form 1040k or Form 1040. 5 line 9a.) Note. If you received a Form 1099-DN or substitute statement from a brokerage firm. list the firm's name as the payer and enter the ordinary 6 Add the amounts on line 5. Enter the total here and on Form 1040A. or Form dividends shown on that form. 1040. line 9a ► 6 Note. If line 6 is over $1.500, you must complete Part Ill. You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends: (b) had a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. Yes No Part III 7a At any time during 2013, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign Foreign country? See instructions Accounts If "Yes." are you required to file FinCEN Form 114. Report of Foreign Bank and Financial and Trusts Accounts (FBAR). formerly TD F 90-22.1, to report that financial interest or signature authority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those (See requirements instructions on b If you are required to file FinCEN Form 114, enter the name of the foreign country where the back.) financial account is located ► 8 During 2013, did you receive a distribution from, or were you the grantor of. or transferor to, a foreign trust? If "Yes," you may have to file Form 3520. See instructions on back For Paperwork Reduction Act Notice, see your tax return Instructions. Cat. No. 17146N Schedule B (Form 1040A or 1040) 2013 EFTA01116009 LEON & DEBRA BLACK ATTACHMENT TO 1040 FY 2013 SSN: RIDER A SCHEDULE B, PART I, INTEREST, LINE 1: NAME OF PAYER AMOUNT AMERICANS ELECT 1,352 BANK OF AMERICA - CKING A/C# 0112-6296 13 BANK OF AMERICA - CKING A/C# 0624-6273 113 BANK OF AMERICA - CKING A/C# 0662-3840 12,667 BANK OF AMERICA - CKING A/C# 3940-0132-0945 1,398 BANK OF AMERICA - MMK SV A/Ctt 3940-0129-9982 31,770 BANK OF AMERICA - SAVNG A/Ctt 0688-6140 42,234 HSBC BANK - RENT SECURITY 73 JPMORGAN A/Ctt 159-16357 30,006 JPMORGAN A/Ctt 159-17426 31 WELLS FARGO A/Ctt 297287T2 4,131 BANK OF AMERICA - CKING A/C# 4830-4482-0384 203 GOLDMAN SACHS A/Ctt 681-57975-1 268 GOLDMAN SACHS A/Clt 681-58333-2 2,185 GOLDMAN SACHS A/Clt 681-58348-0 216,394 GOLDMAN SACHS A/Ctt 681-58001-5 26,514 369,352 EFTA01116010 LEON & DEBRA BLACK ATTACHMENT TO 1040 FY 2013 SSN: RIDER 8 SCHEDULE Et, PART I, INTEREST, LINE 1: NAME OF PAYER AMOUNT AMOUNTS REPORTED 8Y PASS-THROUGH ENTITY: ENTITY EIN: ARTNER TO WHOM ISSUED TO RALLY LABS LLC 6,879 EON O. BLACK APOLLO ADVISORS LP 12,704 EON O. BLACK APOLLO INVESTMENT FUND 574 EON O. BLACK PEGASUS PARTNERS LP 7448 EON O. BLACK 976 MADISON RESTAURANT LLC 11409 EON O. BLACK AP CAPITAL PROP CO 531 EON 0. BLACK APOLLO INTL RE ADVISORS LP 9,336 EON 0. BLACK APOLLO POLAND RE ADVISORS LLC 9,659 EON 0. BLACK AREIF V CO-INVESTORS LLC 1,176 EON O. BLACK APOLLO INTL RE CO-INVESTORS U.0 9,247 EON O. BLACK APOLLO RE MEZZANINE ADVISORS 971 EON O. BLACK AP AR HOLDCO 3,045 EON O. BLACK AP TECHNOLOGY PARTNERS LLC 9,223 EON O. BLACK AP SILL INVESTORS LLC 4,007 EON 0. BLACK ANCHORAGE CAPITAL PARTNERS, LP 204059325 124 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) CANYON VALUE REALIZATION FUND, LP 95-4449342 55,461 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO VIF CO-INVESTORS, LLC 204216554 6,821 LACK FAMILY PARTNERS, I.P I DISREGARDED ENTITY) MN HOLDINGS LP 98-0641994 3,860,395 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) KNOWLEDGE UNIVERSE EDUCATION LP (LBF ICLOINGS LLC) 98-0498581 9,194 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO CO-INVESTORS IV, LLC 13-4002661 68,155 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO SOMA CO-INVESTORS, LLC 20.8472391 1,066 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO CO-INVESTORS VI (EN-A). LLC 98-0511923 4,739 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO CO-INVESTORS VI A I, LLC 20.3396939 145 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) APOLLO CO-INVESTORS V. LLC 13-4125399 1,937 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) AP ALTERNATIVE ASSETS 98-0495844 94,220 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) ATHENE HOLDING LIMITED 713 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) FO CO-INVESTORS II (Al 62,493 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) KING STREET CAPITAL, LP 13-3812174 898 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) SUSTAINABLE WOODLANDS FUND II, LP 20-5192952 994 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) WOLFENSOIIN CAPITAL PARTNERS LP 98-0553759 33,733 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) WCP AIV, LP 27-5271800 2,353 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) AP SILL INVESTORS LLC 5,187 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) AP TECHNOLOGY PARTNERS LLC 20,772 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) CRETE LLC 590 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) TENFORE HOLDINGS FUND I LP 89,880 LACK FAMILY PARTNERS, LP I DISREGARDED ENTITY) MILLENNIUM USA LP 13-3976200 867 BF HOLDINGS LLC (DISREGARDED ENTRY] IIAO CAPITAL FUND II, LP 98/114326 3,676 BF HOLDINGS LLC (DISREGARDED ENTRY] CRETE LLC 37-/528994 19,432 BF HOLDINGS LLC (DISREGARDED ENTRY] LONE CASCADE LP 20/330917 909 BF HOLDINGS LLC (DISREGARDED ENTRY] APOLLO -TO CO-INVESTORS I (A) 322 DB 2011 LLC (DISREGARDED ENTITY APOLLO APOLLO INVESTMENT FUND 95,569 DB 2011 LLC (DISREGARDED ENTITY SEARCHLIGHT CAPITAL LP 599 DB 2011 LLC (DISREGARDED ENTITY SEARCHLIGHT CAPITAL AN I LP 4,626 DB 2011 LLC (DISREGARDED ENTITY QUADRANGLE CAPITAL PARTNERS 26,203 DB 2011 LLC (DISREGARDED ENTITY QUADRANGLE (OFFSHORE) CAPITAL PARTNERS 289 DB 2011 LLC (DISREGARDED ENTITY QUADRANGLE (ACCESS) CAPITAL PARTNERS 5,466 DB 2011 LLC (DISREGARDED ENTITY TENFORE HOLDINGS FUND I LP 49,994 DB 2011 LLC (DISREGARDED ENTITY BHM INVESTORS 9,368 DB 2011 LLC (DISREGARDED ENTITY MICROBES INVESTORS LLC 14,381 DB 2011 LLC (DISREGARDED ENTITY AP TECHNOLOGY PARTNERS LLC 722 DB 2011 LLC (DISREGARDED ENTITY AP SILL INVESTORS LLC 84,039 DB 2011 LLC (DISREGARDED ENTITY QUADRANGLE (OFFSHORE) CAPITAL PARTNERS II 49,421 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR QUADRANGLE CAPITAL PARTNERS II 812 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR QUADRANGLE OM CAPITAL PARTNERS II 459 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR QUADRANGLE (AR12) CAP PARTNERS II 2,123 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR DUNE REAL ESTATE FUND LP 208 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR MARKSTONE CAPITAL PARTNERS 899 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR AREIF IV CO-INVESTORS 5,878 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR BUCKINGHAM RAF PARTNERS LP 94,939 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR BLUE STAR I LLC 211 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR GIFTHORSE PARTNERS, LLC 8,252 LACK FAMILY 1997 TRUST GRANTOR TRUST: LEON BLACK GRANTOR APOLLO CREDIT OPP. I LP 235,812 APO 1 AGREEMENT GRANTOR TRUST: LEON BLACK GRANTOR 5,121,155 EFTA01116011 Schedule B (Form 1040A or 1040) 2013 Page 2 N you receivedinterest as a nominee. Financial account. A financial account includes. General Instructions feu must give the actual owner a Form but is not tinted to. a securities, brokerage. savngs. Section references are to the Internal Revenue Code 1099-1NT unless the owner is your demand. checking. deposit. time deposit. or other unless otherwise noted. spouse. You must also Ole a Form 1096 account maintained with a financial institution (or and a Form 1099-1NT with the IRS. For other person performing the services of a financial Future Developments more cletads. see the General Instructions for Certain institution). A financial account also includes a For the latest information about developments Information Returns and the Instructions for Forms commodity futures or options account an insurance related to Schedule 8 (Form 1040A or 1040) and its 1099-INT and 1099-0ID. policy with a cash value (such as a whole life nstructions. such as legislation enacted after they Accrued interest. When you buy bonds between insurance policy). an annuity policy with a cash were published, go to vnvw.irs.govischedufeb. interest payment dates and pay accrued interest to value. and shares kr a mutual fund or similar pooled the seller. this Merest is taxable to the seller. If you fund (that is. a fund that is available to the general Purpose of Form received a Form 1099 for interest as a purchaser of a public with a regular net asset value determnabon Use Schedule B if any of the following applies. bond with accrued interest. follow the rules earlier and regular redemptions). • You had over $1.500 of taxable interest or ordriary under Nominees to see how to report the accrued Financial account located in a foreign country. dividends. interest. But identify the amount to be subtracted as A financial account is located yr a foreign country if "Accrued Interest.' the account is physically located outside of the • You received interest from a seller-financed United States. For example. an account maintained mortgage and the buyer used the property as a Original issue discount (OW). If you are reporting OID in an amount less than the amount shown on with a branch of a United States bank that is personal residence. Form 1099.0ID, follow the rules earlier under physically located outside of the United States is a • You have accrued interest from a bond. foreign financial account. An account maintained Nominees to see how to report the OID. But identify • You are reporting original issue discount (OID) in the amount to be subtracted as "OID Adjustment." with a branch of a foreign bank that is physically an amount less than the amount shown on Form located in the United States is not a foreign financial Amortizable bond premium. If you are reducing your account. 1099-0ID. interest income on a bond by the amount amatizable • You are reducng your interest income on a bond bond premium. follow the rues earlier under Nominees Signature authority. Signature authority is the by the amount of amortizable bond premium. to see how to report the interest But identity the amount authority of an individual (alone or in conjunction to be subtracted as 'ABP Adjustment." with another individual) to control the disposition of • You are claiming the exclusion of Merest from assets held in a foreign financial account by direct series EE or I U.S. savings bonds issued after 1989. Line 3. If, during 2013. you cashed series EE or I communication (whether in writing or otherwise) to • You received interest or ordinary dividends as a U.S. savings bonds issued after 1989 and you paid the bank or other financial institution that maintains nominee. qualified higher education expenses for yourself. the financial account. See the FinCEN Form 114 your spouse. or your dependents. you may be able instructions for exceptions. Do not consider the • You had a financial interest n. or signature to exclude part or al of the interest on those bonds. exceptions relating to signabse authority yr authority over. a financial account in a foreign See Form 8815 to details. answering Question 1 on line 7a. country or you received a distributico from, or wore a grantor of. or transferor to. a foreign trust. Part III Part II. Ordinary Dividends Other definitions. For definitions of `Mandel of the schedule has questions about foreign interest." 'United States." and other relevant terms. You may have to file Form 5471 X. in O accounts and trusts. see the instructions for FinCEN Form 114. 2013. you were an officer or director of a foreign corporation. You may also Line la-Question 2. See FirCEN Form 114 and its Specific Instructions have to fife Form 5471if, in 2013, you instructions to determine whether you must file the owned 70% or more of the total form. Check the "Yes" box if you are required to file You can Nsf more than one payer on (e) value of a foreign corporation's stock, or fib) the form: check the "No" box if you are not required each entry space for fines 7 and 5. but combined voting power of all classes of a foreign to file the form. be sure to clearly show Me amount paid corporation's stock with voting rights. For defogs, If you checked the 'Yes" box to Question 2 on line next to the payer's name. Add the see Form 5471and its instructions. 7a. FriCEN Form 114 must be electronically feed separate amounts paid by the payers with the Financial Crimes Enforcement Network Line S. Report on line 5 all of your ordinary listed on an entry space and enter the totals the "Amount" column. If you still need more space. attach dividends. This amount should be shown kr box to (FiCEN) at the following website: httpilbseeNing. of your Forms 1099-DIV or substitute statements. finoen.treas.govImain.html. Do not attach FnCEN separate statements that are the same sae as the List each payees name and show the amount. Form 114 to your tax retum. To be considered printed schedule. Use the same format as lines 7 and 5, but show your totals on Schedule a Be sure to put Nominees. If you received a Form 1099-DIV that timely. FinCEN Form 114 must be received by June your name and social security number (SSN) on the includes ordinary dividends you received as a 30. 2014. statements end attach them at the end of your return. nominee (that is. kr your name, but the ordinary If you are required to Ole FinCEN Form Part I. Interest Line 1. Renal on Imo 1 all of your taxable retest. Taxable interest should be shown on your Forms dividends actually belong to someone else), report the total on line 5. Do this even if you later distributed some or all of this income to others. Under your last entry on line 5. put a subtotal of all A 114 but do not properly do so. you may have to pay a civilpenalty up to CAUTION 810,000. A person who willfully fails to report an account or provide account I099-INT. Forms 1099-0ID. or substitute ordinary dividends listed on line 5. Below this identifying information may be subject to a civil statements. Include interest from aeries EE. H. HH. subtotal. enter "Nominee Distribution' and show the penalty equal to the greater of 3100,000 or 50 and I U.S. savings bards. List each payer's name total ordinary dividends you received as a nominee. percent of the balance in the account at the time of and show the amount. Do not report on this line any Subtract this amount from the subtotal and enter the the violation. Wilful violations may also be subject to tax-exempt interest from box 8 a box 9 of Form result on line 6. criminalpenalties. 1099-INT. Instead. report the amount from box 8 on f youreceived dvidends as a nominee, Line 7b. If you are required to file FirCEN Form 114. sne 8b of For 1040A a 1040.1f an amount is you must give the actual owner a Form enter the name of the foreign country or countries in shown in box 9 of Form 1099-INT. you generally 1099-DfY unless the Owner is your spouse. the space provided on line lb. Attach a separate must report eon line 12 of Form 6251. See the You must also Me a For WAS and a Form statement if you need more space. Instructions for Form 6251 for more details. 1099-0W with the IRS. For more Line 8. If you received a distribution from a foreign Seller-financed mortgages. If you sold your details. see the General Instructions for Certain trust. you must provide additional information. For home or other peoperly and the buyer used the Information Returns and the Instructions for Far this purpose. a loan of cash or marketable securities property as a personal residence, list first any 1099-DN. generally is considered to be a distribution. See Merest the buyer paid you on a mortgage or other Part III. Foreign Accounts and Form 3520 for details. form of seller financing. Be are to show the buyer's name. address. and SSN. You must also let the Trusts If you were the grantor of. or transferor to. a buyer know your SSN. If you do not show the Regardless of whether you are required foreign trust that existed during 2013. you may have !o file FinCEN Form 114 (FEAR). you to file Form 3520. buyer's name. address. and SSN. or let the buyer know your SSN. you may have to pay a $50 penally. may be required to fife Form 8938. Do not attach Form 3520 to Form 1040. Instead. Statement of Specified Foreign fee it at the address shown in its ratrucbons. Nominees. If you received a Form 1099-INT that Financial Assets. with your income tax =rides interest you received as a nominee (that is. in If you were treated as the owner of a foreign trust return. Failure to file Form 8938 may result in your name. but the interest actually belongs to penalties and extension of the statute of limitations. under the grantor trust rules, you are also someone else). report the total on line I. Do this even See www.irs.gov/form8938 for more information. responsible for ensuring that the foreign trust files it you later distributed some or all of this income to Form 3520-A. Form 3520-A is due on March 17. others. Under your last entry an line I. put a subtotal Line la-Question 1. Check the "Yes" box if at any 2014. for a calendar year twat. See the nstructions of all interest listed on line 1. Below this subtotal, enter time dung 2013 you had a financial interest in a for Form 3520-A for more details. 'Nominee Distribution* and show the total interest signature authority over a financial account located you received as a nominee. Subtract this amount from in a foreign country. See the defnitions that follow. the subtotal and enter the result on line 2. Check the "Yes" box even if you we not required to file FinCEN Form 114, Report of Foreign Bank and Fnancial Accounts (FBAR). EFTA01116012