EFTA01280154.pdf

651112 Schedule K-1 (Form 1085) Fez Mier Sr year 20- 0. tax 2012 I I ril.P.C.1 C Amended K-1 Part 111 Partner's Share of Current Year Income, OMB No. 1545.009. Department of the Treasury yea- bogInelng Deductions, Credits, and Other Items 'Marna! Reverwe Smite enairc 1 Ordinary business income (loss) 16 Credits Partner's Share of Income, Deductions, 50,213. Credits, etc. ► See separate instructions. 2Newsmeweorcarcoome -6,518. 16 Foreign tensactions Information About the Partnership 3 Other net rental income (Ices) kientication number 4 Tara-deed paymerts B Pedantic s came, address, city, stale) and ZIP code 6 Interest Income 2,576. SV AMERICA HOLDINGS, LLC 13, Cidinary &tends 42 HIGH TECH BLVD 17 Albrnaltve mkt fax (AMT) Pans THOMASVILLE NC 27360 (lb OuallOed dtvklends 1 477. C IRS Center where partersiap filed return E-PILE 7 loyalties 18 Tax-exempt income and D Ej Cneck if this is a publidy traded partnership (PIP) 8 Net short-term capital gain (loss) nondeductble expenses * STMT YAW Information About the Partner 9a lot long-farm capital gain (loss) E Partner s id until ry number 9b Colecttles(28%) gain (loss) 19 Distrindions F Partner's name. address. LitY, state, and Z'P code 12,671. tic Unrecaptured sec 1250 gain 20 Other intormagon BLUE CHIP CAPITAL, LLC 10 Net section 1231 gam (loss) A. 2,576. 329 SEABREEZE AVENUE 130. PALM BEACH, FL 33480 11 Other Income (loss) 0 C General partner or I I.0 DU I imited partner or other LLC member-manager member Domestic oaths' LJ Foreign palter It What typo or entity s It is panne° PARTNERSHIP 12 Section 179 deduction 12 'I m's partner is a retivemeM plan 0FWSEPA(eoginfetc.), check here I I J Partners share of groin, 'ass, and caprat 13 Other deductions Beginning Ending A i 670. Profit 3.6001880% 3.6001880% Loss 3.6001880% 3.6001880% caobi _ 3.9261080% 3.9261080% 14 Self-employment earrings(lass) K Partners share of Ratites at year en& 0. lionrecourse 283,514. Qualified norvecourse financing 'See attached statement for addition information. Recourse $ 0. L Palters copra/ account analysir Beginning capital account Caphal cunt-bared amigo Me year 500,000. Gwent year increase (decrease) 2,416. moorowa:s8 d sbitutiens 12,6710 ending urging exam: 489,745. C Tax basis 0 BAAP 0 Section 704(b) book 71 other (explain) IA Old the partner contribute property wit". a built-in gain o: loss? C Yee MIto If Yee. attach statement (see instructions) 0'413-13 LHA For Paperwork Reduction Act Notice, Bee Instructions for Form 1 65. IHS.gov/forr 1065 Schedule K-1(Fenn 1005) 2012 3 22560411 137428 7386.003 CONFIDEITTlAtfiNGs• LLC 7386.001 SDNY_GM 00032878 EF1'A_00143491 EFTA01280154  SV AMERICA HOLDINGS, LLC SCHEDULE K-1 NONDEDUCTIBLE EXPENSES, BOX 18, CODE C DESCRIPTION PARTNER FILING INSTRUCTIONS AMOUNT EXCLUDED MEALS AND NONDEDUCTIBLE PORTION ENTERTAINMENT EXPENSES 537. OFFICERS LIFE INSURANCE 22. TOTAL TO SCHEDULE K-1, BOX 18, CODE C 559. SCHEDULE K-1 FOOTNOTES TO REDUCE THE PAPER DOCUMENTS WE CIRCULATE, WE OFFER THE FOLLOWING... INSTRUCTIONS IN ELECTRONIC FORMAT FOR SCHEDULE K-1 MAY BE FOUND AT: HTTP://WWW.SMITHLEONARDCPAS.COM/RESOURCES/TAX-CENTER/ CHOOSE TAX FORMS & PUBLICATIONS ENTER KEYWORDS "K-1 INSTRUCTIONS TAX FORM 1065." IF YOU WISH TO HAVE A PAPER COPY OF THIS DOCUMENT, PLEASE CALL US AT PARTNER NUMBER 3 22560411 137428 7386.003 CONP1OENITAt's , LLC 7386.001 SDNY_GM_00032879 EFTA _00143492 EFTA01280155  3 Shhedub K-1 (Form IC65) 2012 Page 2 This list Identifies the codes used os Schedule K-1 for all partners and provides summarized reporting information for partners who file Form 1040. For detailed reporting and Ming Information, see the separate Partners Inductions for Schedule K-1 and the instructions lor your Income tax return. cad Pepol cn 0 -day Nebel» ItMarne:deal peilmie where- the interns ~IS WOrk 0000.11r Ily nedt 1 oceanor nonceee‘e end enter on yo-e tee" at bleed. K De/abed &CMS Credit L Empowerment Ire and tower Repel on cunrunliy e-noio)'rerl creda See Ito Fromerds Pelniddolc Passive I,es /A Confl Ia Increasing -ever& See toe Fahwe'e If Passive lime *envelop Schecitle E. line 28 °clam-i(,y Nronoaerm lee N Orc11 for ~aye' rood ~KY Schedule E. lore 75, oourrn (1) Nerprosebe NCRne Sr:dale E. We 28, inn Medan roam Win 41 O Radon witalholdIng ) 2. Net coed real estate le-came00M Sao tha Pfftreda nat.ohone 8 Oho credits 3. Other net ruts' ter* Bass) Nee ewe Seheckde C. Ins 28, asre (g) IC. Foreign Irsrescbmas Na bee See DePeter's Inegdalkee A sdme of etrinty ce r./ S. 4. Custenleed osyrrerds Schedue E. tine 28, coldme pcososeien 6. kind income FM 1040.'008s • (arob tiOirre err Yl err Ferril 1118 Pal I Se. Ortilniry cols/lards Fr 1048 line Oa C arose bore ;arose al palm 0o. ()wired ehidende Font 1048 bra CO laved 7. I0/00 Schedu • E. We 4 rev cro gem income rtatta a: painefaho his 0. eel tobral-emn moral gin:Kee) Scledue D, lto tr ga het reng.:on Capital oor 30,11./ :meeut D, Inn 12 D Pasehoesteraxy E Goren' ~cry Ja Ferm 1110, Pori I Ob. Colkactibles(3531)geln Mal 20% Arts Gan Verkriwt. One 4 F C533 .Se1ecke O Instrdcliort 1 90. Inecoptal pellen 1203 pin See Ile bebos--bore Dec:echoes Wooers.: ard rippordened in parse INS 10. Nol ~en 123' gee (Ions) See he Palmeri nsuclbrs G Morns mho». 11. Olt. ~rim 9oael Ferm 1118. Ftr: N 0Uhr Rem 1116, Par. Code A Over ~do DechrtIone aecceled sao aPPlelotalm P2213~ berrel erelPn mam iream. Boes) See the Parsee .hendct Cre B hvolterry proem ene booms See re 'etre( nelhctee C Sec. 1228 comrade A MOP% I ~eve draw/ Feyn 5781, Ilne 1 CI el nip expleaden rare trawler. J liontral ~WM } reeve 1118 Plet) See rub. 635 E Ceneeetenerdool Fern 1240, nee 210 'ore 91,2 K Cel. F Oder inane Boa) Sen dePaine Irtriddlcre Other niermarlon • TOlMlbreVhline.pale Far* 1110. Pal II 12. Sect cn *Wee See Me Partnen leemachois Al fob/ lonrch mires aacrued Fan 1118 at II "3. Dthe &tektite, N Raducreen in else eta ado Ia Mode Ferro '118 Ine 12 A CS, eter. tons (5094; O rtra Cad ng gees receipts teen 5071 9 tat ccer.bullone (32)18 P LerodertItrla ircome eon usen Fenn 8ein C henna*, cenebflens(5O%) O Other loreol oareeziler• Seethe Pallets ~morons D hence, corrlabolone See ToPainedc ezbuctor a E CAPI2419•81 Orel:any IO • SCre IT. AreinetA•mlnirni.wn tax W.1- ) rorne otpr Won DO%) 1 F Croke gain property (40%; A Poe1.19805amecratcn r-cljatrant • ContrIbuonn$1180%) B Apusted 1,31,, a' Kea See% Partners II Invaelment hired napens Form 4952. IIM 1 5 Depletion Mee ran el & gee; ~atone end I DeSacainns - tOyely domino Scrondole E. line 12 ) 01, Los. A geothermal • due Income Me ~am /Or Scomen ao»pj «pencils% See lhe • ow, geothermal • drortictom Fenn 0251 nelnattone K Dedreslortr partible (211 coal Schedule A. Ana 23 F Ctn. MAT IFaii• 1. Dedrámard • prone Coen) Sehmaule A. Ilya 28 18. Tax.exarror income alh1nOnee0ACZIto ~refs Al ~cute Wined reeler Nam ce Schedule A, Ono 1 ea Rem 1842 line 20 A Tax exiveal Were« InCrrat Fyn 1040, moet Al Edo:rice/ eaártarce beetle See the Plena(' Intruding* B Obey texeurnol mere Sett,r Python 1.1CLICtialgi O (Lonen( care bend in Ferro 244', Ira I' P %mad:both* period expanses • Nonclod.criale exponocra Ce. the Parretti Ihstructlaw Sul the Peewee Inelnielone o Commercial trhrto 'neon draueien 10. DLinbedlons Bee porn $582 l- sttudlone ran rean real rota AS' A Gant and marmlatie ~riles R Peneona erd HA, See the 8delnet's Inetructbne B Dflutoon eerefl to »Man 737 } Sim the Ported re Inatn.et Ems S Rekroolatre moor. ertsart See the rierMerio Irelrucbce• C Oler prOpIrty T Dorresbn peck/Olen aCtIritee See rein 0033 menaces 20. Othe Inkemetice Inkommecre • Oadirled veal n act:Oleo inane Ferm WA, are ab A Ir~Client ircarre row 4052. rho 4o El kneel-mint expel:am Form 4052. lino 5 ✓ Employe, / remt w.2 wages ram 808 ere 17 C ruit tax decl: Intormancr Ferm 4135 W Wier eedaalt See Be Proem hetrutaill • Quarried remmillbskatexpendIttres (aM« hen rernal lea erM1o) Sim therOarletres Ineduelono See angiomen( coy ngs Ore E Base ce energy property 844 Mair Parretee Ineln.moons F Reesormin cl low-harm teuelrE Nei. 1' yes here a secto^ '79 decbctei a any pa-innr.:evel nentglkne. eer te Pamela hathrzbunie Wire Campletrg Schedle on« (tembr 42C:X58 Earn 201', IntrE G Romany • ot br, unarm housing • Nee tented (oes) tan Selector Sf, Settle, A cell aide room) Fenn Hell, Ine a Weer S1ePw1 11 Readalre of rnartatmant See Fan, 4255 • Ones twining er %bhp h‘cros Fles Peobeee IrotteeSone I ~pin or etthr mina See re Palner's nstnet ono C ter ncedrenn Income Soothe Pries Inethowns J LOolobaci, rimer • complete] keg ken contacts see ran 8027 Is. Credits K Look-bedt Items' - Moamar Mmemaz A Low.nocnte hodre cedit nolod See Fcnn 8680 (BMW 4200 Irmo phh2CM I. Dwocaone.ipwedy with bulldreds «tree 1132 Mrdocrom ▪ Lini.rno.noe Feasilg eredl Ceder> Is ROC *ISO V' *Kb>, 179 delicban turn cre.2005 beano, N Fohreet expense lc, rococo-Ms panner8 C L ow-onoone - 0J*Ing all geode, O &Own 4S7(y3) hternellin 4208atom ~-2507 buildroz P Section 4.53.A:t4 tutelar Co Low-emcee meting own (oral Sates Punnet newel one O Bettie.' -200(]) &yeTarr torn posi•22C7 odlcegs R itemsl dlocable wocren Rae 'I» Pe-tress E Cue led tehabilarthan cape-she", expentAbdets I tams read real orate) S EEG wired:do:1met atmlle ✓ 0 ..ber Nb:real mire Cree'ne T Drooleir^ Irlornellor and gm (I Qtr darts' credlos U Arnen ;sect alralcerdaare are UrideralCuted cap tr toles trier Faro 1040, am 71, chock box e ✓ Unrelated busInctit LAman ircome I Neon°, rod odUlesieeelue hels See the +flees inauctionc W Preozetibulon We X5SO etedt X Stnt3Dr ICXX)IrkrrI1on • Cler ernmthn 2'1252 lle 19 ceNrinurrerAcc""' "c 3 22560411 137428 7386.003 7386.001 SDNY_GM_00032880 EFTA_00143493 EFTA01280156  IT-85 2012 Schedule IN K-1 Ste Form 49181 (R12 / 8-12) Indiana Department of Revenue Partner's Share of Indiana Adjusted (Noss Income, Deductions, Modifications, and Credits Tax Year Beginning 01 01 2012 end Ending 12 31 2012 Name of Partnership Federal Ident" umber LD Distributions -Provide INK-1 to each partner. Enclose IN .<-1 with IT-65 return. for intimation on the acceptable electrons data file format, vial the DepalmenEs website at wortin.gov/dor/3172.htm Pro rata amounts for lines 1 tnrobgh 26 of any nonresident partner must be mulipried by the Indiana apportionment percent, if applicable. from IT-65, Fne 4. Part I - Partner's Ideal flcadon Section (a) If Partner Is an Individual (please print clearly) Sociai Security Nanber: Last Name: Fket Name: al a2 a3 (o) If Partner Is an Ober Entity (abase orbit clearly) Federal Identification Number, Name: 51 BLUE CHIP CAPITAL LLC b2 (c) Partner's Stale of P.asIdenoe or Commercial Do,Meie cl FL (d) Ind9na lax WIthhed for Nonresident Partner (on WH-I8). _ d .00 (e} Partners Federal Pro Rata Percentage 3 . 6 0018 51. (0 Partners Tax as Computed on IT-65CCMP Colimn G .00 Part 2 - Distributive Share Amount (use apportioned figures for nonresident partners) 1. Ordinary business ineOme pons) 1280.00 2. Net rental •eel estate income (loss) -166.00 3. Other net rental income (loss) . 00 4. Guaranteed payments . 00 5. Interest income 66 .00 6. Ordinary &viands .00 7. Royaities . 00 8. No: short-term capital gain (loss) . 00 9. Net long-term capital gain (loss) . 00 10. Net IIIC Section 1231 (AM (loss) 3.00 11. Other income (loss) . 00 12. ;RC Section 179 expense deduct:on . 00 13a. Portion of expenses related tc investment portfolio income, including Invostrnent Interest expense and ether (federal nornemized) deductions . 00 13b. Other fnformation from Eno 20 of federal K-1 related to investrnent Interest and expenses not listed elsewhere . 00 14. Total pro rata distribudoes (And lines 1 threugh 11; subtract eves 12,138, and I31) when applicalle.) 1183.00 Continued on next page ► 2602'1 12-05-12 1019 CONFIDENTIAL SDNY_GM_00032881 EFTA_00I 43494 EFTA01280157  IT-65 2012 Schedule IN K-1 Page 2 Part 3 - State Modification Add or s.:bract the following. Designate the distibutNe share amount of each modification to Indiana ad lustod gross income from line 2 on the front of Form IT-65. For .nonresidents, appty apportioned boxes. (Use a minus sign to denote negative amounts.) IS. State income axes deducted .00 16. Net bonus deprecation allOwance .00 17. Excess IRC Section 179 deduction . 00 :8. Interest on U.S. obligations . 00 19. AddbackMeducoon Coco: . 0 20. Addtack/Ced-ction Code: . 00 21. AddbacIODeductIon Code: .00 22. AgehaowDeduction Code: . 00 23. Addback/DsdoetiOn Code: . 00 24. Addback/Oedustion Code: . 00 25. AdobadvDeduction Code: . 00 26. Addbackteduction Code: . 00 27. Total distributve share of mocite=tions (add lines 15 through 26 and catty total to Column B on Schedule IT-S5COMP) . 00 Part 4 - Pro Rata Snare of Indiana Pass-through Tax Credits front Partnership 28. Enter the lame of to tax credit p(ogram, Its trten-digit ID code, and the dolor amount of the partner's distributive share to each alnwable credit Name of Credit: ID Code: a b c .00 .00 . 00 29. Total pass. two Jell croft (add linos ne, 281. and 28i) . 00 fte212 .!2a3-12 1019 I u hf liii 11111IIIII iligignm11111111 III! CONFIDENTIAL SDNY_GPL00032882 EFTA_00143495 EFTA01280158  NC K-1 (39) 2012 Partners Share of (D-403) N.C. Income, Adjustments, and Credits 1C-11-12 North Carolma Depanmant of Revenue For talendar year 2012 or kcal year hoginring and onding Partner': Identifyl eg Numbei Federal Em rI Partners Name, Addresa, and ZIP Code Partnership': Name, karen, and ZIP Code BLUE CHIP CAPITAL LLC SV AMERICA HOLDINGS LLC 329 SEABREEZE AVENUE 42 HIGH TECH BLVD PALM BEACH PL 33480 THOMASVILLE NC 27360 Individuele Firma Form Partnerebip's Pro Rata Share Item Antoon( 0-400 Enter Amant on: All Partner* 1. Stan of partnerslib income (loss) 46401 2. Additions tO ine0rhe (ÅSS) Addi0on for bonus de:reenden 1363 Page 2,1.Ine 35 b. Ober additi0iS tO boem (ass) 0 Page 2, Line 36 3. Deductiens trom incomo (loss) a Deductie» fot bonus depreciation 0 Page 2, Line 44e b. Other deductrons korn licome (loss) 0 Page 2, Line 49 4. Share of tax credIS 0 Form D-40OI C 5. Share of tas withheld kom nonwage coma/ambo pakt tor persona services peetorned in N.C. 0 Page 2,1Ine 23 Nenresidente Only 6. Nonresident's share of N.C. taxable Interne (loss) 35594 Page 2, Lila 51 1. Nonresldont's share ot net tax pad by the mana0er of the partnership 0 Page 2, Line 24e AFFIRMATION ATTACHED 20020, V.MM CONFIDENTIAL SDNY_GM_OOO32883 EFTA_00 I 43496 EFTA01280159  NC-NPA (39) Nonresident Partner Affirmation D-403 North Carolina Department of Revenue 8.35 3 r Identifying Number Partnership's Federal Employer ID Number n Nonresident Partners Name, Address, and ZIP Code Partnerships Name, Address, and ZIP Code (BLUE CHIP CAPITAL LLC SV AMERICA HOLDINGS, LLC 329 SEABREEZE AVENUE 42 HIGH TECH BLVD PALM BEACH FL 33480 THOMASVILLE NC 27360 Date nonresident became partner In partnership 12/20/11 Partners Tax Year Partnership's Tax Year 01/01/12 12/31/12 O1/Q1/12 12/31/12 beg.nning (MAI-DO-Yr) ending (MM-00-110) bogiming (A4M-DD-Yr ending (MM-DD-Y» Type of Partner. C C Corooratior. S Corporation 50 Partnership Estate or Trust (RU in applicable circle) Note: This toon is not applicable to nomosidect partners who are incateilusts or grantor busts. I affirm that 1. The entity above is a nonresident partner in the pagraship shown above, and 2. I will timely tile the entity's applicable income tax return and pay the tax Imposed by North Carolina on the entity's share of the partnership income. Signature of Manager, Officer, or Fiduciary Date affirm that: the entity above is a nonresident partner In the partnership shown above. SE Signature of Managing Partner Date General Instructions Ina partnership having ore or more nomes'dent partners, the rr arming partner is responsible for reputing the share of the income and paying the tax due tor each nonresident miner. However, line nonresident partner is a corporation, par birdie, trust or estate, the managing partner Is not required to pay the tax an that partner's share of the partnership income provided the partner sirs this Nonresident Partner Affirmation affirming that the partner wit pay the tax wit its corporation, pa'tnership, trust or estate income tax return. Ws form must oe attached Ic the pytnershio return of the partnership shown ahem (Note: Ibis form is nor applicable to nonresident partners who are individuals or grantor tests.) Payment of the tax due by'he managing errs or aerie of corpoldors, Partnmsbara, trusts or estates tits are partners does not retove the partner from ulna a North Carona tax return. 2%a4 I 05-01. 2 CONFIDENTIAL SDNY_GM_00032884 EFTA_00I 43497 EFTA01280160