EFTA Document EFTA01280113

.3 651112 Schedule K-1 2012 I-1 Anal K-1 ]Amended K-1 ohge No. 15454099 (Form 1065) Fcr away yaw 0•2, 7 ; 2• rs, Deurrnert a The Treasury ,.... sn,,,,,ne ?jinn:. Partners Share of Current Year Income, Deductions, Credits, and Other Items Irturnal Regende service eldN 1 Ordinary business s'ome (loss) 16 GredItS Partner's Share of Income, Deductions, I 50,213. Credits, etc. 1 See separate inane:net 2 hie renter real Woe torn pppel I — 6 , 518. 19 Fannon tentedicns _.. . . . Part. I Information About the Partnership 3 Other net rental income (10M) denNication number 4 Guaranked PaymentS r---I B Part4ershp s name, address, cry, stale, and ZIP mde 5 Interest hcome 2,576. SV AMERICA HOLDINGS, LLC Se Ordinary artclends 42 HIGH TECH BLVD ! 17 Alternatta rein tax (M.17) 'errs THOMASVILLE, NC 27360 SD Qualified dividends 1 4 7 C IRS Cobs where partersnIpMed ran IC —FILE 7 Royalties IS Taximimpt Income and 0 In end( :t tills is a cubecly traded partnership (PIP) 8 Net shcrt-term Capital gain (boss) I nondeductible * °vanes STET 019ffillt Information About Partner 9a Net long-term nodal win (loss) the I E Partner's Went renter 9b Gollenteles (28%) gain (loss) IS OiStrtutions 12,671. F Partners name, address, cily, state, and ZIP code So "recaptured sec 1250 gain 1 20 Odier aroma:ion BLUE CHIP CAPITAL, LLC ___-, 10 Net section 1231 gain (Mae) r 2,576. 329 SEABREEZE AVENUE I 130. PALM BEACH FL 33480 1f Other Income Doss) G U General partner a LLD Ix] Limiled partner or other LW member-marega neater H LI Domestic partner SI Foreign partner It What typo of endN is this palm? PARTNERSHIP 12 Section 179 deduction 12 'I lYs partner is a ter m pkn 0RMEPINeogiVetch tiled( hare Li J Partners share &profit, toss, and conk 13 Other deduction BegInnieg Ending A 67Q. Pion 3.6001880% 3.6001880% Loss 3.6001880% 1 3.6001889% I Cap tal 3.9261080%j 3 . 9261080% 14 Seif-ernpiornent earnings (loss) K Partner's sure of Sanas al year ant A 0. Nenrecourse $ 283,514. Quailed racecourse nnanchg $ 'Sea attached statement la adeln nal in amaticn atX01$56 S 0. I. Partre's coed./ account analysis: Beginning capital account ...., . $ CapIMI contributed during the year $ 500,000.4 g Current yes increase (decrease) $ 2.416. Withdrawn & OStrihuLloris .... .......... ,.. ._ $( 12,67142 Ending capital =cunt $ 489,745.1 Tax tan 0 SW 0 Section Taro) bock r....._,-1 Otter (Wain) IA CM the partner mature property with a Ou et-in oath or loss? FT Yes Odra II Yes' attach suterrent (see instrudNes) ra l owers /a LHA For Paperwork Redaction Act Notice. are Instruction of Font 1066. IRSdovitarr.1065 Schedule K-1 ?Form 10851 2012 22560411 137428 7386.003 3 2012.03030 SV AMERICA HOLDINGS, LLC 7386.001 CONFIDENTIAL SDNY_GM 00031942 EFTA_00 142555 EFTA01280113 SV AMERICA HOLDINGS, LLC SCHEDULE K-1 NONDEDUCTIBLE EXPENSES, BOX 18, CODE C DESCRIPTION EXCLUDED MEALS AND ENTERTAINMENT EXPENSES OFFICERS LIFE INSURANCE PARTNER FILING INSTRUCTIONS AMOUNT NONDEDUCTIBLE PORTION TOTAL TO SCHEDULE K-1, BOX 18, CODE C 537. 22. 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 2012.03030 SV AMERICA HOLDINGS, LLC 7386.001 CONFIDENTIAL SONY_GM 00031943 EFTA_00 I 42556 EFTA01280114 3 Scheduk (Fnrm 1065) 2r2 Pace 2 Tbis fief Identifies the codes used ou Soudoie K-1 for ail purren mnd provider tu remartred redonne, Informelion foi paniers who file Form 1040. For detailed repordno and filin° information, tee Mt sapante Permets instructions for Schadule K-1 and the instructions for your 'atome tu rature. 1. Calta buillnea booms :ose >et var • 'esta ba tirer 0,44) case rs rame. rc rll4 ab taon ana91040 ..sial laye Panamas %annale/03MB 2. a mal ne Sa bain Den 3. OONMNIIW Ølbil at 2140a NKbN 4, Guaraaid eyras 0. ara lame Os. Carry cintra Ø Cuira eedni. 7. Raya 5. eari.lern men en ;on, Os %el nier mole pir )044/ Ob. Colonies 0.4m)o•kl oomi, OC. laniend enta 1220 en IO. 1nt inee 1221 ar fa) 11 Oer hnonsuloss) Code A ce. comble ncem• Une • aranry arases C Sa 1220 cornas I. sine« D M nhp espbaten ~erratum E Craie= cldcl • Oar cars tut 12 Sera I79 aber '2. Olar defalone A Cie orebrorb 51714) • Que ccrebtial• /KM) C ‘orpte. catItufrore 03911 O Vasa convitutla (1011) Capa W n paerly 10 • 8014 caviar 00%) F Cao« en Ornely012091) • Centrbueone(WOM antan ara erra I DaKtIone • font/ rima 819,83/130(1)7) esperaltne K Damas • peren lexj L 0441..ceta - poralbefia M Non! Pari for aulal bene N anzeonet nesbent beau O Cserela nia Draa ' PrnaZI.C1Au pw11.1..asal O Carnet/ t/....neetn «taon henern -I ...nient ard • Fnammier aer-ce <Stace I Overr produe r sienne arrnourin U 0-na0vco-cOon /Lean bons  Evelpkry tee I ri W-2 «el W OOeØaow sael Osa the Erres Ineucaw Sohn/J0 E. 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Férus Far, !Olt lhiS ;Ivevor 4255 Sean ',hanses n't -.? rs 'a 1 ce, 2027 • Erm 8800 Ste a Piana nerveciris 2012.03030 SV »MICA HOLDINGS, LLC 3 7386.001 CONFIDENTIAL SONY_GM_00031944 EFTA_00142557 EFTA01280115 IT-SS 2012 Schedule IN K-1 State Form 49181 (R12/8-12) Indiana Department of Revenue Partners Share of Indiana Minted Gross Income, Deductions, Modifications. and Credit. Tax Year Beg' e elfl9 01 01 2012 sad Ending 12 31 2012 Name of Partnership Federal Identification Number SV AMERICA HOLDINGS LLC Oleldbitions - Provide INK-1 Meath partner. Enclose IN K-1 WM IT-65 return. For information on the acceptable assents data tile lomat, visi the DepartMents vitimite at wed win.00vidorf3772.htm Prorate amounts for lines 1 through 26 of any nonresident patina mast be mu tiered by the (ndiana edema nment percent, I/applied:A tom IT-65, line 4. Part I- Partners Ideillflestioa Section (a! If (farina Is an Individual (please pint c'early) Last Name: FER Name: al a2 a3 SOCL,11 &corny Ndrrter. (a) If Partner's en °tier Fmk/ (pease Dint deany) Federal Idendreation Number: iiarre: b I BLUE CHIP CAPITAL LLC C2 (c) Femurs Slate of Parldenm or Communal Domicil° c1 FL (d) Indiana Tax WitWleid for Nonrcsidert Partner (on W11-18) d .00 (e) Partnere Federal Pro Nan Percentage 3.60018.0 (0 Partner's Tax as Computed on I1.65COMP Column G .00 Part 2 • Distrketive Share Amount (use apportioned !Mures V nomesident partners) I. Ordinary business income (loss) 1280.00 2. Net rectal real estate Income (lass) -166.00 3. Other nct rental income (toss) .00 _ 4. Garanleed Palmas .00 — 5. Merest Income 66.00 6. Ordinary divaends . 0 0 7. Royailies .00 8. Net short-term capital gab (loss) .00 9. Net longterm caPM1 darn (ass) .00 10. Net IRC Section 1231 gait (loss) 3.00 II. Other income (MSS) .00 47. Inc Secton 179 expense deiuteen . 0 0 12a. Portion of expenses reared to investment portfolio Income, ott.rdingl-nestrrent interest expense and ether (federal nonnemiaed) deductions .00 13b. Oiler Trot maim from fro 20 01 federal K-1 related to 'nvestraut Interest and tapecoes net etewNere .00 fa Total pro rata distribettoos tAal fines 1 through II: subtract fines 12, 13a, and 13b when ape:male.) 1183.00 2502'1 12-S3 '2 1019 NMI MI i iIPuu Continued on next page Cu CONFIDENTIAL SDNY_GM 00031945 EFTA_00 142558 EFTA01280116 IT-85 2012 Sendai. INK-1 Page 2 Pals - State Modification A43 or &Moan the following. Designate no distibutive share amount of each modification for Indana adjusted gross ncome from the 2 on the hoot of For. IT-65. For nonstudents, aoPlY apportioned I tin. (Use a minus sign to denote negatMs amounts) IS. State wow Was deducted . 00 18. Net bonus depredation allciserice . 00 17. Excess INC Seclfun 179 deduction . 00 18. Interest on U.S. obigatiens . 0 0 19. AddbadoeeductIOn Coco: . 00 20. Adelina/Deduction Code. . 00 21. AddbatleDeduadcn Code: . 0 0 22. AdcbactuDeductIon Code: .00 2a Addbac/Dedoction Code: . 00 24. AildbackAleduclon Code: ______ .00 25. Addback/DeductIon Code: . 00 28. Addbaciveteduction Coda: 27. Total distributive Niro of medications (add lines 15 through 26 and catty tod to Column B on Schedue IT-65COMP) .00 .00 Put 4 -Pro Rita Won of Indiana Pan-throvsh Tax Credits front Partnership 28. Enter the name of die tax creds program, its dwetudign ID COCK and the dollar amount of the parolees distributive share for each allowable credit Name of Credit ID Code: a b c .00 .00 g h . 0 0 29. Total casothrough ("odds (add lines At, a% arid 28i) . 00 250212 NIL ,'INI I VIII kill all rill 1243-12 1019 136121210'19 I CONFIDENTIAL SDNY_GM 00031946 EFTA_00142559 EFTA01280117 NC K-1 (39) (D-403) 1C-11-17 For calendar year 2012 Partner's Share of N.C. Income, Adjustments, and Credits North Carolina Department of Revenue 2 012 or hscal year boptnnind Partner's Identifying Number Partner's Name, Address, and ZIP Code BLUE CHIP CAPITAL LLC 329 SEABREEZE AVENUE PALM BEACH FL 33480 and ending Federal Employer ID Number Pi dnership's Name, Address, and ZIP Cods SV AMERICA HOLDINGS LLC 42 HIGH TECH BLVD THOMASVILLE NC 27360 Partnership's Pro Data Share Items All Pe/there t. 3. 4 S Share of canrershlp income (loss) Additions lc income (.pm) a- Addition fa bonus derrectstion b. Other additions to income (loss) Deductions train ',come (ions) a. le:motion for bows doweation b. Other deduct:ins from Income (loss) Share of tax credits Share of tax %Infield from nonsapis compensation paid tor persona', services pertorned lo N.C. Nonresident Only 6. flonessident's share or L.C. !arable income (loss) I. Nonresident's Oars of net lax paid by dm manner of the pal teemtep Amount Individuals Filing Form 0-100 Eater Amount on; 46401 1363 'age 2, Line 35 0 Page 2, Line 36 0 Page 2, L 4/e 0 Dade 2, Line 49 0 Forma-40CE C 0 Page 2, I inc 23 35594 Pape 2, I ine 51 0 Page 2, L' 24c AFFIRMATION ATTACHED CONFIDENTIAL SDNY_GM 00031947 EFTA_00142560 EFTA01280118 NC- N PA (39) O-403 8-05 Nonresident Partner Affirmation io,;;;) .:arckna Doan meet pt Revenue 3 MooresId eat Partners Identifying Number f lonresident Partners Name, Address, aid ZIP cpds LOH CHIP CAPITAL LLC 329 SEABREEZE AVENUE BEACH FL 33480 Delo nomeoldent became partner le peraffitebio 12/20/11 Pennon Tax Year 01/01/12 12/31/12 beginning (MM-Cally aiding 01.44-DO-Y12 Partnership's Federal Employer ID Ile mho PIMesMlo's Name. Address rod ZIP COO AMERICA HOLDINGS, LLC LL4 2 HIGH TECH BLVD PHOMASVTLLE NC 27360 Partserstdp's Tax Year 01/01/12 12/31J12 beginning (MM-00-YY) ending (NM-00-YY) Wee of Partner: Q Ca/Morahan s Corporation 011 partnersito n estate or Trust (ntin applicable cackg Notn. 77uS form is not applicable ro nonresident partners who are individuals or grantor trusts. i I Mini that 1. The entity above Is a nonresident pa-Mer in the partnership sham above, and 2. I vnll frosty Me the cnntys applicable Income tax return and pay the tax iMpOSed by North Carolina on the eMitys share of the partnership incomt ffigeeture of Manager, Officer, or Fiduciary Mite I affirm mat he en. I ty above s a nom ident partner in Pie Nffneiship shorn above. Signatare of lifeeeplep Pettier Date General Instructions In a partnership having one or more nonresident partners. the tramping partner n responsible ter reporting the share of lie Income and paying rho lax due lot oath nonresident pa-trier. however, if the nonresident partner is a corporation, paMoishp, trust or mtge, the managing partner is not renueed to pay the tax on that partners share of the partnership inome provided the partrer tors Mrs Noerealdeet Partner Affirmation affirming that the partner vial nay the tax with its corporation, par An Uhl', halo; estate incorre :Wm. This form must oe attached Ic me par Inersenp return of the partnership shown ahem. (Motor Title form le not applicable to noorrieldent partnere vim are indivkleals or grantor ban.) Payment of the tax sue by she manapinp partner on behalf of corporadOrs, partnerships, busts Cr estates Malang partners does not relieve the partner from Itfrg a North Carolina tax return. 20464i 0501.12 CONFIDENTIAL SDNY_GM_00031948 EFTA_00142561 EFTA01280119