Text extracted via OCR from the original document. May contain errors from the scanning process.
651112
Schedule K-1
(Form 1055)
Department of the Treasury
Internal Revenue Service
oxiMg
Partner's Share of Income, Deductions,
Credits, etc.
Is See separate instructions.
'.dagencutrynt20/2, atm
year bolinr
2012
Information About the Partnership
A P
•
erldentratien number
B Partnership's name, address, city, state, and ZIP code
270 LAFAYETTE STREET SUITE 409
NEW YORK, NY 10012
C IRS Center where partnership fled Mum
E-FILE
a L7 Check If this is a publicly traded partnership (PIP)
NW Information About the Partner
Liter
F Partners name, address, city, state, and ZIP code
27 HIGH TECH BOULEVARD
THOMASVILLE, NC 27360
G t_J General partner or LLC
IL limited partner or other LLC
member-manager
member
N
0onestic partner
C] Foreign partner
11 What type of entkly is this pa rhter? PARTNERSHIP
12 If this partner is a retirement plan (IRNSEPAreogiVetc.), dieck here
J Partners share of mit, loss. and caPMII
Be0inning
Prat
1.3548951%1
BMW
1.3548951%
Lon
1.7482520%!
1.7482520%
aC
ts'
1.7482520%)
1.7482520%
K Partners share of kabllitieS at year end:
Nomecourse
2,609.
Qualified nonrecourse financing
92,108.
Recourse
0.
L Partner's capital acCoollt allaVsb:
Beginning repeal account
$
47,413.
Capital contributed during the year
11
Current year increase (decrease)
$
—13,943.
Wadrawars & distribudons
k
3,2904
Ending capital account
$
30,180.
Final K•4
I
I Amended K-1
0MB No.1545-0099
,
it Partner's Share of Current Year Income,
Deductions, Credits, and Other items
1 Ordinary business income (loss) 16 Credits
0.
24wwwmflomailow
—13,669.
3 Otter net rental income (loss)
4 Guaranteed payments
6 Interest income
Ba Ordinary dividends
58 Ouskted dividends
7 loyalties
8 tit short-term capital gain (loss)
9a Net longterm capital gain (less)
16 Foreign transactions
-±
17 Atonally* min tax (AMT) Items
2,024.
—6.
18 Tax-exempt Income and
"L nondeductible expenses
r
Tax basis
GMP
Li Other (ersolaln)
M Did the partner contribote property with a built-In gain or loss?
L— Yes
Moo
It 'Yes'. attach statemer.t (sea Instructions)
El Sedan 704(b)90k
91) Collectibles (28%) gain (loss)
9c Uinmeaptu red sec 1250 gain
10 Net section 1231 gain (loss)
—68.
11 Other income (loss)
2.
19 Olshtutione
3,290.
20 Other inforMation
_r
12 Section 179 deduction
13 Other deductions
I9*
STMT
14 Self-employment earnings (loss)
A
0.
'Sea
triads te
farad
on 1 informa on
8
Co; Ca-IS LHA For Paperwork Reduction Act Notice, see Instructions for Form 1086.
IFISGovirorm1085
08320312 758241 21146.213
Weenie
(Form 1000) 2012
6
CON
FILDIENT
A
tOSSING, LW 21146 Al
SDNY_GM_00033079
EFTA_00143692
EFTA01280219
SCHEDULE K-1
OTHER DEDUCTIONS, BOX 13, CODE W
DESCRIPTION
AMOUNT
ACCOUNTING FEES
15.
MISCELLANEOUS
4.
TOTAL TO SCHEDULE K-1, BOX 13, CODE W
19.
SCHEDULE K-1
GAIN OR LOSS, BOX 17, CODE B
DESCRIPTION
AMOUNT
SEE FORM 6251 INSTRUCTIONS
-6.
TOTAL TO SCHEDULE K-1, BOX 17, CODE B
-6.
SCHEDULE K-1
NONDEDUCTIBLE EXPENSES, BOX 18, CODE C
DESCRIPTION
AMOUNT
SEE IRS SCH. K-1 INSTRUCTIONS
PASSTHROUGH
2.
TOTAL TO SCHEDULE K-1, BOX 18, CODE C
2.
SCHEDULE K-1
DESCRIPTION
SECTION 1231 GAIN (LOSS)
SCHEDULE K-1 INCOME SUBTOTAL
SCHEDULE K-1 DEDUCTIONS SUBTOTAL
NET INCOME (LOSS) PER SCHEDULE K-1
AMOUNT
TOTALS
-13,669.
-68.
-19.
-2.
-13,737.
-19.
-13,756.
PARTNER NUMBER 6
08320312 758241 21146.213
CONEllbrNtrA
CROSSING, LLC 21146_Al
SDNY_GM_00033080
EFTA_00143693
EFTA01280220
-198.
13.
-187.
TOTAL TO SCHEDULE K-1, ITEM L
-13,943.
PARTNER NUMBER 6
08320312 758241 21146.213,..ANciblE1/411gYfROSSING,
LLC 21146 Al
SDNY_GM_00033081
EFTA_00143694
EFTA01280221
SONIC& K-1 (Flinn 1065) 2012
• Page 2
This list Identities the codes used on Schedule K-1 for all partners and provides summarized reporting Information lor partners who file
Form 1040. For detailed repotting and thing Information, see the separate Pannen Instructions for Schedule K-1 and the Instructions
for your Income tax return.
O-diroy o7sness roond era Cohen de Mee!~ le iroodle (weal is
«ink'« rosate* end &ter or yn,r ree.
:Co fd Ode.
Pooh** too
~Ho IrEeno
None/too cis
Noemove -tome
2. Detract/0o rerrO;ncorge (oes)
•
03. OP nob hone toe)
Net Income
\ et Ode
4. Gored Ord Pf/T4'11,
C. Intro: Moro
es. CoIntry °Nerds
eb. Doted OV.Orde
•
hcolto
8
\et shc,!.!rrr, Cdeldf Cde Cc.*
ate,
ge I (ON
Ob. Coiectles OW gel Neel
Pe. UnnewLmc seabed 260 ge
W. NE octlen 1231 gage WO
11. Cas &mum glos)
Code
A Cdher m11/460 bone POO
B Irmelotary Of Melees
C Sc 12s3 codecte roc es
ID Marko ~radon mete retaohre
E Cenceánter c' MC:
Ors! wore does)
12. Snnol 179 corwwen
Other deCu011One
A Corn cow' ocdos ro3%)
B Coe contitatices pou)
c \onme cormarsprei roose
13 honors OCeMbutCns (30%)
E Caiole ddr property te e 5.)94
meeedeCedOOW
F Card on oniony 20%;
G Caw ed:bneel33/1)
14 nos:rent a- one expense
I
De:Lorene - Mealy $03,To
J Seceol 430.3/ alordfLI1d
K Drethoenno porrelki (214 'cot)
L Deduontne - Carona lotto)
Arroan pdd
Todd& Moro
N Edocatand ~lame bernite
O Dependent ore borers
P PrenrodooLve doled express
O Commettla rote taken dedocebn
kern MnronY real rate rota lies
▪
Noon* ere Roe
S fieteettel en axone oedwrinr
T
Dernbalc proc.otan ecEdues
Wormelem
J Ora fled redo:on ;whaled hai-ane
Employes Fern W-7 ogee
W Cnter dedurelo-s
Paco:. on
Sen ne dtetlef • eadIC1010
Sededule E. Ire 25 cc ern (go
SEC. *DO E. Ire 28 coin! Di
Utedule E. ne 78, °Oro (2
•
te Pitied* Vend:tee
BOO. • E, Md2a, O Jrm (og
Se* Of direlsoli
ScheduleE. Ina 2$ OCiarne:
Fo-rn 1040, I rno ea
Font 151.0, ilns as
Form 1340, One Do
Sena • E, Ono/
&hole • El, Mee
SetedUes 0, to 12
28% nee CM Waterer, ere 4
c• ledule13 Ins:meda)
See to Panner's keno-lore
See to onetetrallordoes
See he Patmee • tetrads.
Sea to Penns?, '.edr.stiCele
Fcm1678' line'
See PA> 535
corn '040. no 21 or f.crri 932
See Pe Penroe dsbLotoo
See the Partners hetwankes
See be
Ins:voters
corn 4952 Oro 1
get ode. E, We 19
Seethe Ponno's Instrootlem
sclOwe A ire 23
Soled de 11. '1e28
Schoch A. . -nr of For '040. Ina 29
Bee he Pettier a of:oleos
Form 2441, ere la
See he Partner's Insoteatlens
So Fenn b62 dOlvdene
See tie Partners leatAmtbre
See ns Pretrets -00votene
See cone 8903 Irdhogene
Fern SSW, lln7b
Dam 5903. One '7
Son
PartnwIr totwoSone
14
Salt oWkorgen1 earn I xis goon
%co If you hem a eactoi 179 deducdon or ary pryer kod deducaens. see
Me ~ono rehactlme begot cemOrt ng When* SF.
A Net eertip, Coo) Yon
stV-rep
B Gross lenig er merry Stone
C Goo ron-!sen Irate
IS Codes
A LoOeineade betting «edit
Henke 420150 Fran pre 3008
bull~
B 1 ow-Incen•nolnindoc11:(oto)
*OM on-not &deign.
C Low-lreame hoo1na erode:mien
421159 groin post-200'7 :7401r9*
O Lor "care Jansen eneget Fond
non port-21;07 be
E On led -boo testico ooreireres
Field red sited
F °tor nine reel eratererodO
O Oein-^eedlOte.ta
H
+A betted ~del Ons odd
'
kernel end cielh ca0 &OM ruas
rc:t
711222
01-C3-13
Schedule SE Sevtr Ace
See the coon's kedructlors
See the %tames hoodlum
See he NOW* ~not ons
For 1343, nne
creed to
Soft POMP. Innualors
Cede
Pegen
•
Wo.d 0000'd.
Cidde
K
Dhoblerc exam creel,
•
Erocrordird 70f Dee neeirdd
edewurry etrolnynen1 coca
M Cott Cot Irons eg mooch
Whiter
N Croak et• ~owe wool eteXiety
old 1t*Derre teas
O Bea" wig OWN
P C!re Credits
It
%Midi bireadbas
A Mr* Of medley ee
PaCeaealM
B Goa Meer» bye SI some
C Grose Horne ward et perloy
Foredo wee dotelfe sourced at patient p erred
F Othre
L
~got
U
eetrOh'
Deduclens alkeLtled and ecparJeew re panne' mw
CY
',doe: open»
on Olio
Dec actors Woad ere moot!~ et ponentle
Intone
I
Pooh. category
J Ornot °Megan
< Orde
Catter.aberaeor
L
boy ham pao
M Tote knew Sae decrad
N Medea-We In twee Bedded Oar Credit
O Foreign OwOrg roe ~Ws
P ]IOabrtaa'ir,dpry,9exeusbn
O Chrenkmean trimmillor •
17.
Altar salvo rehintern tax (Ain) ;Here
C 3wWlon father !tan et dos)
D Ca." Egooderea on home
get I ~ors
dedoctans
•
OtherAM• hems
A Pos1-19138orodalket Oustncrot
9 Adjudge gale or OM
la
Tomcat-rot incone end nondealaL
woes
A lexoerpt HOW none
B Cenze tetaracenot none
C Needed needle expense
ie. DletrOutOre
A Use and maltetable seetrlace
•
Ystr coder alleged !cr oo:kei 737
C OtWoropody
20
Other Infeenerne
A Inwetnent :roan,
B leveentided Otedetre03
C Fun tax cred". ~Or
•
Ohellied onetrietaloi etendEen`a
Haw Der orb rel otehg
E Ran Melon own
F ~Ode ale* wane -outing
~WOO« 44150
G Drool" orlavolreow toeing
Credit end,
H Hoopoe or .nennnert COS'.
I
Ree4pla Of oriel derte
.1 lociotack 'tweed complain
long- oil ounneets
< -oak- deck Wane! -lane Wooer
netted
L Ulapohon of piton. one
riodlon 1/9 Ow :Begone
81 Groapl,o ~SI
Fig oeckecten
\' 1r Went «pree for coots:* mews
O Socion 453(.Y0; ilernman
1r Settler 46.3.4k) Worrogar
O Seeger 12003» Wong«,
Ti Intro' Mottle la weelacten
~arrow
S CCF ronqualirOvelherewes
T 2.•Hotonlneweet.or • ne IOC ote
U Arne-Anton of recerestclee cots
Unfolded business Home node
W Porno-Irma Or Or ,keel
X Seakn'C8711rberMO
Y Odor One on
•
Ske the Peter's cor.itorns
}
Font 1110, Pet 1
Poo 1116, Per.
Frio 1114 Poll
Porn 1118, Poll
1.0 IOW Owes
} For 1110. Peril
For 11, 6, news
Few tilt Pole
Ertl" 18. do 12
Fenn $573
Fornsen
sae tlp Part-ote I nstamtiene
See he Prods
oboe ens end
kn Inetwelkne
Ern. MI
reoirC43. lino Cc
Wee he Pal note nstrooder.
See It,. Pathos .re'rJet one
)
See be Panned* hele.clone
1
08320312 758241 21146.213 ce5Kirrn
Y Tr/XI:ROSSINC ,
rani 4982. .'0 de
Coen 4902. Hr.* 5
Fenn 4135
See the Pat's a .nsletacree
See the vat. Inf 'owe erte
Ferri $611. got
Fen sty
Se* Porn 4266
ach be carine+3 bereaves
See Fear 9697
So Eon" gated
See
Panen4tt
Ireuctkrne
6
LLC 21146_A1
SDNY_GM_00033082
EFTA_00143695
EFTA01280222
6
SCHEDULE
NJK-1
(Form NJ-1065)
2012
PARTNER'S SHARE OF INCOME
For Calendar Year 2012, or Fiscal Year Beginning
_
2012 and ending
PART I
General Information
Parhoss SS. r Email EA
20-3161309
Pmfremhirs Nelerai EIN
45-3131018/000
Panacea Kam
Pahrokes Nemo
MAE Mime
27 HIGH TECH BOULEVARD
Pammist.p's Some/awn
70 LAFAYETTE STREET SUITE 409
cl,
as.
ZP Gem
THOMASVILLE, NC 27360
City
Stet
za, C0Je
EW YORK, NY 10012
What type of entity is partner i
NP
Enter Partner's percentage of:
(See instructions)
Code
Data Partners interest in Partners,* began:
0 8 / 1 7 /201 1
(I) Before Decrease
(I) End of Year
or Temanation
Profit Sharing
1.3548951 %
1.3548951 %
Mmh Ory
Wm
Loss Sharing
1.7482520 %
1.7482520 %
in Final KIK-I
Hedge Fund
Capital Ownership
1.7482520 %
1.7482520 %
Amend d NJK-1
Member of C m os 4 Return
PART II Income Information
income Miele:anon
I
41.140411 Pig
8.
A. Total Ditirlavtloo
EnlorAmounto on
Line Shown Below
New Jersey
Source Amounts
NJ-1040NR Filen
1 „Partnership Income gossi
d.aen2 .iI
-1
2. Net Guaranteed Payments
3. Partners 401 ) Contribution
4. Distributive Share of Partnership
Income (loss)
Une 1 plus Una 2 minus Una 3j
—13,732.
Line 20. Page 2
i.,:le 22 P2ge 1
5. Pension
Line 19, Page 2
1
6. Net Gain (loss) from Disposition
of Assets as a Result ot a
Complete Liouldelon
Line 1B,Page 2
Line is. Page 1
PART III Partner's Information
I. Nonresident Partner's Share of NJ Tax
1.
Line 10a, Page 1 CST-100
tine 10a, Page 1 COT-700S
Line 8, PART-100
Ilse 46, NJ-1040NR
Lhe 22 i.I-1080C
Line 31a, W-104 I
2. Partners HEZ Deduction
q,
vas'
3. Partners Sheltered IP/OrathOo Tax Creak
' 1019
2ant.1
12.Ch i
08320312 758241 21146.213 coNnuarvistALRossiNG, LLC 21146_A 1
SDNY_GM_00013083
EFTA_00143696
EFTA01280223
45-3131018
NJ NJK-1
DESCRIPTION
AMOUNT
TOTAL
0.
NJ SECTION 179 DEDUCTION ALLOWABLE
0.
0.
SUBTOTAL
0.
NJ ADJUSTMENT TO FEDERAL 179 RECAPTURE INCOME
0.
0.
SUBTOTAL
0.
23.
PARTNER NUMBER 6
08320312 758241 21146.213 (::(!pqr21101E!1‘1-15f)5LROSSING, LLC 21146 Al
SDNY_GM 00033084
EFTA_00 I 43697
EFTA01280224
New Ycrk State Department of Taxation and Finance
2012
New York Partner's Schedule K-1
Tax Law - Article 22 (Personal Income Tax)
IT-204-1P
6
Final K-1
For calendar year 2012 or tax year beginning
0 1 0 1 -2 0 1 2 and encins
12-31-2012
Amended K-1
Partners: Before completing your Income tax return, see Form IT•2344P4, Partnera Instructions for Form IT-204•IP (avalabk at www.tetuw.gov).
Partnership's Information (see instalcUons)
Partnership's name (as shovm on Fcrm IT•204)
Partnership's EN
45-3131018
A Mark an X in the box if either applies to your entity
IT:
PublIGy traded partnership
L3
Portfolio Investment partnership
B Tax shelter registration number, If any
C Business allocation percentage
Partner's information (see hi/ructions)
Partners name
Partner's address
27 HIGH TECH BOULEVARD
City
State
THOMASVILLE
NC
ZIP code
27360
Partner's identifying number
20-3161309
D The partner Is a hieli a, ark. s 000prn btu)
1: 1_
General partner or LLC mernbermanager
X
Limited partner or other LLC member
E What le the tax filing status of tne partner? ern el X ht,. &layoff Ma box 'felon.)
El Individual
J Estats4rust
al
Partnership
F If the partner is a disregarded entity or grantor trust,
enter the tax 10 of the entity or individual reporting the income, If known
0 Did the partner sel its entire Interest during the tax year?
O
Yes 0
No X
H
i
Partner's share of profit, loss, and Capital
1) Profit
2) Lose
3) Capital
Partners share of liabeties at the end of the year
Beginning
Hi
1.3549 %
142
1.7483 %
H3
1.7483 %
Encino
1.3549 %
1.7483 V.
1.7483 %
1) Nonrecourse
It
2,609.
2) Qualified nonrecourse financing
12
92,108.
J
3) Recourse
Partner's capital account analysis
1) Beginning capital account
13
J1
47,413.
2) Capital contributed during the year • cash
3) Capital contributed during the year - property
4) Current year increase (decrease)
42
J3
44
-13,943.
5) Withdrawais and cfistributIors - cash
a
3,290.
6) Withdrawals and distnbutions • property
7) El ding capital account
,p;
J7
30,180.
8) Method of accounting (mcvk an X in the appropliste box)
IX
Tax basis
L__I
GASP
0
Book
0
Other (submitexp/anatIon)
K Resident status (mar* an X in as boxes that appl0
li
NYS full-year resident
U
Yonkers ful•year resident
fl NYC full-year resident
O
NYS pallear resident
I—J
Yonkers pan-yew resident
0
NYC part•year resident
DC
NYS nonresident
L 7 Yonkers nonresident
L If the partner was included In a group return, enter the special NYS identlication number, If known
•
118001121019
III IIII III 10111111
HI 111 I III II 111
CONFIDENTIAL
SDNY_GM_00033085
EFTA_00143698
EFTA01280225
Page 2 of 4
IT-204-IP (2312)
M 1) Was Form I-1.266SE filed with the partnersh:p?
2) Was Form MTA.405-E Wed vAth the partnership?
N NYS estimated tax paid on behalf of partner (from Form IT-2658)
Date
Amount
1) Fest Instalment
2) Second Installment
142
3) Third installment
NI
4) Fourth Installment
N4
Total NYS estimated tax paid on behalf of partner (add Ines NI through N4)
0 Estimated MCTMT paid on behalf of partner (from F0IMMTA-405)
Date
1) First Installment
01
2) Second installment
02
3) Third installment
03
4) Fourth installment
04
Total estimated MOTMT paid an behalf of mew; (add inn O1 Utrough O4)
0
Amount
Partner's share of income, deductions, etc.
A - Partner's dishibutive share Items
1 Ordinary business Income Goes)
1
B - Federal Kel amount
1
C - New York State amount
2 Net rental real estate Income Oces)
2
—13,669.
2
3 Other net rental income (loss)
3
3
4 Guaranteed payments
4
4
5 Interest income
5
5
8 Ordinary dMdends
6
8
7 Royalties
7
7
8 Net ehort-term capital gan (loss)
8
8
9 Net long-tern capital pain (toss)
9
9
10 Net section 1231 gain Qom)
10
—68.
10
11 Other income Oces)Identify:
11
11
12 Section 179 deduction
12
12
13 Other deductions identify.
SEE STATEMENT
13
19 .
13
14 Tax preference items for minimum tax
kktntifr
14
2,018.
14
15 Net earnings (loss) from self-employment
15
15
16 Tax-exempt Income and nondeductible expenses
16
2.
16
17 Distributions • cash and marketable securities
17
3,290.
17
18 Distributions • other property
18
18
19 Other items not Included above that are required to be
reported separately to partners .
19
19
Identity:
M1 Yee E1 **El
M2 Yee 0
No C
Partner's share of New York modifications (sse instructions)
20 New York State addtt ions
Number
A - Total amount
8 - New York State allocated amount
20a EA-
16
133.
133.
2% EA-
20c EA-
20d EA-
20e EA-
201 EA-
21 Total addition modfIcationa (total of colUmn A, lines 20a through 20f)
21
133.
118002121019
288602
11,19-'2
CONFIDENTIAL
SDNY_GM_00033086
EFTA_(() 143699
EFTA01280226
11-204-IP (2012)
Pago 3 of 4
Partner's share of Now York modifications (continued)
22 New York State subtractions
Number
A - Total amount
22a ES-
21
110.
22b ES-
22c ES-
22d ES-
22e ES-
22f ES-
- New York State allocated amount
110.
23 Total subtraction modifications (total of COkintn A, lava 22a through 220
24 Additions to fedeal itemized deductions
toner
Amount
24a
24b
24c
24d
24e
24f
23
110.
25 Total additions to federal itemized deductions (add Cries 24a through 240
26
28 Subtractions from federal itemized deductions
Letter
Amount
26a
26b
26c
26d
26e
281
27 Total subtractions from federal itemized deductions (add Ones 26a through 26!)
27
28 New York adjustments to tax preference Item
28
Partner's other information
29a Partner's share of New York source gross income .
29e
29b MGM allocation percentage (see Instructions)
29b
Partner's credit information
Part 1 - Flow-through credit bases and factors
Brownfield redevelopment tax credit (Form IT-611 or IT-611.1)
A - Form IT-611
B - Form I7-611.1
30 Site preparation credit component
30
30
31 Tangibre property credit component
31
31
32 On-site groundwater remediatica credit component
82
32
118003121019
Gill
211891
11-19-12
CONFIDENTIAL
SDNY_GM_00033087
EFTA_00143700
EFTA01280227
Page 4 of 4
IT-204-IP (2012)
Partner's credit information (continued)
EZ capital tax credit (Fenn IT-602)
33 Contributions of money to EZ community development projects
33
34 Recapture of credit for investments in certlfleo EZ butheeses
34
35 Recapture of credit for contributions of money to EZ community development projects
35
QEZE tax reduction credit (Form IT-604)
38 OEZE employment increase factor
36
37 QEZE zone elicitation factor
37
38 QEZE benefit period factor
36
Excelsior fobs program tax credit !Form 17-607)
39 Excelsior jobs tax credit component
30
40 Excelsior Investment tax credit component
40
41 Excelsior research and development tax credit component
41
42 Excelsior real property tax credit component
42
Fanners' school tax credit (Form IT-217)
43 Acres of qualified egricuitural property
43
44 Acres of qualified conservation property
44
45 Eligible school district properly taxes paid
4$
46 Acres of qualified agriculture/ properly converted to nonquaRlied use
46
Other flow-through credit bases and faotore
Credit bases
Code
Amount
Code
Amount
47a
474
47b
47e
47c
471
Credit factors
Code
Factor
Code
Factor
Code
Foolor
47g
47i
47k
47h
47j
471
Part 2 - now-through credits, addbacks and recaptures
48 Long-term care insurance credit (Form 1T-249)
as
49 Investment credit (Including employment incentive credit and h(stork barn rehabiltadOn credit• Form/T-212)4g
50 Research and development - investment credit (Form?-212)
50
51 Other flovethrough credits
Code
Amount
Code
Amount
51a
51e
51b
51f
51c
61g
Sid
51h
52 Addbacks of credits and recaptures
Code
Amount
Code
Amount
52a
52d
62b
62e
52c
52f
118004121019
III Oil Ill I IIl F II III II I IF II III
288802
11-'9-12
CONFIDENTIAL
SDNY_GM_Coo33088
EFTA 00143701
EFTA01280228
45-3131018
NY IT-204-IP
DESCRIPTION
ACCOUNTING FEES
MISCELLANEOUS
TOTAL TO FORM IT-204-IP, PAGE 2, LINE 13
AMOUNT FROM
NEW YORK
FEDERAL
STATE
SCHEDULE K-1
AMOUNT
15.
O.
4.
0.
19.
0.
PARTNER NUMBER 6
CONFIDENTIAL
SDNY_GM_00033089
EFTA ((1143702
EFTA01280229
NC k-1 (39).
(D-403)
10-I1-12
2012 Partner's Share of
N.C. Income, Adjustments, and Credits
North Ca roina Department of Revenue
For calendar year
or fiscal year beginning
Partner's (dent ying Number
203161309
Partners Name, Address, and ZIP Code
27 HIGH TECH BOULEVARD
THOMASVILLE NC 27360
01 01 12
and ending
12 31 12
Federal Employer ID Number
453131018
Partnership's Name, Address, and ZIP Code
270 LAFAYETTE STREET SUITE 409
NEW YORK
NY 10012
Partnership's Pm Rata Share Rams
All Partners
1. Share of partnership income (loss)
2. Additions to Income (loss)
a. Addition for bonus depreciation
b. Other additions to inoorne (loss)
3. Deductions from income (loss)
a. Wooden for bonus depreciation
STMT
b. Other deduction from income (loss) STMT
4. Share of tax credits
5. Share of tax verthheld from nomvage compensation
paid for personal services performed le N.C.
Nonresident Only
6. Non reskleN's share of N.C. taxable Income (loss)
7. Non resIder.t's share of net tax paid by the manager
of the partnership
Amount
Individuals Filing Form
D-400 Enter Amount on:
-13737
133
Page 2, Lhe 35
0
Page 2, Line 96
110
Page 2, Lire 44e
19
Page 2. Line 49
0
Form D-400TC
0
Page 2, Line 23
0
Page 2. Una St
0
Page 2, Line 24c
"2-2n.12
CONFIDENTIAL
SDNY_GM_00033090
EFTA_00143703
EFTA01280230
45-3131018
NC SCH K-1
DESCRIPTION
AMOUNT
15
4
TOTAL TO SCHEDULE K-1, LINE 3B
19
NC SCH K-1
DESCRIPTION
AMOUNT
ADJMNT FOR 1ST-YEAR DEPRECIATION ADDED BACK IN 2011
110.
TOTAL TO SCHEDULE K-1, LINE 3A
110.
PARTNER NUMBER 6
CONFIDENTIAL
SDNY_GM_00033091
EFTA_00143704
EFTA01280231
6
PARTNER'S SHARE OF SOUTH CAROLINA
For calendar year 2012 or tax year beginning
0 1/01/12
Partners identifying number le 20-3161309
Partners name, address ar.d ZIP code
27 HIGH TECH BOULEVARD
THOMASVILLE, NC 27360
Check If applicable'
(1)
Final K•1
Partners Share of Current Year
Income, Deductions, Credits, etc.
B
1 Ordinary business Income (ices)
2 Net rental real estate Income (Ices)
3 Other net rental Income (loss)
4 Guaranteed payments
5 Interest income
6 Dividends
7 Royalties
8 Net short.terrn capital gain (loss)
9 Net long-term capital gain (ices)
10 Net Section 1231 gain (loss)
11 Other Income (loss)
12 Section 179 deduction
13 Other deductions
SEE STATEMENT
Amended K1
(A)
Federal
kl Amounts
and endno_
SC1065 K-1
(Rev. 5/27/11)
3515
12/31/12
Perbtereblpie REN
► 45-3131018
Partnership's name, address and ZIP code
270 LAFAYETTE STREET SUITE 409
NEW YORK, NY 10012
(3) W Nonresident
(B)
Plus or Minus
SC Adjustments
STMT
Amount Not
Allocated
or t.t Wed to SC
1
1
II
II
e
PI
I! II
II
PI
MN=
I
I
a
PI
PI
Pale"
PI
-681
—13,669.
19.
30.
CD)
Amounts Alloceled
("Apportioned to SC
—13 639.
10
—68.
19.
14 Withholrino tax for nonresident partner
15
1 16
List applicable South Carolina two credits. (Attach an additional sheet If needed.)
17
18
19 Total South Carobs tax crenate
14
16
to
17
18
0 .
L
35151018
27701 SII-Ce-12
J
CONFIDENTIAL
SDNY_GM_00033092
EFTA 00143705
EFTA01280232
45-3131018
SC SCHEDULE K-1
SCHEDULE K-1 ADJUSTMENTS
LINE NO.
DESCRIPTION
AMOUNT
LINE 2
TOTAL OF FORM SC1065, SCHEDULE K-1, COLUMN B
30.
30.
SC SCHEDULE K-1
DESCRIPTION
COL A
COL B
COL C
COL D
19.
0.
0.
19.
COLUMN TOTAL
19.
0.
0.
19.
PARTNER NUMBER 6
CONFIDENTIAL
SDNY_GM_00033093
EFTA_00
I 43706
EFTA01280233
CONFIDENTIAL
soxy_Gu_aansom
EFTA,I037.
EFTA01280234
5
651112
Schedule
(Form 1066)
Department of the Treasury
internal Revenue Servtx
cot iudennt yoar 1Cl2
rot oe‘Irnir,
2012
Partner's Share of Income, Deductions,
Credits, etc.
lo.8as separate Instructions.
Information About the Partnership
A Partnership's employer kienbficaben number
45-1814195
8 PartneMiltka name, addmssAnty. Mal& and ZIP code
270 LAFAYETTE STREET STE 409
NEW YORK, NY 10012
C IRS Center where partne "hinged return
E-FILE
D Q
Check 11 this is a publicly traded partnership (rill))
nit
11
Information About the Partner
E Partner's identifying number
20-3161309
F Partners name, address, city, state, and ZIP code
27 HIGH TECH BOULEVARD
THOMASVILLE, NC 27360
G
General partner or LLC
QC Limbed partner or other LLC
member-manager
member
H
Domestic partner
Q
Foreign partner
II What type of entity is tht partner? PARTNERSHIP
12 if this partner is a retirement plan (IRAISEPrKeog Nieto.), check here
J Partner's share of profK, loss, and Cavite
Beginning
Prof*
1.3478261%1
Loss
1.7391304%
captai
1.7391304%
K Partners share of Malt* at year end:
Ending
1.3478261%
1.7391304%
1.7391304%
Nonrecourse
2,844.
oualified nonrecourse financing
9
104,518.
$
O.
Recourse
L Partners capital account analysis:
seafood capWaccount
42,061.
$
$
—5,531.
27,0904
Ending capital account
9,440.
Capital contributed during the year
Current year increase (decrease)
Yhthdrawals 8 distributions
CE Tax basis
I.
OAAP
0
Other (ercelain)
Ill Did the partner contrioute properly will a buk-In gain or loss?
0
Yes
IX No
If Yes', attach statement (see Instrmtions)
a co. re LHA For Paperwork Redaclion Aet Notice, see instructions for Form 1080.
iRSdovilorm1065
Section 704(b) book
L. Final K-1
E.: Amended K-1
OMB kb. 1545-009
,
;.pattilli Partner's Share of Current Year Income,
Deductions, Credits, and Other Items
15 Credits
1 Ordinary business income (loss)
0 .
2
ot rental rah eaNt• tona(lose)
—5,205.
3 Other net rental income (loss)
16 Foreign transit:none
4 Guaranteed paynr.ts
5 truest Income
Ordinary dividends
Ob Ouallled dividends
17 Alternative min tax (NAT) kerns
1 252.
8*
-21.
F*
7 Royalties
8 Net short-term capital gain (loss)
9a fir long-term Capital gain (loss)
9b Coilecttles (28%) gab, Coss)
9c Unrecaptured sec 1250 gab
18 Tax-exampt Income and
nondeductible expenses
1 .
19 TrIeMbutiors
27,090.
20 Other Intonation
10 Net Wan 1231 gain (loss)
—185.
11 Otheancome (loss)
12.
12 Section 179 deduction
19 Other deductions
L*
W*
12.
STMT
14 SelhemMOYment °amines90m)
0.
*Sea Mood statement for additional IlltOrMeOn
I
Schedule K-1 (Form 1066) 207E
15450311 758241 21146.210 CONFEIDENTIAL
AS LLC C/0 blIsap ott ea
s
EFTA_00143708
EFTA01280235
45-1814195
SCHEDULE K-1
OTHER PORTFOLIO DEDUCTIONS, BOX 13, CODE L
DESCRIPTION
AMOUNT
SEE IRS SCH. K-1 INSTRUCTIONS
12.
TOTAL TO SCHEDULE K-1, BOX 13, CODE L
12.
SCHEDULE K-1
OTHER DEDUCTIONS, BOX 13, CODE W
DESCRIPTION
DISTRIBUTIONS
MISCELLANEOUS
AMOUNT
YOUR RETURN
135.
4.
22.
TOTAL TO SCHEDULE K-1, BOX 13, CODE W
161.
SCHEDULE K-1
GAIN OR LOSS, BOX 17, CODE B
DESCRIPTION
AMOUNT
SEE FORM 6251 INSTRUCTIONS
-21.
TOTAL TO SCHEDULE K-1, BOX 17, CODE B
-21.
SCHEDULE K-1
ITEMS, BOX 17, CODE F
DESCRIPTION
AMOUNT
SEE FORM 4626 ACE WORKSHEET
INSTRUCTIONS
12.
TOTAL TO SCHEDULE K-1, BOX 17, CODE F
12.
PARTNER NUMBER 5
15450311 758241
21146.210CON
PPDENTIALAS
LLC C/O MI 21146 91
SDNY_GM_00033096
EFTA_00 I 43709
EFTA01280236
45-1814195
SCHEDULE K-1
NONDEDUCTIBLE EXPENSES, BOX 18, CODE C
DESCRIPTION
AMOUNT
SEE IRS SCH. K-1 INSTRUCTIONS
PASSTHROUGH
1.
TOTAL TO SCHEDULE K-1, BOX 18, CODE C
1.
SCHEDULE K-1
DESCRIPTION
AMOUNT
TOTALS
-5,205.
SECTION 1231 GAIN (LOSS)
-165.
SCHEDULE K-1 INCOME SUBTOTAL
-5,390.
-12.
-161.
SCHEDULE K-1 DEDUCTIONS SUBTOTAL
-173.
NET INCOME (LOSS) PER SCHEDULE K-1
-5,563.
-1.
-36.
19.
-74.
124.
32.
TOTAL TO SCHEDULE K-1, ITEM L
-5,531.
PARTNER NUMBER 5
15450311 758241 21146.210 CONFIDENItAt
LLC C/O MI 21146 91
SDNY_GM_00033097
EFTA_00 437 0
EFTA01280237
5
SoletureS-1 (ForrnIC65) 29'2
Papa 2
This list identirres the codex used on Schedule
for all partners and provides sommarized reportIng Information lor partnere who Ille
Form 1040. For detalled reponIng and fliing Information, see the separate Partners Instructiont lor Scheture K•1 and the etstruclions
lor your Interne tax return.
'
assy erts
leoorre par) %erm
ul•thw ne iØe
tes; 3
pa** ot nerteerve end enser yen. nrem es tellaire
Pren oas
Pese ve Sirs
Noreats• b.
Nr es ni Sir
9
Apa
'ml SMS Inerre(ter
3. ~ner
renter Pose (eee)
Net :Ø
Seise
4. GutranSe pet/7• 74
6. Iren« Isne
•
OrnIrery <Mana
90
Cralerl Stemde
7. Royalls
8. Nanna* torn tapre/ 901 NS
9a Nm bus trrue CeN191 gein ecule)
9b.
Cksilacibk83 (29%; 9e9" 3e«
ge
wW.L.90 ~on 1260 9.1,1
10. X« ~ku 12719x1 eter
11. Oter lesne Os:
Cede
A OSP ponlolie no:miss
"v.:luntar/ corveralors
C Sec 1256 stare & seeren
3
71år i eg exproreeor
0cepairs
E ~Atal
ol død
-
Otre res30,119 (13«
12
See9er -19ar11.Cer
13
Olher ducludons
A Cent, rettare
(50%)
•
Caen ecnellnllos P0/4)
C Nonner carte bils ffl0313
D norner rele *Ser 20%)
E Gnette gele preprey te • 90%
ergeSzet
(30e9)
F Cinet gein preptry^
G CortrIbuiles (1X94)
H Inneber lertart =pers
I
Descekrna - royalty Insdne
J 9suilre 15~)etatur<atios
K %duellar, :officio CP% lbaae,
Defuelrots »Se (Sal
14 Ansees pele Sirs en reurence
N Educabored mais:~ ~Pi%
O %priori dr* benellea
P ~ecry*
perto3 «perm«
•
Orneeltele rerteltratlen den Sen
from retel sinns SMS
R "es Se SI Se
3 ttebreetatIon eXperrie deductn
:;arele 3,00 JellOn ~Sn
etorrnotIon
J Orelleacl preselen sters Isne
Fseyernr Forn W•2 sir*
W Otenteeduriene
Flest ei
See the Pairer* inseriens
&nedre E 11.19 28 Sure 1m
~ME
em 29 Murre per
~ia
E. Ona 28 Surr C
Sea te Patere Inntrer«
&Seie E, Are 29 telen, ø
&e en ~9
InITLICCOM
SetsJ • E, ka 29 orre Q;
Form 1940, lira&
Familie" Ona Sa
Forn 1040, ku 90
er40:4eE,Yed
tlehects 0. ene
•
54.1.6a• 0. ene 12
28% Fr. Gir Vielser, He 4
Feehedule 0 Inestere1
Srie Vie ~a
Inatrucdoes
8.94 Patrer • Irceuctbra
Bere ts Paret. IS/0S«
8•• Vi Parbal* IneScteare
Feen (1781, ne I
Sea kn. sa
Ferm 1040, Sn 21 nr Fer. 982
See M Parteer ermer
S. Ihe Prege I snertes
I
Sn th e Peses lensens
Feen eke, Ilne 1
Sc1.90J • E. IMe 19
8.91,14,Ntedu Irwtnectcne
SchedJ e A 8e23
Schrina A IS 28
541.611•Allerr1 ot Ferm 1040, frre 29
Setrer Parteres k-tese:ny
Felle 2447 as -2
Son te* Perterastesires
Sn Fart 8332 ~st an
9.moPreWtkstrucw.n
Sea MPresh Irtelsratne
Sen Ferm 8036 wkxena
Ferm 8903, liren
Fare 8303, Nila li
Seo ne/Pre« Ifbinet.016
14
3Senieleyrren: ~lege Foe6
Na Uyw huva sinn 179 titrert:n er cry perterlerod ~sis
in
Oie Parters Isracet, erre ørner eg sztio:kg•et
•
NM reernetp Spe tran
Sdioe.ne SF AececnAortl
sull•rtiorral
13 Grus* hm", or eNr9 Isen
~Ne ~is
Inetruelluen
C Gro» roa-Sir imot°
Set IS Genro fotottas
76. ender
A Ler-freon* Isteg ret1
»Sen 420341 lent ree-zooe
bk.:se
•
uovi-Irco-4
han pre-2008 bukenes
C Lor frøs entesing eire Melen
42(85)3 9tentreet-20C7 Du icing.
D ~etse
enurrts tnell134791
horr ecree2C07 Dell61831
E Oeilhd nristilset CA axpenelturote
Inntil ne« «PM
9 Oter rest ner entre sale
G Olher reral nerts
H UndletrtnIe0 atal peSt selt
I
ACSOI ere eelMotte tiarar RIS
onil
21'2®
G1.03.11
See
~re
~Uere
toen 1043, line 31; Snek cox e
Sie Ole Penere Inreeelores
CAtb
esn
J Wen rienett ety rer
•
Derter sees Cre31
_
Grpeevernert se
sovne
orierunktrente °Vert ree
II Orten Ice seerne sete
Syler
Creal1
ler1910yer *cola' wickiity
Sid Mit ese tan
o Beekup viserne
P Oltee aren
l& FOrorr ~Ude,
A
Nenen or sart et US
~on
R Gres frose 'rom al esse
C
arip9 Irc031,1 1~
pliblee
evM
Eske grae Inxn• »na M pornettern
E Genar treget/
fy
F Orer
Pare ategrY
~Snes tasse tid portteet et erter Sel
O Inna: «pene
II ~
%Pute en Soare tea sereonee et pannerse::
Ø
lro
93.341411
J Gana legery
K Oter
Oter neiser
L
Total broen ros
3013
M Tete Snøe Se, tese/
Redrefter Ir tare re ere br olla
O Feer ~N
0,0•4 rice973
P ~Mødd
i riCeennee3 Utal
•
0914ctiagn ensalkis
Ses 81e PerIncrs.W.st,s‘*iis
} Es. I " 8. Part
17. Aterrernestelsm tem (AAMIterei
A Per-19138 ~ei*
on Sutrent
O Falluelad geiner len
O Depleden lers sn on i gru)
D C4L ses. & greeeerre4 ses Semi
E ce øla. & ~flid
dedurJona
F ~AMT Iberia
Tegiwienpl 1~
«I neraauctION case«.
A Taue", lunn erm
B Oter nor ~ript IrCOT,
C Hencledri:471•snee
19 Deatibulas
A Cash ere rrwketable turellte
B D aterrian *unett re sex 737
O Oter ecry
20 Oter Sinerree
A
i rotar! eser
9 InVostralt capereien
•
Wel tat cnert InbniNikm
D arter, rettrillb687 ~lures
(Ser Us stel ned eatate)
e Bero rense ParlerlY
F Reeers Of Isner.
SeIng
realt terten 4243162
•
Resenro ot icnv•ecare eoric
selt tethr)
Rfl33.,r001 hvestmer1 ni;
I
8931.33» ortrofedits
J Leeeteck
- ccrneeted
1339 term coi39Cto
K Ledets Irrer - Iss
frost
~roe
L Orepentliee ei ser/ ell6
sten 1/0 CitarrIs
9/ %SMS C4 ~Gen 179 deduolcit
rest sees try =este Festne*
O Sects 4.6.7gig lebrelSr
P ~n
4.63/Vd InforTM
o stette inerx P671771404
R sn* 9,900194
pionceba
8 CCF neser rad vaier rosa
T Dedebee Siste
• al end gui
J Sorte/ete e! nelostatten øsb
~Sec Uerer Irar. frose
W Prester:4ot pair tas)
X SeclOn'OOPInid99,1":0
Y Olteretertnancn
15450311 758241 21146.2100ON
FIDENTIALNAS
LLC
Forn 1' 18, Pert.
Fan 1118, Pert I
Fan 1118. Pert I
Ps re krige Geis
} ram 11113 Pr I
Fore 7116 Part II
Feen 7116 Omn
%stylta, ine12
Fern 6873
Fere 8973
Somme Penere Meistre
}
Si. te erhers
Insevotcate rc
lee Inelseene /er
Fer 6261
Fos 1040, IS»
Sr the Parerra lesses
Sea tere Persia IneetralSe
Ste en Patere Sterte,
Forn 41152. le ta
Forn 4962, e6
Forn 4138
Son Pro Pare litsin,c1Or.
Sea me Nyere ',st:Atten
Forer 88' 1, ene i
Sur 88'1. lell
deo •orn 4266
Sua 9.1PerInt :ncticeleas
S. Fot:1MP
%e ruin 88199
3.1.
Part-aia
'-tstructprs
C/0 MI
5
2114691
SDNY_GM_00033098
EFTA_(() I 437 I I
EFTA01280238
Schedule of Activities
For caunOir yet 201 a arta yew OK/Wm
.2012, end irc
Mac C/o MIDWAY INVESTORS
Mn
IA. Number. 45-1814195
Descdription
hm4
Aunty Nulty
1
107% COCO* Purity Toodul =
DoK0pdan
p.m's*
m044-
1
may-
404-
Ordinary business income (nes
Net rental real estate income Goss)
Other net rental linen, (loss)
Interest income
Cividentis - Ordinary dividends
'
- Ouali6e1 dividends
Royalties
Net short-term capital gain (loss)
Net longterm capita' gain (loss)
- Collecibles (28%) gain (loss)
- Unrecaptured Section 1250gain
Net section 1231 gain (loss)
Other portfoio income
Section 125E contracts and straddles
Other income
Section 179 deduction
Chara bre contributions
Portfolio deductions
Investment Interest expense
Section 59(e)(2) expend tures
Other deductions
Net ea m ngs from self-employment
Gross farming or fishing Income
Etr NS nontarm Income
LIH credit • Section 420X5)partnerelips
• Other
Welled rehabilitation °Veldts NS mated to
Other rental credits
Credits related to other rental activities
Recapture of LTH credit - Section 42(1)(5) partnerships
• Other
Other credits .
Post-1986 depreciation adjustment
Adjusted gain or loss
Portion of adjusted gairvloss allocable to short-term
Portion of adjusted galnAcss allocable to long-tern
Porten of adjusted g&niloss allocable to section
Depletion (other than oil and gas)
OiL gas and geothermal properties -gross income
Olt gas and geothermal properties - deductions
Other Afilif &errs
invesbnent Income
Investment extensile
•
•
metal reel estate
gainioss
gahnoss
1291 gain/loss
-.3,197.
-181.
135.
713.
-20.
20101
1101-12
15450311 758241 21146.210 C ON.F1 DEN:RAIL
AS LLC C/O MI 21146 91
SDNY_GM_00-033099
EFTA_00143712
5
EFTA01280239
New Yak State Department of Taxation and Finance
2012
New York Partner's Schedule K-1
Tax Law - Article 22 (Personal Income Tax)
For calendar year 2012 or tax year beginning
01 -01 -2 0 12
and ending
12-31-2012
Partners: Before completing your income tax return, see Form IT-2044N, Partners Instructions for Fonn IT-204-1P (available at
Partnership's information (see Instructions)
Partnership's name (as shown on Form IT-204)
IT-204-IP
5
Final K-1
Amended K-1
www.tax.ny.gov).
Partnership's EN
45-1814195
A Mark an Ar in the box if either applies to your entity
CI
Publicly traded partnership
L
I
Portfolio investment partnership
B Tax shelter registration number, if any
B
C Business allocation percentage
Partner's information (see Instructions)
Partners name
Pattner's address
27 HIGH TECH BOULEVARD
City
THOMASVILLE
State
NC
ZIP code
27360
Ok
Partners Identlying ncnter
20-3161309
D The partner Is a @en a
sk, sirepreto etc
C
General partner or LLC mamba( manager
Limited partner or other LLC member
E What is the tax filing statue of the partner? buns, X in view:mores box, it MOWN
E
I
I OrrIVICklei
L
EVateutrust
rxl
Partnership
F If the partner is a disregarded entity a grantor trust,
enter the tax ID of the entity or Individual reporting the Income, If known
G Did the partner sell its entire interest during the tax yea/
H Partner's share of profit. lose, and capital
1) Profit
2) Loss
3) Capital
Partner's share of liabilities at the end ti the yet
1) Ncnrecourse ..............
2) Qualified nonreccUree financing
3) Recourse
'
J Partners capital account analysts
111
1.3478
%
HR
1.7391
%
H3
1.7391
%
ii
M
13
1.3478
%
1.7391
%
1.7391
%
2,844.
104,518.
1) Beginning capital account
J1
42,061.
2) Capital contributed during the year • cash
J2
3) Capita) contributed dux igt the yea- property
J3
4) anent year increase (decrease)
J4
-5,531.
5) Withdrawals and distributions • cash
A
27,090.
6) Withdrawals and distributions • property
JO
7) Ending capital account
J7
9,440.
8) Method of accounting (rnerfcen JIM the appropdate box)
XI
Tax taws
ED ami,
ED Book
1:71 Other (submit explanation)
Beginning
Yes DI
No
Ending
K Resent status (mark an X in .1 boxes that eppol
C
NYS futyear resident
LD Yonkers full-year resider.!
I J NYS pante& readent
C
Yonkers parttyear resident
DC NYS nonresident
...
Yonkers nonresident
L If the partner was Included Ina group return, enter the special NYS Identification number, Nknorm
iluillvinilliii1
211iii1111o111
0
NYC Sutler resident
0
NYC part-yew resident
L
286561
11-10.P1
CONFIDENTIAL
SDNY_GM_00033100
EFTA 00143713
EFTA01280240
Page 2 trf 4
1T-2O4-O1 (2012)
M 1) Was Form ITr2658-E fled with the partnership?
2) Was Form MTA4O5-E fled with the partnership?
N NYS estimated tax paid on behalf of partner (from Form IT-2868)
Debt
Amount
1) First ir sta1ment
Ni
2) Second Listallment
N2
3) Third instailment
N3
4) Fourth installment
114
Total NYS estimated tax paid cn behalf 04 partner (add/nes NI through N4)
N
O Estimated MCTMT paid cn behal of partner (from Form MTA-405)
Date
Amount
1) First Installment
01
2) Second installment
O2
3) Third Instalment
O9
4) Fourth instalment
04
1.41 Yea 0
.No a
M2 Yes 0
No 0
Total estimated.MCTMT paid on behalf of partner (odd lines O1 through O4)
Partner's share of income, deductions, etc.
A - Partners distrioutNe share items
B - Federal Kel amount
0
C - Novi Yorn State amount
1 Ordinary business income (loss)
1
1
2 Net rental reel estate income Goes)
2
-5,205.
2
3 Other net rental income OM)
3
3
4 Guaranteed payments
4
4
5 Interest income
a
5
6 Ord'nery dividends
8
6
7 Royalties
7
7
8 Net shortterm capital gain pose)
8
8
9 Net long-term capital gain (loss)
9
9
10 Net section 1231 gain (loss)
10
—185.
to
11 Other income (loss) Identify:
11
11
12 Section 179 deduction
12
12
13 Other deductions IdentifY:
SEE STATEMENT
19
173.
13
14 "fax preference hems for minimum tut
14
1,243 .
14
Identify(
15 Net earnings (ices) from matt-employment
18
15
18 Tax-exempt Income end nondeductible expenses
10
1 -
16
17 Distributions • cash and marketable securities
17
' 27,090.
17
18 Distnbutions - c4her property
18
18
19 Other items not included above that we required to be
reported sepanatety to partnem
19
12 .
19
/donor
SEE STATEMENT
Partner's share of New York mO8111)83OO119 (beektranithons)
2O New York State additions
Number
A - Total amount
B - New York Stale allocated amount
247.
20a EA-
16
247.
2Ob EA-
2Oc EA-
2Od EA-
2Oe EA-
2O1 EA-
21 Total addition modifications (total of column A lines 20a through 200
21
247.
118002121019
1111!111111111111)1111111
1111
28880
11.'9.12
CONFIDENTIAL
SDNY_GM_OOO331O1
EFTA_00143714
EFTA01280241
IT-204-IP (2012,1
Page 3 of 4
Partner's share of New York modifications (centime<
22 New York State subtractions
Number
A - Total amount
22a ES-
21
503.
22b ES-
22c ES-
22d ES.
22e ES-
22f ES-
B - New York State allocated amount
503.
23 Total subtraction modifications (total of column A lines 22a through 221)
23
503.
24 Additions to federal Itemized deductions
Letter
Amount
24a
24b
24c
24d
24e
24f
26 Total arldhlons to federal itemized deductions (add Ines 24a through 244
25
26 Subtractions from federal Itemized deductions
Letter
Amount
26a
26b
26o
26d
26e
26f
27 Total subtractions from federal itemized deductions (add *les 26a through 261)
27
28 New York adjustments to tax preference tams
28
Partner's other Information
29a Partners share of New York source gross income
29a
29b NICT0 allocation percentage (see Instructions)
29b
Partner's credit information
Part 1 - Flow-through credit bases and factors
Brownfield redevelopment tax credit (Form lT-677 or 1T-611.1)
A Form IT-611
B - Form IT-611.1
30 Site preparation credit ocrnponent
30
30
31 Tangible property credit component
31
31
32 Onsite groundwater remediatlor credit component .....
32
118003121019
III III III 101111111111111111
Jill
num
11 19-12
CONFIDENTIAL
SDNY_GM 00033102
EFTA_00 1 437 15
EFTA01280242
Page 4 Of 4
IT-204-IP (2012)
Partner's credit inforination (continued)
EZ capital tax credal (Form
(Form IT-602)
33 Contributions of money to EZ community development pro:ects
33
34 Recapture of credt fora-vestments in certlfed EZ businesses
34
35 Recapture of credit for contributions of money to EZ community development protects
35
OEZE tax reduction credit (Form IT-604)
30 CEZE employment Increase factor .
38
37 OEZE zone allocation lector
37
38 OEZE benefit period factor
38
Excelsior robs program tax credit (Form IT-607)
39 Excelsior jobs tax credit component
30
40 Excelsior Investment tax creak component
40
41 Excelsior research and deve.opment tax credal component
41
42 Excelsim rea property tax credit component
42
Farmers' school tax credit (Form fT-217)
43 Acres of qualified agricultural property
43
44 Acres of qualified conservation property
44
45 Eligible school district property taxes paid
48
48 Acres of qualified agricultural property converted to nortqualieed use
46
Other flow-through credit bases and factors
Credit bases
Code
Amount
Code
Amount
47a
47d
47b
47e
47c
471
Gracia factors
Code
Factor
Code
Factor
Code
Factor
479
47i
47k
47h
47r
471
Part 2 - Flow-through credits, addbacks and recaptures
48 Long ten care insurance credit (Form IT-249)
48
49 Investment oredk (including employment Incentive credit and historic ban rehabifilation credit Form IT-212) 49
50 Research and development • Investment credit (Form IT-212)
80
51 Other flow through credits
Cods
Amount
Cods
Amount
51a
51e
511
51c
51g
51d
51h
52 Addbacks of credits and recaptures
Code
Amount
Cods
Amount
52a
52d
52b
52e
52o
52f
p
118004121019
285842
11 -19-12
CONFIDENTIAL
SDNY_GM_00033103
EFTA_00143716
EFTA01280243
45-1814195
NY IT-204-IP
DESCRIPTION
AMOUNT FROM
FEDERAL
SCHEDULE K-1
NEW YORK
STATE
AMOUNT
12.
0.
135.
0.
MISCELLANEOUS
4.
0.
22.
0.
TOTAL TO FORM IT-204-IP, PAGE 2, LINE 13
173.
0.
NY IT-204-IP
DESCRIPTION
AMOUNT FROM
FEDERAL
SCHEDULE K-1
NEW YORK
STATE
AMOUNT
12.
0.
TOTAL TO FORM IT-204-IP, PAGE 2, LINE 19
12.
0.
CONFIDENTIAL
PARTNER NUMBER 5
SDNY_GM_00033104
EFTA_00143717
EFTA01280244
NC K-1 (39►
(D-403)
10.11.i2
2012 Partner's Share of
N.C. Income, Adjustments, and Credits
North Carolina Department of Revenue
For calends• year
Cr fiscal year basic ning
Partners Identifying Number
203161309
Partners Name, Address, and ZIP Code
27 HIGH TECH BOULEVARD
THOMASVILLE NC 27360
01 01 12
and ending
12 31 12
Federal Employer ID Number
451814195
Partnership's Name, Address, and ZIP Code
270 LAFAYETTE STREET STE 409
NEW YORK
NY 10012
Partnership's Pro Rata Share Items
All Partners
1. Share of partnership Intorre (loss)
2. Additions to Income (loss)
a. Addition for bons depredation
b. Other additions to home (loss)
3. Deductions 'roil Ircome (loss)
a. Deductkn fcr henna depreciation
STMT
b. Other deduclons from Income (loss) STMT
4. Snare of tax credits
5. Snare of tax withheld from non wage compensation
paid for personal Services performed in N.C.
Nonresidents Only
6. Nonresident's share of N.C. taxable !mane (loss)
7. Nonresident's snare of net tax paid by the manager
of the partnership
Amount
Individuals Piling Form
(1-400 Enter Amount on:
-5390
247
Page 2, Line 35
0
Page 2, Line 36
503
Page 2, Lite 44e
34
Page 2, the 49
0
Form D-40OTC
0
Page 2, Lite 23
0
Page 2, Line 51
0
Page 2, Line 24c
269291
'2.20-12
CONFIDENTIAL
SDNY_GM_00033105
EFTA_OO143718
EFTA01280245
45-1814195
NC SCH K-1
DESCRIPTION
AMOUNT
22
12
TOTAL TO SCHEDULE K-1, LINE 3B
34
NC SCH K-1
DESCRIPTION
AMOUNT
ADJMNT FOR 1ST-YEAR DEPRECIATION ADDED BACK IN 2011
503.
TOTAL TO SCHEDULE K-1, LINE 3A
503.
CONFIDENTIAL
PARTNER NUMBER 5
SDNY_GM_00033106
EFTA_00 I 43719
EFTA01280246
r 1019
5
PARTNER'S SHARE OF SOUTH CAROLINA
For calendar year 2012 or tax year beginning
Partners Identifying number 11, 20-3161309
Partners name, address end ZIP code
27 HIGH TECH BOULEVARD
THOMASVILLE, NC 27360
Check if
•
(1)
Fine! Kel
Partner's Share of Current Year
Income, Deductions, Credits, etc.
(0:9
Federal
Ic1 Amounts
(0)
Plus oc Minus
SC Adjustmems
(C)
Amounts Not
or ApAllocated to SC
ocnione
(0)
Amounts Allocated
or Apportioned to SC
1 Ordinary business income (lose)
2 Net rental real estate income (loss)
3 Other net rental Income aces
4 Guaranteed payments
i
5 Interest Income
Div
8
Idends
$
c
7 Royalties
8 Net skin-tem) capital gain (loss)
9 Net long-term capital gain (loss)
10 Net Section 1231 pale (loss)
11 Other ircome (loss)
1
1
STMT
1
2
-5,205. 2
86. 2
-3,197. 2
-1,922.
3''
3
3
3
4
4
4
4
6
5
5
5
8
8
8
6
7
7
7
7
8
8
8
8
9
9
9
9
10
-185.10
10
-185.10
11
11
11
11
,, 12 Section 179 deduction
S
13 Other deductions
12
12
12
12
13
173.13
13
154.13
19.
SEE STATEMENT
14 Withholding tax for nonresident partner
14
0 .
Ust applicable South Carolina tax credts. (Attach an additional sheet if needed.)
15
15
le
- . -----
—
1
., 18
17
17
18
18
19 Total South Carona tax credits
19
0 .
SC1065 K-1
(Rev. 5/27/11)
3515
01/01/12
ard ending 12/31/12
Amended K 1
Partnership's FEIN
O. 45-1814195
Partnership's name. address and DP coda
270 LAFAYETTE STREET STE 409
NEW YORK, NY 10012
Nonresident
L
35151018
277t2i 0/4)242
J
CONFIDENTIAL
SDNY_GM_00033107
EFTA_00143720
EFTA01280247
45-1814195
SC SCHEDULE K-1
SCHEDULE K-1 ADJUSTMENTS
LINE NO.
DESCRIPTION
AMOUNT
LINE 2
TOTAL OF FORM SC1065, SCHEDULE K-1, COLUMN B
86.
86.
SC SCHEDULE K-1
DESCRIPTION
COL A
COL B
COL C
COL D
173.
O.
154.
19.
COLUMN TOTAL
173.
0.
154.
19.
CONFIDENTIAL
PARTNER NUMBER 5
SDNY_GM_00033108
EFTA_00 143721
EFTA01280248
CONFIDENTIAL
SON,M,013.
EFTA,I03722
EFTA01280249
4
651112
Schedule K1
(Form 1065)
tor rearteryewarns max
Department of the Treasury
yew enionnfrg
intern' Reverue Service
enwo
Partner's Sharo of Income, Deductions,
Credits, etc.
P. See sepias Instuctione.
2012
ik
Information About the Partnership
A Partnership's employer identifkation number
45-1534785
8 Partnership's name, address, c'ty, state, arid ZIP code
270 LAFAYETTE STREET, SUIT 409
NEW YORK NY 10012
C IRS Center where ;arboreta thed return
E-FILE
0 0
Check it thls Is a publicly traded partnership (PIP)
Pad II
Information About the Partner
E Partner s identifying number
20-3161309
F Partners name, address, city, state, and ZIP ode
27 HIGH TECH BOULEVARD
THOMASVILLE, NC 27360
11 0
General partner or 1.1.0
Limited partner or other la
member-manager
member
H
Oornestic partner
El Foreign partner
II What type of Godly b this canner? PARTNERSHIP
12
this partner is a retirement plan (IEWSEP/Keogralt.), thick here
J Peepers share ci prat. Mss, and capital:
Beginning
Email
Prom
2.3484848%
2.3484848%
-
Cr
Loss
3.0303030%
3.0303030%
Casket
3.0303030%
3.0303030%
K Partners share of Kates at year end:
Nonrecourse
Quailed nonrettursetinancing
Recocrse
$
1,405.
0.
I. Partner's capkal account analysis:
Beet ring capital account
Capital contributed clurthig the year
r re r t year increase (decrease)
Withdrawals & distributicns
Ending capital account
$
Sl
S
LIC Tax basis
U
GARP
Other (explain)
M Old the partner contribute property wer a bull-in gain or loss?
I
I Yes
LL. No
If Yes'. attach statement (see instructions)
73,650.
3,782.
7,0594
70,373.
Seaton 704(5) book
ofsa
las u LHA For Paperwork Reduction Act Notice, see Instructions tar Form 1065.
IRSgovarrn106.5
k
lnal K-I
Amended K-1
OM No. I545-009
OC Partner's Share of Current Year Income,
Deductions, Credits, and Other Items
1 Ordinary business Income (loss)
1
O.
21,cmwme..t.ii.a.moree
—6,686.
8
her net rental Income (loss)
4 Guaranteed payments
interest Income
1.
54 Ordinary dividends
a Clotted dividends
15 Cradits
15 Foreign transactions
17 A temative mm tax (AMT) items
-2.
l
et short-term capital gain (loss)
Net long-term capital gain (bas)
911 erllectithes (28%) gain (loss)
Sc recaptured sec 12500th
10 let settler 1231 gala (loss)
11 Other Income (loss)
12 Section 179 deduction
18 Other deductions
Cive
30.
14 Self-employment earnings (loss)
O .
1$ Tax-exempt income and
nondeductible Martha
11*
5 .
19 Distributions
A
7,059.
28 COW Women
1 .
A
E2
16090315 758241 21146.209 CONFIDENTALEER,
LLC
Schedule K-1 (Form 1065) 2012
4
sarilbiAmato
EPTA_00143723
EFTA01280250
45-1534785
SCHEDULE K-1
OTHER PORTFOLIO DEDUCTIONS, BOX 13, CODE L
DESCRIPTION
AMOUNT
SEE IRS SCH. K-1 INSTRUCTIONS
30.
TOTAL TO SCHEDULE K-1, BOX 13, CODE L
30.
SCHEDULE K-1
OTHER DEDUCTIONS, BOX 13, CODE W
DESCRIPTION
AMOUNT
ACCOUNTING
27.
DUES & FEES
6.
TOTAL TO SCHEDULE K-1, BOX 13, CODE W
33.
SCHEDULE K-1
NONDEDUCTIBLE EXPENSES, BOX 18, CODE C
DESCRIPTION
AMOUNT
SEE IRS SCH. K-1 INSTRUCTIONS
PASSTHROUGH
5.
TOTAL TO SCHEDULE K-1, BOX 18, CODE C
5.
SCHEDULE K-1
DESCRIPTION
INTEREST INCOME
AMOUNT
TOTALS
-6,686.
1.
SCHEDULE K-1 INCOME SUBTOTAL
-6,685.
-30.
-33.
SCHEDULE K-1 DEDUCTIONS SUBTOTAL
-63.
NET INCOME (LOSS) PER SCHEDULE K-1
-6,748.
16090315 758241 21146.209 CON.F1
PARTNER NUMBER 4
SDNWAI gO0V111
EFTA_00 I 43724
EFTA01280251
45-1534785
-5.
-95.
2,979.
7,651.
10,530.
TOTAL TO SCHEDULE K-1, ITEM L
3,782.
16090315 758241 21146.209
Fl
PARTNER NUMBER 4
LLC
21146 El
SDNY_GM_00033112
EFTA 00143725
EFTA01280252
4
Schedule K-: (Form I005) 2D:2
Page 2
This list Identifies the codes used on Schedule K-1 for all partners and provides summarized reporting Information for partners' ho tile
Form 1040. For detailed reporting and tiling information, see the separate Partners Instructions Ion Schedule l(-1 and the Instructions
for your income lax return.
1. Octal, %class inGOWI coat Dannina Inn
to Inn
:KW;
pawns or renews va and one rn your fl m is 15 bvs.
Passive ow
Pone !memo
NOW033V0
MOIWINe/0 Income
2. M: nn No into Hoene Ion)
3
outer re, teens Inner Caen
het inn
Nal ion
4
Guaranteed Gann
5
meet Irene
as °rainy charade
50 (boallbi ann.
7. /nits
I. Not tot torre apt: go (cob
94 Net bibunre craprN Ca' Serb
Cla.
Collect oars 128%; gse no)
9e
Unrocapurod wen 1250 gib
*O. NM nen 1231 go -6 rob)
1. Ohm- nate -es)
COW
A On Bona IrecnuElow)
8 Invcrurtery oannolono
C Soo. :258 corn.. One co
O at beg axpleralloa Ctrs eweetils
E Ca-celtraceta, &rot
F Olhar Inn* ( oe
12. Sene 179 &dna.
13. Oi'e doonnea
A
O
F
K
L
N
O
P
0
R
S
T
V w
OW ante. one NM)
teen nonteo4: one 1301(4
Nolen *noun
NOW
Non* contemns POW
Cam: 61 ca MOM, 10 650%
ovanIzaJoB(J616)
Copt sae mm6..912210
Cot orlon' GOON
Inner: and oxpeeno
0'40.1.1.4>III• rewire ton
Senn 58822; oxen tin
Deduct amr • polio ot% azen
oxsuann. • pen C rote
Araunto Boo br trednel nine
Enacatorb omit ence Webb
Donn! rem beeratx
Preprodacwo porn bean
Caren el rennin an deluoton
eon rent ma aralc art von
Persicns Are IRA,
Relertatathr nano dant an
Del-a8Se produeser acrthrlies
Intoenben
Ora fled nun.
elute, mccr,e
Erbroyera Fern W-2 ono
Otter denrunow
FIIPOn 01
S. the Pate.. teetwOcas
Seln. • E. Nes 28, earn ro:
8040.0E Iln•28. cobra 92
Inn
• 2 Ilne28, =bre 0
SW be Naga henna
Bon • t lino 28, note Nell
Sae Vs Pones Inotactlara
Scans E, Illy 28. nab I
Farr 1043, nib
Fan
IIM96
Fan 1040, Unit
Sown E. Ilmo 4
Bar o
D.Pre 5
&mucus 0, S.
2816 Rat. Gain Wen* les 4
(Bonk 0 belraWona)
Soo ha Peron lestsieSSis
Bw ttw Parton Inshau-Sans
See tee Panto Innotbrs
SW. tw SSW* Unthaws
Faro 8781 Ml
See Pon B35
Forr10.10,
21 °liana
Sao he Pon
w
t brim:tees
Sae me Parinv's 'Saab
I
Soothe artery -sbucOon•
Fan 4£42. !we 1
Sneau • F., lira 15
So• to Penmen lostankes
5ceea le A 01022
Sunk A rho BS
San Jo A antler Form 10740, Ono 29
Soo to Panwe's loan:Ione
;orm 2441.11ra '2
See no Panic's estsambra
See Fern 56821estuotam
See he Parkin Insholons
Sea he Pawn Henn
See Far !NW Insluatbb
neerows$, 'lb 7a
econamni n17
Sas the NOW's rnisbuCtCm.
14. 8411-nowtort breirea keel
Nob Ilyou In a won 179 CerlutSor Cs, Sly petter-tevel clecluvion sw
IN) Partrwes InStuctcns Snot oxrploUns Schwa SE
A Vol nabs ben 'Mil
SCriedL 0 St, UMW, A«0
soluaxmoyese
B CFAs twang Cc gist 19 Inn
C Sites mn-larn income
:8. Cmdta
A Low ben Mae 19 met
Infer 42015 tan pre-20111
wean
8 Unworn@ "Oiling Ore 94104
ton me-2n ouno
C uweIncarta noun an Noon
427.0:1 kw owl-2007 WINN,
O LLY/NrtAtM2 lattiN credit :arm)
born pet:-2007 s...11dets
F.
areered ntiritatior centrum
}orta cod =my)
F Otte torte Ntrl blab urn*
O Oter rob ta -ts
H Lire atabJlod card (Ons &ode
I
Mcoh5
*AA.," c ttolurl ebb
C/CCIN
.1
See to 3iIrroftilretwatIore
Sea
'rrtarli Ins:runny
Sea he Partin ben lens
Form 1043 Ins 71; Wadi bane
See he sense. Nititatless
211282
01.01-13
16090315 758241 21146.209 CON.F1
C'wo
J Wore nortunny credit
K Elbabeed ens beer
L Ernowbrent rob Ind newel
Coney enployment creel t
51 Ono t let Ireton lo mama%
N Creel be employer von baby
.rc Medlueer
o
Backup Atroo
P Ono:nob
141 Farolgn noon*
A %no* earn «US.
POWS/Woe
R ran room In NI bun
O Gas ben oxen m Peher
Ise
FON121(POIN fICCIMINurec K intiertillp evd
F Cenv
E GIC44110rherf
}
Fenn
Pell
0 Pane cobweb
Csoactlet stored arc sppcil Oft] K prom WM
O 'Man Mine
Farm 1118. Part I
H Ohm
Fenn 1118. Pearl
Dnc..stlow a. cacaod orxl sppoiSared K 0•44WirCe WoW Sr lone bun
horn
I
Penang canal
Ono. witegray
Fon '111, Putt
K Otot
Otler Ur tenni cm
L Teti beer ton pale
•
7c-cl Emir ten accrued
N RoducriCei IM Wad won • tram t
O Fortin Nebo grew nob
P EntlintfAil tan arcausen
•
boys SanucSaw
17 Nunn el -rum tea :tan ben
A Put-'988 &ankle, aclan0tt
B Adrusaret sec er
C ;win'
(:411b Ste e tat
•
OR oa & protean 9000 Ircone
E 04 Glaa. & plums - Sw-elloca
F Cater MA1 bee
It
Tee many: heart era condonable boobs
A Image/mat newt tore
Carer LleeeXele: Incur,*
C NOrCetkU.Ibler expenses
19. DIshbutions
A CaW awl larktratMe 'burn
8 Distriout on &ebb to sector 737
C Ober properm
20. Mar Wanton
A Wren. norre
B Inner lawns
O Gas lax fed: Inkenen
O
ewe +Ow ex one Ally
:Oho, thon fental roe can)
•
Bees aceau-y property
F Hearn Of bee-Income 7ouslrg
moll nice 42225.1
G Hearn el row-In Wee towline
cfecit :on•I
H nacapteto or Inner( caret
I
sxcapwre al att. avails
.1
...v.,...tpack Flat
ownpletscl
ong-terrn satiate
K
nor beck Urban boons bent
14
O
0
S
w
x
-tr
wnloo
sportown noun rem
motion 179 deduebn
144c•pl.n of beaker 179 be Jan
Inter capon. br corporate person
Stela, 403=0 Ir berailan
114clun M.3.697)Irtynt20:1
Sectt :283>I1rbentIca
Inn
allocable b 2ICCIJaal
abort crow
CCF relocated MIndetrwas
Dacron Irbonet
- o and me
Arructust on gleafrestat.ol orate
rnseed arA vas enable Income
Precorle *an San Gab)
Scan 1000 VilOgrreloi
01W Inlbsmake
} Fermi,* Peel
Pow ilift Pon
how 11 tfl. Port I
En 11'4 Ito 12
Farr 8873
Fan. aRra
See the aerrot • nornore
1
Soo to Poirer's
Ireherbes 00
Car Wenders br
Fan 8251
Form 1240, be 8b
See he Parties Imbue:Ions
Sec Ina Penn In
}
Ow IM Prow. IrStoutt One
J
NTObiktNEERs LLC
For 40 52. 1110 4+
Far ab2. SW
Few 4136
See he ate enr
burctior •
rut ho Pert ere 'sutra:Sore
cern sr 1. Ihe 8
Fenn tall. '508
See Foto 4255
See to Pan's Irenrces
See Fsw ma>
We Fuer 8886
Sea Be aarher's
nu-Surs
4
21146 El
SDNY_GM_OOO33113
EFTA_00143726
EFTA01280253
2012
New York State Depalment of Taxation and Finance
New York Partner's Schedule K-1
1T-204-IP
Tax Law - Article 22 (Personal Income Tax)
4
Final IC-I
For calendar year 2012 or tax year beginning
01-01-2012
and ending
12-31-2012
--
Amended Kr1
Partners: Before completing your Income tax return, see Form IT-204•IP-1, Partner's InstmctIons lei Form IT-204-IP (avalable at vnrnv.tax.ny.gov).
Partnership's information (see Instructions)
Partnership's name (as shown on Font IT-204)
Partnership's EIN
45-1534785
A Mark an Asir the box if either applies to your entity
Publicly traded partnership
C
Portfolio Investment partnership
B Tax Shelter reatration number, it ary
B
C Busiress alocation percentage
C
Partner's information (see instructions)
Par.rer's name
Par.rer's address
27 HIGH TECH BOULEVARD
City
State
THOMASVILLE
NC
ZIP code
27360
Parmer's identifying number
20-3161309
D The partner is a ran or X N n,. aoprepdn oax)
General partner or LLC merrber-manager
Limited partner or other LLC member
E What lathe tax fling status 0.l the partner? :flit
Acpwratn Ø If Knew.)
El
Individual
Estate/trust
X
Partnership
F If the partner is a disregarded entity or grantor trust,
enter the tax ID of the entity or Individual reporting the Income, If known
O Did the partner ea its entire interest during the tax year?
G
Yes __
No al
H Partner's share of profit, loss, and capital
Beginning
Encino
1; Profit
Ht
2.3485 •
2.3485
3.0303 %
2) Loss
H2
3.0303
3) Capital
H3
3.0303 •
3.0303
I
Partner's share of Ilabilitee at the end of the year
1) Nonrecourse
H
1,405.
2) Otagfied nonnscourse thawing
12
3) Rama.
I3
.1 Partner's capital account ennyss
1) Beginning capital °mount
J1
73,650.
2) Capital contributed during the year • cash
J2
3) Capital contributed during the year property
J3
4) Ounent year Increase (decrease)
J4
3,782.
5) Withdrawals and distributions - cash
JS
7 , 059 .
6) Withdrawals and clstributens • property
J6
7) Ending capital account
J7
70,373.
8) Method of accounting (mark an Xin the apprspriate box)
Ix] Tax basis
C
ØP
Book
1_1 Other (submit explanation)
K Resident etalue (mark an X in 2 boxes that apply)
C
NYS lubyear resident
C
Yonkers full-yew resident
C
NYC fullyear reeldent
L._ NYS part-yea:resident
D
Yonkers part-year res:dent
C
NYC peat-year resident
MC
WS nonresident
C
Yonkers nonresident
L It the partner was Inc.uded In a group return, enter the special NYS identification number, K known
118001121019
258%1
•-•e12
CONFIDENTIAL
SDNY_GM_00033114
EFTA 00143727
EFTA01280254
Page 2 of 4
17-204-IP (2012)
M 1) Was Form IT-2658£ Ned with the partnersnlp?
Ml Yes
No
2) Wee Form MTA405•E Ned with the partnership?
M2 Yes 17
No 0
N NYS estimated tax paid on behalf of partner (from Form IT-2858)
1) Find Installment
NI
2) Second Instalhent
N2
3) Third Instalment
NS
4) Fourth Installment
IN4
Date
Amount
Total NYS estimated tax paid on behalf of partner (add toes Ni through N4)
0
Estimated MOTM7 paid on behalf of panne, (fmm Form A4TA-405)
Dab
1) First ins'alhent
01
2) Second Installment
02
3) Third rstallment
03
4) Fourth Installment
04
Total estimated MCTMT pad cn behalf of partner (add Ines O1 through O4)
Partner's share of income, deductions, etc.
0
Amount
A - Partner's cletributhe share Items
1 Ordinary business IfICOM.6 Coss)
1
8 - Federal 147 amount
C-
1
New Yak State amount
2 Net rental real estate income (loss)
2
-6, 686.
2
3 Other net rental Income (Ices)
3
3
4 Guaranteed payments
4
4
5 Interest Income
a
1.
5
8 Ordinary dividends
6
8
7 Royalties
7
7
8 Net short-term capital gain (loss)
8
8
9 Net long-term capital gain Goes)
9
9
10 Net section 1231 gain (lose)
10
10
11 Other Income (loss)identIPT
11
11
12 Section 179 deduction
12
12
13 Other deductions Identif:
SEE STATEMENT
is
63.
13
14 Tax preference items for minimum tax
14
-2.
14
Identify:
16 Net earnings (loss) Iron sett-employment
16
15
18 Tax-exempt income and nondeductible expenses
16
5.
16
17 Distributions - cash and marketable securities .
17
7,059.
17
18 Distributims - other property
18
18
19 Otter items not Include° above that are required to be
reported separately to partners
19
31.
19
Identify:
SEE STATEMENT
Partner's share of New York modifications (ees instructions)
20 Nev. York State tdcl
Number
A - Total amount
20a EA-
16
92.
20b EA-
20c EA-
20d EA-
20o EA-
20f EA-
8 - New York State allocated amount
21 Total addition modifications dotal el colUrna A, fines 2Ca through 20f) .
118002121019
CONFIDENTIAL
92.
aim
SDNY_GM_00033115
EFTA_00 143728
EFTA01280255
IT-204-IP (2012)
Page 3 of 4
22a ES-
22b ES-
22c ES-
22d ES-
22e ES-
22f ES-
Partner's share of New York modifications /continued)
22 New York State subtractions
Number
A - Total amount
21
9 7 .
B - New York State allocated amount
23 Total subtraction modifications (total of column A lines 22a through 226
23
9 7 .
24 Additions to federal itemtzed deductions
Letter
Amount
24a
24b
24c
24d
24e
24f
25 Total additions to federal kemized deductions (add lines 24a through 240
26
28 Subtractions from federal ttenfzed deductions
Letter
Amount
26a
26b
26e
26d
26e
26f
27 Total subtractions from federal itemized deductions (add lines 26a through 260
27
28 New York adjustments to tax preference items
28
Partner's other Information
29a Partners Sure of New York source gross income
29a
29b MCTD allocation percentage (seeinstructions)
29b
Partner's credit Information
Part 1 - Flow-through credit bases and factors
Brownfield redevelopment tax credit (Form IT-611 or 1T-6 t 1.1)
A - Form IT-611
B - Form IT-611.1
30 Site preparation credit component
30
30
31 Tangible property ore& component
31
31
32 On-site groundwater remediatIon credit component
32
32
11.10-.2
CONFIDENTIAL
SDNY_GM_00033116
EFTA 00143729
EFTA01280256
Page 4 of 4
17-2044P 0012)
Partner's credit information (continued)
EZ capital tax credit (FAINT-602)
33 Contebutions of money to EZ community development projects
33
34 Recapture of credit for Investments in °rifled EZ businesses
34
36 Recapture of matt for oontributions re money to t1 community development orotects
35
CUE tax reduction credit (Form IT-604)
38 QEZE employment increase factor
38
37 QEZE zone stocation factor
37
38 QEZE benefit per cd factor
38
Excelsior jobs program tax crest (Form IT-607)
39 Excelsior lobe tax credit component
30
40 Excelsior Investment tax creclt component
40
41 Excelsior research, and development tax credit component
41
42 Excelsior teal property tax credit component
42
Farmers' school tax credit (Form IT-217)
43 Acres of quallied agricultural property
43
44 Acres of quailed conservation property
44
45 Engine school district property taxes paid
48
48 Acres cf qualified agrkult t.ral property converted to nonquakfled use
45
Other flow-through credit bases end factors
Credit bases
Code
Amount
Code
Motet
470
47d
47b
47e
47c
471
Credt factors
Code
Feotor
Code
Factor
Code
Factor
47g
471
47k
47h
473
471
Part 2 - Flow-through credits, addbacks and recaptures
48 Long-term care insurance credit (Form 1T-249)
48
49 Investment credit (including employment incentive crest end historic barn rehabilitation emS F019171T-212) 40
50 Research and development • investment credit (Fenn IT-212)
50
61 Other flow-through credits
Code
Amount
Code
Amount
51a
51e
61b
511
51c
51g
51d
51h
52 Addbacks of credits and recaptures
Code
Amount
Code
Amount
52a
52d
52b
62e
52c
521
118004121019
CONFIDENTIAL
MOM
11-19-12
SDNY_GM_00033117
EFTA_00143730
EFTA01280257
45-1534785
NY IT-204-IP
DESCRIPTION
AMOUNT FROM
NEW YORK
FEDERAL
STATE
SCHEDULE K-1
AMOUNT
30.
0.
ACCOUNTING
27.
0.
DUES & FEES
6.
0.
TOTAL TO FORM IT-204-IP, PAGE 2, LINE 13
63.
0.
NY IT-204-IP
DESCRIPTION
AMOUNT FROM
NEW YORK
FEDERAL
STATE
SCHEDULE K-1
AMOUNT
1.
0.
30.
0.
TOTAL TO FORM IT-204-IP, PAGE 2, LINE 19
31.
0.
CONFIDENTIAL
PARTNER NUMBER 4
SDNY_GM_0003311B
EFTA_00143731
EFTA01280258
•
NC K-1 (39)
(D-403)
10-11.12
For calendar year
2012 Partner's Share of
N.C. Income, Adjustments, and Credits
North Carolina Department of Revenue
or hut year begmning
01 01 12
amending
12 31 12
Partner's Identifying Number
Federal Employer ID Number
203161309
451534785
Partner's Name, Address, and ZIP Code
27 HIGH TECH BOULEVARD
THOMASVILLE NC 27360
Partnership's Name, Address, and ZIP Code
270 LAFAYETTE STREET SUIT 409
NEW YORK
NY 10012
Partnership's Pro Rata Share Items
All Partners
1. Snare of partnership Income (loss)
2. Additions to Income Doss)
a. AddRion for bonus depredation
b. Other additions to income (loss)
3. Deductions from Income (loss)
a. Deduction for bonus depredation
STMT
b. Other deductions from income (lass) STMT
4. Share of taxcredits
5. Share of tax withheld from nonwage comper.satiar
paid for personal services performed In N.C.
Nonresidents Only
6. Nonresident's share of N.C. taxable income (oss)
7. Nonresident's store of net tax paid by the manager
of the partnership
Amount
Individuals Filing Form
0400 Enter Amount on:
-6685
92
Papa 2, DM, 35
0
Page 2, Line 36
97
Page 2, :Me 44e
33
Page 2, Line 49
0
Form 0-400TC
0
Par 2. Line 23
0
Pace 2. Line 51
0
Page 2, dm 24c
241091
CONFIDENTIAL
SDNY_GM_00033119
EFTA_001 43732
EFTA01280259
45-1534785
NC SCH K-1
DESCRIPTION
AMOUNT
DUES & FEES
6
ACCOUNTING
27
TOTAL TO SCHEDULE K-1, LINE 3B
33
NC SCH K-1
DESCRIPTION
AMOUNT
ADJMNT FOR 1ST-YEAR DEPRECIATION ADDED BACK IN 2011
97.
TOTAL TO SCHEDULE K-I, LINE 3A
97.
CONFIDENTIAL
PARTNER NUMBER 4
SDNY_GM_00033120
EFTA_00143733
EFTA01280260
CONFIDENTIAL
SONV_GN_OOMI 21
EFTA,103734
EFTA01280261
3
631112
0
Section 704(b) book
17540322 758241 21146.20C ONIFIDEN4- PIALTION LLC.
Recourse
Schedule K-1
(Ram 1066)
Fermlividwrier2iraortex 2012
Department of the Treasury
yea- bectnn
Internal Revenue Service
"wine
Partner's Share of Income, Deductions,
Credits, etc.
► See separate Instructions.
Part I
Information About the Partnership
A Partnership's employer Identification number
27-3304656
Partnership's name, address, city, state, and ZIP code
270 LAFAYETTE ST. STE 409
NEV.; YORK, NY 10012
C IRS Center where partnership Sled return
E—FILE
D
Check it this is * publicly traded partnership (PTP)
Information About the Partner
E Partners Identifying number
20-3161309
F Partner's name, address, city, state, and ZIP code
27 HIGH TECH BOULEVARD
THOMASVILLE, NC 27360
a 0
General partner or LLC
DU Limited partner or other LLC
member-manager
member
H aid Domestic partner
0
Foreign partner
What bile of entity Is this partner? PARTNERSHIP
2 it mks partner is a retirement plan (IFINSEPdthoghtetc.). check here
Partners share of croft loss, and caplet
Beginning
Beim
Pratt
3.2978723%
4.2553191%
Lon
4.2553191%
4.2553191%
Capita'
4.2553191%
4.2553191%
K Partner's Share of liabilities at year end:
Nonrecourse
5,485.
Cualified nonrecourse Financing
303,782.
0 .
n
Foal K-1
—I Amended K-1
CMS No 1545-009
AO; MP Partner's Share of Current Year Income,
Deductions, Credits, and Other items
1
15 Credits
1 Ordinary business income (loss)
0.
2 Not mai red astute income in*
-27,051.
3 Other net rental income (loss)
4 Guaranteed payments
6 Interest Income
16 Foreign transactions
Oa lathery dividends
6b QualKled dividends
7 Royalties
8 let short-term capital gain (loss)
17 Atemathre min tax (MT) Items
2,529.
B*
—14.
9a let long-term capital gain (loss)
gs Collectibles (28%) gain (loss)
19 thstrkidons
18 Tax-exempt income and
nondeductible expenses
9 392.
9c Unrecaptured sac 1250 geln
10 Net section 1231 gain (loss)
—54.
11 Other Income (loss)
20 Other information
12 Section 179extudlos
13 Other deduction
iW
t
STMT
14 Sell -employment earnings (loss)
0.
had statement for addtionm information.
L Partners capital account analysis:
Beginning capital account
$
40,524.
Capital contributed during the year
$
Current year Increase (decrease)
$
—27,735.
witsdrawaissaistiessons
SI
9,3924
Ending capital account
S
3,397.
pp Tax basis
0
OAAP
0
Other (explain)
PA Did the partnercontasse property with a built-In gain or loss?
C
Yes
LXJ No
N' es'. attach statement (see hist ruC0onsl
e•th-
ti 1Lb la LHA For Paperwork Reduction Act Notice, see Bistro lions for Form 1055.
I 6.0oWlornil 065
SchedtleK4 (Form 1066) 2012
3
21146 41
SDNY_GM_00013122
EFTA_00143735
EFTA01280262
2'7-3304656
SCHEDULE K-1
OTHER DEDUCTIONS, BOX 13, CODE W
DESCRIPTION
AMOUNT
AMORTIZATION
688.
DUES & FEES
9.
42.
TOTAL TO SCHEDULE K-1, BOX 13, CODE W
739.
SCHEDULE K-1
GAIN OR LOSS, BOX 17, CODE B
DESCRIPTION
AMOUNT
SECTION 1231 GAIN OR LOSS
SEE FORM 6251 INSTRUCTIONS
-14.
TOTAL TO SCHEDULE K-1, BOX 17, CODE B
-14.
SCHEDULE K-1
DESCRIPTION
AMOUNT
TOTALS
-27,051.
SECTION 1231 GAIN (LOSS)
-54.
SCHEDULE K-1 INCOME SUBTOTAL
SCHEDULE K-1 DEDUCTIONS SUBTOTAL
NET INCOME (LOSS) PER SCHEDULE K-1
-739.
-28.
137.
-27,105.
-739.
-27,844.
109.
TOTAL TO SCHEDULE K-1, ITEM L
-27,735.
TNER NUBER 3
17540322 758241 21146.20002NLEIDENTPIAL
IONPAR
LLC.
SDNMY 2 1
_000
46 41
33
_G 1M
23
EFTA_00143736
EFTA01280263
3
Schedule K-1 IForrn 10651 2012
• Page 2
This list Identifies the codes used on Schedule K-1 for all partners and provides summarized reporting Information for partners who rile
Form 1040. For detailed reporting and tiling information, see the separate Partners Instructions for Schedule K-I and the instructions
for your income tax return.
'
Orene-, itnInetit ewe., Beeil DeWen ~her Ste non MO l•
~eve al noncene end enter an yewfete fee kern
Pathan
Per 'ome
11~4
kee
Noneeeere lenei
2. Net tent MI Cane Iron ONO
a Other rig noted eiene01441
Net Inn
4. Ennierliee polymer's
5. lent ineerne
OrIntry &Men
lb. Cluetred dinette
7. Floyett
& NM short-r
malts pin (net
9a Net enttern Mate
On«
9t.
E25144geir (bee
Sa Unreceptur0 neon 1250 pin
13
Net melon 1231 tea (ces)
Ohir 'eon Ma)
Cede
A Other priloho Incon(aern)
B evolution cenvembins
C See 1259 a"net16 Vienna
O Mktg etplorliten con naps"
E
Cenetednan el 001
F Othre knee 200
'2. 5eolon 179 doeluetlen
13.
Other deaecen
A fah conteeuleas pC94)
B Caen centittrJore 430/41
O \ant
cer e >Aire
Et)
D Sar
tone talons OC45)
E Capital pen propeny to a 504
anniZ0000, 4
F Caen Gain Wendy 0014:
•
CaTE-0400000151
H Irvestment 'tweet ten
I
Dedtietere • royalty inn
•
~Tan 69e42/elnecilturee
K Doe.iesore ^la
C2SS Teal
L
Dec titan* • oaten (eY0
M &mullein Mid tarpon cal *nascrco
'1 Caseation evenvr* bete Le
O Upended an benches
2 PrOteduCehe Oared ones
Q Contested rwIttlentioo dedue3on
torn an roe Mate ettivlin
•
IhenNeine ono IRAs
S Renernn etkPerbee ~MIDI
T Dalwede: pion Jane nviteie
Irkerrenn
U 040110 eedoctien aceNnie eon
Sept.:Ire Fenn 44-2•4•944
W Olher 00 echoes
Repo,: on
544 eri Petra a Irstnictart
Selectee 5. lino 211. CO Jeri
Schochl a
lino 24 w Jon Tj
•riCllwl.0 é, Ire 28, note in 0
See ire area's Irene:lee
24•90•40 E. in 28. court CO
See lie %hen instanter*
Schearlo E lire 2a. ~rt. 0
Torn 134C, lee 8a
goo, 101C, rir• 9a
Fein 1340 tiro 90
SciecJleir fine 4
Stench ro 0 Snob
Schenk •
lire 12
2131‘ Fete Gen Weekterit ime
Patient* 0 Inn-chore)
See eieFsetnefet tenth:tons
Ste tie Peetner's eeeuntore
See Be auto?* Mnotctlana
See I" Pawnee Innottlitee
Fenn Ent the 1
54, Pa. 635
Fen 1040 line 21 orEen 982
SemePaYmre..roAMdirs
See the Partner* havens
I
En Vie Punta Ineestkne
Fart 4062 line
5eredslie E Ike 19
See the Pertnerit MM *:lens
Ser•OLIer& Ike 23
Sonny& M 25
Schedtee A. lb» 1 or Few 10eD, ne 29
See the nark. fl extime
:ore 2e41, lee 12
Se es 'Wen Inflections
~Font t682 iratructen
Sea te P*7.0es inate.cLore
See es knees Nientke•
Sec roan RCS Ineroneons
Fens. 893. Ire 73
Foie ESA Vii
See eit Pedreis Irstructiene
14.
SWABIOleffilelt ern 10.0~
Wee II you here e settlel 179 elso neon cr ary ~nor- ere ~tacos. see
the ~We Intones before Cerratetn2 Sehodule
A Nal metro ;net hem
acne.. SE Santee A or
eetneensio/Trat
B Oren bring or IlatInei Boon
See te Peen'. nnettfors
C One noels-in Interne
See en Freer a nelrueleen
15. Own
A LON-Incerne teeing credit
Beebe 47$01) fain P111-2COE
tJMFP
B Lereincon nas os
lone/
heel pre-2= toulltires
C Ln•Intrin -nee his not lent,
/2054 h.r. pc41.23C7 e.doinhe
O
„Oes•trearre tIctaing ant: I (Cite°
kit :-7.1•201/ toradires
E One.: rate) tear enrols-es
flied Not testel
F Ober metre in estate ante
O One fenta theirs
14 Untie:41/nd &Iona Leine ~Oh
I
Akche anti nor Enna blend tin
en&
2112(12
J1-01 13
See he arrtne's Ineorttent
Fein lea, line 71; Yin Pox •
See the Panne?. Irsevenni
Code
~Oft nn
J Wait aPeatterheteedi
K ~Knee
nett
Entiernereint xole Inc Netted
owns- fie employment net
to Often kr inneotng meek,
elehátes
X Cneo.1
emecyer vent en et,
arid Medan nee
O Socket tetireklin9
P One areffie
15 Fenian neffellons
A Nier. procurer or U.3
poseeeeke
B Co.. Ion toe all sconces
C Oren ran. oaten meat'«
Forcer gees none essOICI n: pen ~hip eve.
pasen ~gory
E Ginn creepy
F Oter
reducheire ercae ant isoperroi id at tanner eel
O Intern nine
Fern • el& Pan 1
H Other
con. 1118 Pet I
See to Pen, * ireetxtnrs
}
;Jn I' le Part I
}
Facr 1I'8, Pet
owe-Iona 411~ aid ettltrt-cred ne Petreelle
ixomB
1
Palen err/9n
J Genre cenegoir
f( Other
One Irbetaloh
I. Tool faelse tines Pad
1A To:01 01191 BAca ac'-44TI
N Reduetlen In Zees avasbn Ex cx t
O Fever two hg greer wept.
P Extend:04.1'm~ endue'«
O Other knees ternacters
17
AtinetIve r* Turn tits (MT) Mr»
A int.19414 Mandator BEJSIPlent
3 Munn gain or bee
C Depediet Biter etill oil 8 00
•
015 gee geonerre - Oreta inncre•
F
Ca, gm apo7arra • defied-ens
F OlherAtfrlen
It
Tie-sawn noon rod nendeinelitle «peen
A
ex-eadlelst beent hccere
B Otne• tax-wend Iran
C tkirdedrcro•ashenfee
10. Dreetutkera
A Ceara awresszobabe
•
2leeteten next to ~en 737
C Oteir newt!
20. Ohl« 9-tenter
A ItheoWnre irr.orti
tl fawner: eitoneas
C FLel tat CatIlt IrbertelcC
D alarm ~la,
eatendit. Se
totter than tent* reel eon;
E
Bade °Inn? proPetY
F ~pin
rbeencome Intern
craft tane5on 421(5))
O ~tare of low- nnOrie hat.fdry
«edit (peat)
-
ROZZOtve al kennel:awl:
Fkoapt.h: ol other an%
J
Look-hook Irtnet • toneetec
bug hen cemeeest
K Leokntit le tense Irene* krecnst
fretted
L Dleptellithit of oieporly tee
since 179 eted.0one
Irl Rectiotinte senton "79 cerkintio-
N Ina,: expanse kw obi:crate eerttere
O Set on 45300 ntinabon
P Sector 453A0 remain
O Settee '283(o) thrholnE
P newt blocttie in enter on
~fen
8 C:CF fer&icifted wiener's
T
Dopetior ir biltatintel • all and On
U Anortneter of reknit-don mite
Unmated boatmen won socrie
•
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21146 41
SDNY_GM_000U124
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New Yak State Department of Taxation and Finance
2012
New York Partner's Schedule K-1
Tax Law - Article 22 (Personal Income Tax)
3
-
Final K-1
For calendar year 2012 or tax year beginning
01-01-2012 end ending
12-31-2012
Amended K-1
Partners: Before completing your income tax return, see Earn IT•2044134, Partner's Instructions for Fonn1T-204-IP (available at envw.tax.ny.gov).
Partnership's Information pse instructions)
Partnership's name (as shown on FormITI04)
IT-204-IP
Partnership's EIN
27-3304656
A Mark an X in the box If either applies to your entity
C
Publicly traded partnenitio
O
Portfolio Investment partnership
B
Tax shelter registration number, Harry
C Business allocation percentage
Partner's information (see Listarcnons)
Partners name
Partners address
27 HIGH TECH BOULEVARD
City
State
ZIP code
THOMASVILLE
NC
27360
46
Partners identifying number
20-3161309
D The partner b a nen se X in re apprpodate bog,
General partner or LLC member-manager
'XI United partner or other LLC member
E What Is the tax Piing status of the partner? owe., X ir tio eporcrate boA, it xrcreen)
ED Individual Li.
Estate/trust
M
Partnership
F If the partner Is a disregarded entity or grantor trust,
enter the tax ID of the entity a individual reporting the Income, If known
F
O Did the partner sell Its entire interest during the tax year?
0
Yee __
—
No LXJ
H Partner's share of profit, loss, and capital
Beginning
Ending
1) Profit
N1
3.2979
%
4.2553
2) Loss
H2
4.2553 %
4.2553
3) Capital
10
4.2553 %
4.2553
i
Partners share of liabilities at the end of the year
1) Nonrecourse
11
5,485.
2) Qualified nonmcourse financing
12
303,782.
3) Recourse
13
J Partner's caplin account analysis
1) Beginning capital account
J1
40,524.
2) Capital contributed during the year - cash
J2
3) Capital contributed during the year • property
.13
4) Cunard year increase (decrease)
J4
-27,735.
5) Withdrawals and distributions • cash
.15
9,392.
6) Withdrawals and distdbutions • property
J6
7) Ending capital account
J7
3,397.
8) Method of accounting (mai/can X In the eppropriete box)
M
Tax basis
GAAP
O
Sock
EJ Other (svbrrdt explanation)
K Resident status (mark an X In &boxes that apply*
CI NYS full•year resident
Yonkers full-year resident
U
NYC ful-year realdent
C
NYS part-yea- resident
=
Yonkers parbyear resident
Ei
NYC part-year resident
IT NYS norresident
17 Yonkers nonresident
L If the partner was included in a group return. enter the special NYS Identification number, If known
L
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•
11 1) Wee Form IT-2868-E filed writ- the partnership?
151 Yea 0
No 0
2) Was Form MTA406E filed with the partnership?
rA2 rod=
No 0
N NYS estimated tax paid on behalf of partner (from Fonn IT-2658)
1) First instalment
NI
2) Second installment
N2
3) Third Installment
N3
4) Fourth Vistallinent
114
Total NYS estimated tax paid on behalf of partner (add Ines N1 through N4)
O Estimated MOUNT paid on behalf of partner erOM FOM7MTA-405)
Date
Amount
1) First instalment
01
2) Second Installment
02
3) Third installment
03
4) Fourth installment
04
Total 'shouted MCTMT paid on behalf of partner (add Mesa/ through 04)
Partner's share of Income, deductions, etc.
A - Partner's distrbutive share hems
B - Federal K-1 amount
0
C - New Yo-k Stale amount
1 Ordinary business income (loss)
1
1
2 Net rental real estate Income (loss)
2
—27,051.
2
3 Other net rental Income (loss)
3
3
4 Guaranteed payments
4
4
6 Interest income
5
5
6 Ordinary dividends
0
6
7 Royalties
7
7
8 Net shorttemi capital gain (loss)
8
8
9 Net lor.g-term capital gain (Ices)
9
9
10 Net section 1231 gain (toss)
10
—54.
10
11 Other income Ooss) Identify:
11
11
12 Section 179 deduction
12
12
13 Other deductions Identify:
SEE STATEMENT
14 Tax preference Items for minimum tax
identify:
13
14
2,
739.
515.
13
14
15 Net eamk-igs (loss) from selfomployment
15
15
18 Tanxempt hoome and nondeductible expenses
10
16
17 Distributions - cash and marketable securttles
17
9,392.
17
18 Distributions • other property
18
18
19 Other Items not ircluded above that we required to be
reported separately to partners
identity:
19
19
Date
Amount
Partner's share of New York modifications (seeinstructions)
20 New York State additions
Number
A - Total amount
20a EA-
16
484.
20b EA-
20c EA-
20d EA-
20e EA-
201 EA-
B New York State allocated amount
21 Total addition modifications (total of coiumn A. lines 20a through 200.
21
484.
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Partner's share of New York modifications (continued)
22 New York State subtractions
Number
A • Total amount
22a ES-
22b ES-
22c ES-
22d ES-
22e ES-
221 ES-
B New York State &boated amount
23 Total subtraction modifications (total of col✓mn A knos 22a through 22f)
28
24 Additions to federal Itemized deductions
Letter
Amount
24a
24b
24c
24d
24e
241
25 Total additions to federal Itemized deductions (add lines 24a through 240
26
26 Subtractions from (edema itemized deductions
Letter
Amount
26a
26h
26c
2fid
26e
261
27 Total subtractions from federal itemized deductions (add Mee 26a Through 26f)
27
28 New York adjustments to tax preference items
20
Partner's other information
29a Partner's shale of New York source gross income
28.
29b MCTD allocation percentage (see instructions)
294
Partner's credit information
Part 1 - Flow-through credit bases and factors
Brownfield redevelopment tax credit (Form IT-611 or IT-671.1)
A - Fawn IT-611
Et - Form IT-611.1
30 Site preparation credit component
30
30
31 Tengble property credit con'pcner.t
31
31
32 On•site groundwater remediaticn credit component
92
32
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Partner's credit Information (continued)
EZ capital tax credit (Form IT-602)
33 Contributions of money to EZ community development pro)ects
33
34 Recapture of credit for Investments In certified EZ businesses
34
36 Recapture of credit for contnbutions of money to EZ community development prorate
35
QEZE tax reduction credit (Form IT-604)
36 QEZE employment increase factor
35
37 QEZE bone allocation factor
37
38 QEZE benefit period factor
36
Excelsior Jobs program tax credit (Form 17.607)
39 Excelsior jobs lex credit component
30
40 Excelsior investment tax credit component
40
41 Excelsior research and development tax credit component
41
42 Excelsior real property tax credit component
Farmers' school tax credit (Form IT-217)
43 Acres of qualified agricultural property
43
44 Acres of qualified conservation property
44
45 Eligible school district property taxes paid
45
45 Acres of qualified agricultural property converted to r.onqualified use
46
Other flow-through credit bases and factors
Credit bases
Cods
Amount
Code
Amount
47a
47d
47b
470
47c
471
Credit factors
Code
Factor
Code
Factor
Code
Factor
47g
47i
47k
47h
471
471
Part 2 - Flow-through credits, addbacks and recaptures
48 Long-term care insurance credit (Form IT-249) .......
48
49 Investment marl (Including employment Incentive credit and historic barn nattilltatIon credit Form IT-214 40
50 Research and development • investment credit (Form IT-212)
50
51 Other flow•through credits
Code
Amount
Code
Amount
51.
51e
51f
51c
519
5141
51h
52 Addbacks of clerks and recaptures
Code
Amount
Code
Amount
52e
52d
521)
52.
52c
521
p
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