EFTA01280154.pdf

651112
( S F c o h r e m d u 1 l 0 e 8 K 5 - ) 1 2012 I I ril.P.C.1 C Amended K-1 OMB No. 1545.009.
Fez Mier Sr year 20- 0. tax Part 111 Partner's Share of Current Year Income,
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u ry yea- bogInelng Deductions, Credits, and Other Items
enairc 1 Ordinary business income (loss) 16 Credits
Partner's Share of Income, Deductions,
50,213.
Credits, etc. ► See separate instructions. 2Newsmeweorcarcoome
-6,518. 16 Foreign tensactions
Information About the Partnership 3 Other net rental income (Ices)
kientication number 4 Tara-deed paymerts
B Pedantic s came, address, city, stale) and ZIP code 6 Interest Income
2,576.
SV AMERICA HOLDINGS, LLC
13, Cidinary &tends
42 HIGH TECH BLVD
17 Albrnaltve mkt fax (AMT) Pans
THOMASVILLE NC 27360
(lb OuallOed dtvklends 1 477.
C IRS Center where partersiap filed return
E- PILE
7 loyalties
D Ej Cneck if this is a publidy traded partnership (PIP) 8 Net short-term capital gain (loss) 18 n T o a n x- d e e x d e u m c p tb t l i e n c e o x m pe e n a s n e d s
* STMT
YAW Information About the Partner 9a lot long-farm capital gain (loss)
E Partner s id until ry number 9b Colecttles(28%) gain (loss) 19 Distrindions
12,671.
F Partner's name. address. LitY, state, and Z'P code tic Unrecaptured sec 1250 gain
20 Other intormagon
BLUE CHIP CAPITAL, LLC 10 Net section 1231 gam (loss) A. 2,576.
329 SEABREEZE AVENUE
130.
PALM BEACH, FL 33480 11 Other Income (loss)
0 C General partner or I I.0 DU I imited partner or other LLC
member-manager member
Domestic oaths' LJ Foreign palter
It What typo or entity s It is panne° PARTNERSHIP 12 Section 179 deduction
12 'I m's partner is a retivemeM plan 0FWSEPA(eoginfetc.), check here I I
J Partners share of groin, 'ass, and caprat 13 Other deductions
Beginning Ending A i 670.
Profit 3.6001880% 3.6001880%
Loss 3.6001880% 3.6001880%
caobi _ 3.9261080% 3.9261080% 14 Self-employment earrings(lass)
K Partners share of Ratites at year en& 0.
lionrecourse 283,514.
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n o rvecourse financing
$
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'See attached statement for addition information.
L Palters copra/ account analysir
Beginning capital account
Caphal cunt-bared amigo Me year 500,000.
Gwent year increase (decrease) 2,416.
moorowa:s 8 d sbitutiens 12,6710
ending urging exam: 489,745.
C Tax basis 0 BAAP 0 Section 704(b) book
71 other (explain)
IA Old the partner contribute property wit". a built-in gain o: loss?
C Yee MIto
If Yee. attach statement (see instructions)
0'413-13 LHA For Paperwork Reduction Act Notice, Bee Instructions for Form 1 65. IHS.gov/forr 1065 Schedule K-1( Fenn 1005) 2012
3
22560411 137428 7386.003 CONFIDEITTlAtfiNGs• LLC 7386.001
SDNY_GM 00032878
EF1'A_00143491
EFTA01280154

SV AMERICA HOLDINGS, LLC
SCHEDULE K-1 NONDEDUCTIBLE EXPENSES, BOX 18, CODE C
DESCRIPTION PARTNER FILING INSTRUCTIONS AMOUNT
EXCLUDED MEALS AND NONDEDUCTIBLE PORTION
ENTERTAINMENT EXPENSES
537.
OFFICERS LIFE INSURANCE
22.
TOTAL TO SCHEDULE K-1, BOX 18, CODE C 559.
SCHEDULE K-1 FOOTNOTES
TO REDUCE THE PAPER DOCUMENTS WE CIRCULATE, WE OFFER
THE FOLLOWING...
INSTRUCTIONS IN ELECTRONIC FORMAT FOR SCHEDULE K-1 MAY
BE FOUND AT:
HTTP://WWW.SMITHLEONARDCPAS.COM/RESOURCES/TAX-CENTER/
CHOOSE TAX FORMS & PUBLICATIONS
ENTER KEYWORDS "K-1 INSTRUCTIONS TAX FORM 1065."
IF YOU WISH TO HAVE A PAPER COPY OF THIS DOCUMENT, PLEASE
CALL US AT
PARTNER NUMBER 3
22560411 137428 7386.003 CONP1OENITAt's
, LLC 7386.001
SDNY_GM_00032879
EFTA _00 143492
EFTA01280155

3
Shhedub K-1 (Form IC65) 2012 Page 2
This list Identifies the codes used os Schedule K-1 for all partners and provides summarized reporting information for partners who file
Form 1040. For detailed reporting and Ming Information, see the separate Partners Inductions for Schedule K-1 and the instructions
lor your Income tax return.
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Passive I,es S R e e e p t e o l e o F n a hwe'e If /A C cu o n n r f u l I n a li y In e cr -n ea o s io in ) g 'r - e e r v l e cr r e & da See Ito Fromerds Pelniddolc
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Nee ewe Seheckde C. Ins 28, asre (g) IC. Foreign Irsrescbmas
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Code
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CI el nip expleaden rare trawler. See rub. 635 J liontral ~WM } reeve 1118 Plet)
E Ceneeetenerdool Fern 1240, nee 210 'ore 91,2 K Cel.
F Oder inane Boa) Sen deP aine Irtriddlcre Other niermarlon
12. Sect cn *Wee See Me Partnen leemachois • A l T fo O b lM / lo lb n r r e c V h h m li i n re e s . p a a a l c e rued F F a a r n * 1 1 1 1 1 1 0 8 . P a a t l I I I I
"3. Dthe &tektite, N Raducreen in else eta ado Ia Mode Ferro '118 Ine 12
A CS, eter. tons (5094; O rtra Cad ng gees receipts teen 5071
9 tat ccer.bullone (32)18 P LerodertItrla ircome eon usen Fenn 8ein
C henna*, cenebflens(5O%) O Other loreol oareeziler• Seethe Pallets ~morons
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E o CA tp PI2 r 4 W 19 o •8 n 1 D O O re % l:a ) n y IO • SCre IT. AreinetA•mlnirni.wn tax W.1-) rorne 1
F Croke gain property (40%; A Poe1.19805amecratcn r-cljatrant
• ContrIbuonn$1180%) B Apusted 1,31,, a' Kea See% Partners
II Invaelment hired napens Form 4952. IIM 1 5 Depletion Mee ran el & gee; ~atone end
I DeSacainns - tOyely domino Scrondole E. line 12 ) 01, Los. A geothermal • due Income Me ~am /Or
Scomen ao»pj «pencils% See lhe nelnattone • ow, geothermal • drortictom Fenn 0251
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1. Dedrámard • prone Coen) Sehmaule A. Ilya 28 18. Tax.exarror income alh1n Onee0ACZIto ~refs
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C ter ncedrenn Income Soothe Pries Inethowns J LOolobaci, rimer • complete]
keg ken contacts see ran 8027
Is. Credits K Look-bedt Items' - Moamar Mmemaz
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bulldreds «tree 1132 Mrdocrom
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turn cre.2005 beano, N Fohreet expense lc, rococo-Ms panner8
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Co Low-emcee meting own (oral Sates Punnet newel one O Bettie.' -200(]) &yeTarr
torn posi•22C7 odlcegs R itemsl dlocable wocren Rae 'I» Pe-tress
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(I Qtr darts' credlos U Arnen ;sect al ralcerdaare are
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22560411 137428 7386.003
7386.001
SDNY_GM_00032880
EFTA_00143493
EFTA01280156

IT-85 2012 Schedule IN K-1
Ste Form 49181 (R12 / 8-12) Indiana Department of Revenue
Partner's Share of Indiana Adjusted (Noss Income, Deductions, Modifications, and Credits
Tax Year Beginning 01 01 2012 end Ending 12 31 2012
Name of Partnership
Federal Ident" umber
LD
Distributions -Provide INK-1 to each partner. Enclose IN .<-1 with IT-65 return. for intimation on the acceptable electrons data
file format, vial the DepalmenEs website at wortin.gov/dor/3172.htm Pro rata amounts for lines 1 tnrobgh 26 of any
nonresident partner must be mulipried by the Indiana apportionment percent, if applicable. from IT-65, Fne 4.
Part I - Partner's Ideal flcadon Section
(a) If Partner Is an Individual (please print clearly) Sociai Security Nanber:
Last Name: Fket Name:
al a2 a3
(o) If Partner Is an Ober Entity (abase orbit clearly) Federal Identification Number,
Name:
51 BLUE CHIP CAPITAL LLC b2
(c) Partner's Stale of P.asIdenoe or Commercial Do,Meie cl FL
(d) Ind9na lax WIthhed for Nonresident Partner (on WH-I8)._ d .00
(e} Partners Federal Pro Rata Percentage 3 . 6 0018 51.
(0 Partners Tax as Computed on IT-65CCMP Colimn G
.00
Part 2 - Distributive Share Amount (use apportioned figures for nonresident partners)
1. Ordinary business ineOme pons)
1280.00
2. Net rental •eel estate income (loss) -166.00
3. Other net rental income (loss)
. 00
4. Guaranteed payments
. 00
5. Interest income
66.00
6. Ordinary &viands
.00
7. Royaities
. 00
8. No: short-term capital gain (loss)
. 00
9. Net long-term capital gain (loss)
. 00
10. Net IIIC Section 1231 (AM (loss)
3.00
11. Other income (loss)
. 00
12. ;RC Section 179 expense deduct:on
. 00
13a. Portion of expenses related tc investment portfolio income, including Invostrnent
Interest expense and ether (federal nornemized) deductions
. 00
13b. Other fn formation from Eno 20 of federal K-1 related to investrnent Interest
and expenses not listed elsewhere
. 00
14. Total pro rata distribudoes (And lines 1 threugh 11; subtract eves 12,138, and I31) when applicalle.) 1183.00
Continued on next page ►
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12-05-12 1019
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IT-65 2012 Schedule IN K-1 Page 2
Part 3 - State Modification Add or s.:bract the following. Designate the distibutNe share amount of each modification
to Indiana ad lustod gross income from line 2 on the front of Form IT-65. For .nonresidents, appty apportioned boxes.
(Use a minus sign to denote negative amounts.)
IS. State income axes deducted
.00
16. Net bonus deprecation allOwance
.00
17. Excess IRC Section 179 deduction
. 00
:8. Interest on U.S. obligations
. 00
19. AddbackMeducoon Coco: . 0
20. Addtack/Ced-ction Code:
. 0 0
21. AddbacIODeductIon Code:
.00
22. AgehaowDeduction Code:
. 00
23. Addback/DsdoetiOn Code:
. 0 0
24. Addback/Oedustion Code: . 00
25. AdobadvDeduction Code: . 00
26. Addbackteduction Code:
. 0 0
27. Total distributve share of mocite=tions (add lines 15 through 26 and catty total to Column B
on Schedule IT-S5COMP)
. 0 0
Part 4 - Pro Rata Snare of Indiana Pass-through Tax Credits front Partnership
28. Enter the lame of to tax credit p(ogram, Its trten-digit ID code, and the dolor amount of the partner's distributive
share to each alnwable credit
Name of Credit: ID Code:
a b c .00
.00
. 0 0
29. Total pass. two Jell croft (add linos ne, 281. and 28i)
. 00
I uhf liii 11111IiIIlIIi gignm11111111 III!
fte212
.!2a3-12 1019
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SDNY_GPL00032882
EFTA_00143495
EFTA01280158

NC K-1 (39)
2012 Partners Share of
(D-403)
N.C. Income, Adjustments, and Credits
1C-11-12 North Carolma Depanmant of Revenue
For talendar year 2012 or kcal year hoginring and onding
Partner': Id entifyl eg N u m bei Federal Em r I
Partners Name, Addresa, and ZIP Code Partnership': Name, karen, and ZIP Code
BLUE CHIP CAPITAL LLC SV AMERICA HOLDINGS LLC
329 SEABREEZE AVENUE 42 HIGH TECH BLVD
PALM BEACH PL 33480 THOMASVILLE NC 27360
Individuele Firma Form
Partnerebip's Pro Rata Share Item Antoon( 0-400 Enter Amant on:
All Partner*
1. Stan of partnerslib income (loss) 46401
2. Additions tO ine0rhe (ÅSS)
Addi0on for bonus de:reenden 1363 Page 2,1.Ine 35
b. Ober additi0iS tO boem (ass) 0 Page 2, Line 36
3. Deductiens trom incomo (loss)
a Deductie» fot bonus depreciation 0 Page 2, Line 44e
b. Other deductrons korn licome (loss) 0 Page 2, Line 49
4. Share of tax credIS 0 Form D-40OI C
5. Share of tas withheld kom nonwage coma/ambo
pakt tor persona services peetorned in N.C. 0 Page 2,1 Ine 23
Nenresidente Only
6. Nonresident's share of N.C. taxable Interne (loss) 35594 Page 2, Lila 51
1. Nonresldont's share ot net tax pad by the mana0er
of the partnership 0 Page 2, Line 24e
AFFIRMATION ATTACHED
20020,
V.MM
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EFTA01280159

NC-NPA (39) Nonresident Partner Affirmation
D-403
North Carolina Department of Revenue
8.35
3
r
Identifying Number Partnership's Federal Employer ID Number n
Nonresident Partners Name, Address, and ZIP Code Partnerships Name, Address, and ZIP Code
(BLUE CHIP CAPITAL LLC SV AMERICA HOLDINGS, LLC
329 SEABREEZE AVENUE
42 HIGH TECH BLVD
PALM BEACH FL 33480 THOMASVILLE NC 27360
Date nonresident became
partner In partnership 12/20/11
Partners Tax Year Partnership's Tax Year
01/01/12 12/31/12 O1/Q1/12 12/31/12
beg.nning (MAI-DO-Yr) ending (MM-00-110) bogiming (A4M-DD-Yr ending (MM-DD-Y»
Type of Partner. C C Corooratior. S Corporation 50 Partnership Estate or Trust
(RU in applicable circle) Note: This toon is not applicable to nomosidect partners who are incateilusts or grantor busts.
I affirm that 1. The entity above is a nonresident partner in the pagraship shown above, and
2. I will timely tile the entity's applicable income tax return and pay the tax Imposed
by North Carolina on the entity's share of the partnership income.
Signature of Manager, Officer, or Fiduciary Date
affirm that: the entity above is a nonresident partner In the partnership shown above.
SE
Signature of Managing Partner Date
General Instructions
Ina partnership having ore or more nomes'dent partners, the rr arming partner is responsible for reputing the share of the income and paying the tax due tor
each nonresident miner. However, line nonresident partner is a corporation, par birdie, trust or estate, the managing partner Is not required to pay the tax
an that partner's share of the partnership income provided the partner sirs this Nonresident Partner Affirmation affirming that the partner wit pay the tax wit
its corporation, pa'tnership, trust or estate income tax return. Ws form must oe attached Ic the pytnershio return of the partnership shown ahem (Note: Ibis
form is nor applicable to nonresident partners who are individuals or grantor tests.) Payment of the tax due by'h e managing errs or aerie of corpoldors,
Partnmsbara, trusts or estates tits are partners does not retove the partner from ulna a North Carona tax return.
2%a4 I
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SDNY_GM_00032884
EFTA_00I 43497
EFTA01280160