EFTA01280113.pdf

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D ( S F c e o h u r e m r d r u 1 n l 0 e e 6 r K 5 t - a ) 1 The Treasury F ,. c . r . ; . a sn w ,, a ,, y ,n y e aw 2•0 •2, 7 rs, 2012 I- ? 1 j i A n na n l K : - . 1 P artners ] S Am h e a n r d e e d o K f - C 1 urrent Y oh e ge a N r o In . 1 c 5 o 45 m 40 e 9 , 9
Irturnal Regende service Deductions, Credits, and Other Items
C Pa re rt d n it e s r , ' s e t S c h . are of Income, e D ld e N d uctions, 1 O I rdinary busines 5 s 0 s'o , m 2 e 1 (l 3 os . s) 16 GredItS
_.. .. . 1 See separate inane:net 2 h I i e renter real Wo — e t 6 o r , n 5 p 1 ppe 8 l . 19 Fannon tentedicns
Part. I Information About the Partnership 3 Other net rental income (10M)
denNication number
4 Guaranked PaymentS
B Part4ershp s name, address, cry, stale, and ZIP mde r-- 5 - I I n terest hcome
2,576.
SV AMERICA HOLDINGS, LLC Se Ordinary artclends
42 HIGH TECH BLVD !
C T H IR O S M C A ob S s V w I he L re L pa E rt , er sn N Ip C M ed r 2 a 7 n 3 60 SD Qualified dividends 17 Alternatta rein tax 1 (M .1 4 7) 'e 7 rr s
IC —FILE
7 Royalties
0 In end( :t tills is a cubecly traded partnership (PIP) 8 Net shcrt-term Capital gain (boss) IS n T o a n x d im ed i u m c p tib t I l n e c ° o v m a e n a e n s d
I * STET
019ffillt Information About the Partner 9a Net long-term nodal win (loss)
I
E Partner's Went renter
9b Gollenteles (28%) gain (loss) IS OiStrtutions
F Partners name, address, cily, state, and ZIP code So "recaptured sec 1250 gain 12,671.
r
B 3 L 2 U 9 E S E C A H B I R P E E C Z A E P I A T V A E L N , U L E L C 10 N 1 e t section 1231 gain ___-, 20 Odier aroma:ion 2,576.
I (1M3ae0) .
PALM BEACH FL 33480 1f Other Income Doss)
G U General partner a LLD Ix] Limiled partner or other LW
member-marega neater
H LIDomestic 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
Pion
Be
3
gI
.
nn
6
ie
0
g
01880%
En
3
di
.
ng
6 001880%
A 67Q.
Loss 3.6001880%1 3.6001889% I
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%j 3. 9261080% 14 Seif-ernpiornent earnings (loss)
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.g4
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
ra II Yes' attach suterrent (see instrudNes)
l owser /a LHA For Paperwork Redaction Act Notice. are Instruction of Font 1066. IRSdovitarr.1065 Schedule K-1? Form 10851 2012
22560411 137428 7386.003 2012.03030 SV AMERICA HOLDINGS, LLC 7386.00 3 1
CONFIDENTIAL
SDNY_GM 00031942
EFTA_00 142555
EFTA01280113

SV AMERICA HOLDINGS, LLC
SCHEDULE K-1 NONDEDUCTIBLE EXPENSES, BOX 18, CODE C
DESCRIPTION PARTNER FILING INSTRUCTIONS AMOUNT
EXCLUDED MEALS AND NONDEDUCTIBLE PORTION
ENTERTAINMENT EXPENSES
537.
OFFICERS LIFE INSURANCE
22.
TOTAL TO SCHEDULE K-1, BOX 18, CODE C 559.
SCHEDULE K-1 FOOTNOTES
TO REDUCE THE PAPER DOCUMENTS WE CIRCULATE, WE OFFER
THE FOLLOWING...
INSTRUCTIONS IN ELECTRONIC FORMAT FOR SCHEDULE K-1 MAY
BE FOUND AT:
HTTP://WWW.SMITHLEONARDCPAS.COM/RESOURCES/TAX-CENTER/
CHOOSE TAX FORMS & PUBLICATIONS
ENTER KEYWORDS "K-1 INSTRUCTIONS TAX FORM 1065."
IF YOU WISH TO HAVE A PAPER COPY OF THIS DOCUMENT, PLEASE
CALL US AT
PARTNER NUMBER 3
22560411 137428 7386.003 2012.03030 SV AMERICA HOLDINGS, LLC 7386.001
CONFIDENTIAL
SONY_GM 00031943
EFTA_00 I 42556
EFTA01280114

3
Scheduk (Fnrm 1065) 2r2 Pace 2
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for your 'atome tu rature.
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22560411 137428 7386.003 2012.03030 SV »MICA HOLDINGS, LLC 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 wedw in.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) SOCL,11 &corny Ndrrter.
Last Name: FER Name:
al a2 a3
(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
Continued on next page Cu
NMI MIi iIPuu
2502'1
12-S3 '2 1019
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: .00
27. Total distributive Niro of medications (add lines 15 through 26 and catty tod to Column B
on Schedue IT-65COMP)
.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
NIL ,'INII VIII kill allr ill
250212
1243-12 1019 136121210'19 I
CONFIDENTIAL
SDNY_GM 00031946
EFTA_00142559
EFTA01280117

NC K-1 (39)
2012 Partner's Share of
(D-403)
N.C. Income, Adjustments, and Credits
1C-11-17 North Carolina Department of Revenue
For calendar year 20 12 or hscal year boptnnind and ending
Partner's Identifying Number Federal Employer ID Number
Partner's Name, Address, and ZIP Code Pi dnership's Name, Address, and ZIP Cods
BLUE CHIP CAPITAL LLC SV AMERICA HOLDINGS LLC
329 SEABREEZE AVENUE 42 HIGH TECH BLVD
PALM BEACH FL 33480 THOMASVILLE NC 27360
Individuals Filing Form
Partnership's Pro Data Share Items Amount 0-100 Eater Amount on;
All Pe/there
t. Share of canrershlp income (loss) 46401
Additions lc income (.pm)
a- Addition fa bonus derrectstion 1363
'age 2, Line 35
b. Other additions to income (loss) 0 Page 2, Line 36
3. Deductions train ',come (ions)
a. le:motion for bows doweation 0
Page 2, L 4/e
b. Other deduct:ins from Income (loss) 0 Dade 2, Line 49
4 Share of tax credits 0
Forma-40CE C
S Share of tax %Infield from nonsapis compensation
paid tor persona', services pertorned lo N.C. 0 Page 2, I inc 23
Nonresident Only
6. flonessident's share or L.C. !arable income (loss) 35594
Pape 2, I ine 51
I. Nonresident's Oars of net lax paid by dm manner
of the pal teemtep 0 Page 2, L' 24c
AFFIRMATION ATTACHED
CONFIDENTIAL
SDNY_GM 00031947
EFTA_00142560
EFTA01280118

NC-N PA (39)
Nonresident Partner Affirmation
O-403
io,;;;) .:arckna Doan meet pt Revenue
8-05
3
MooresId eat Partners Identifying Number
Partnership's Federal Employer ID Ile mho
flonresident Partners Name, Address, aid ZIP cpds PIMesMlo's Name. Address rod ZIP COO
D
3
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C
C
27360
partner le peraffitebio 12/20/11
Pennon Tax Year
Partserstdp's Tax Year
01/01/12 12/31/12
01/01/12 12/31J12
beginning (MM-Cally aiding 01.44-DO-Y12 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 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.
i
Signatare of lifeeeplep Pettier
Date
General Instructions
p f i o o I t o n a s n a r r a m t c t t h n h o p e l a n r e a p r t o r s o p n t n h n r a o r i a e e p r t t r t s s i a s n o i , p h d e n b i p e r , p u s n l p i s h c t a s t a a p r s h v b a a C i A - l n r e t r e n r g e i U t e o o s o r f h t n . n a t l h e h ' t o , e o e o o h s w r r p a M r e a m ie l v r a o o t l e d l n a ; r r e e e , n r n i e n g s f t s o h t p p t h n i a a p a e r t r r e e i t n t n n n s i o n e o i e d n c r r m e r s o e e n r d e s v t r o i e i p d p m e a e r s o r n t a n v n t r : i o p e d e W a t r e s r i r d n e t . m n l d t t i e h e h i . v r e v e k T e i t p s l h r e t a a a h is a r m e c t l f r s o o p e p a o r r r i p m n r r t t o g n o g m r e r a p r a r u t a s i n s o f r r t t t M n o n o o , m e r r e p s b r I a a N n a t t M f o t r a n r e g e o c r . s h i e a ) s p e a h P o N d l n d p a o I s e y c , r i m e t t b h r m t l u e e P C e s n a a t t t p e r r o o a r o t n r f r l r i I e e m t n n h r p a e e t o r A g s t t r a f e a e t f x i n i x n , r p r m g t s e h r u t a t e e u h e t t m r i e u o b n r s a n y . n h n a s a o a h f r f g f e e i i r t m n h m o g e f a i n l p n p i g a a a e r p r t t t I h i n n n n a e e c p t r r o s t p i h m h s a e i e r n p t p n o a s a e t n h r r r d t o e n o w n p e n u a r n b y e v a e i e i n a h h d g l e a n t r m l o a h f o o y . p f ( a t l M h a c y e o x o t r t h d t o p a e u r o x e r t T a a w l i x d o t i l t e O t h rs,
20464i
0501.12
CONFIDENTIAL
SDNY_GM_00031948
EFTA_00142561
EFTA01280119