EFTA Document EFTA01280297

5 651112 Schedule K-0 (Form 1006) Department of the Treasury internal Revenue Service Fa COWS, ye. 2012. Cic oestereba nitro 2012 Partner's Sham of Income, Deductions, Credits, etc. O. See separate nstructions Pi tt Information About the Partnership dentlIcadon number 9 Partnerships name, addreacIty,Mte. and ZIP code MIDWAY TRIAD, LLC 270 LAFAYETTE STREET, SUIT 409 NEW YORK, NY 10012 C IRS Center were partnership filed return E-FILE 0 CO:adrift* Is a nubbly traded prthershIP (PIP) ISIff Information About the Partner E Partners laentrylnp number F Partners name. address. cly, stab, and ZIP code BLUE CHIP CAPITAL LLC 27 HIGH TECH BOULEVARD THOMASVILLE, NC 27360 13 lip Omenl partner of LLC member-manager H Domestic partner C Foreign partner T1 What 1700 cf entity 4 thts padner? PARTNERSHIP 12 If this partner is a retirement plan (IFIATSFP/KaogiVetc.), J Partners share of profit, los, and capital: Beginning Profit 1.1346999% LOSS 1.4641288% capg3i 1.4641288% It Partner's share of liablilttee at year eat Harmonise Oualifted nomecourse financing Recourse LIU United partner Of other LLC ember check here Ending 1.1346999% 1.4641288% 1.4641288% 3,652. 135,488. 6 0. t Partners capital account anslysle: Beg limbo capital accouM S 45,696. Capital contributed during the year S Current year Increase (decrease).. S -14,753. Withdrawals 8 dstributlorts Ei 7 / 5104 Ending capital accouM $ 23,433. CET Tax basis U GAAP Other (expialn) IA Did the partner contribute property with a buit-A gain or.oss7 Ei yes MN* if Nee attach statement isee instructional ESI, Section 704(b) book 7 Amended K-1 0M8 No. 1545-009 Part IH Partner's Share of Current Year Income, Deductions, Credits, and Other Items I ordinary business income (oss) 16 Credits 0. 1 2 .44 Meth POO .as IrOteC COlj -14,807. I 16 Foreign transactions 3 Tier net rental Income (loss) 4 Guaranteed payments 6 Interest income tie &dug dividends 6b Cruailled dMdends 17Mo-chines nYn tax (ANT) items A 2,554. 7 Royalties 8 let short-term capital gain (Ion) et long-Inn capital gain (loss) 9b recbtles (28 Os Urrecaptured SIC 1250 gain 10 Net section 1231 gain (loss) Join (Ion) 18 Tax-exempt Income and nonclenoctible expenses 10 Oistittiotona 7,510. 11 Other income floss) 20 Otter tdormation 12 Section 179 deducted 13 Ogler deductions W*I STMT 14 Self-employment earnings Goss) rt 0. ilSere attached statement for addhisnal in ormation. g A ol-os.ra L.MA For Paperwork Reduction 141 Notice, see Instructions for Form 1066. IRSgov/form1026 13060311 758241 21146.212 2012.03011 MIDWAY TRIAD, LLC Sclimilule K-1 (Form 1006) 2012 5 21146_B1 CONFIDENTIAL SDNY_GM_00033168 EF1'A_00143779 EFTA01280297 MIDWAY TRIAD, LLC 45-2929589 a SCHEDULE K-1 OTHER DEDUCTIONS, BOX 13, CODE W DESCRIPTION K-1, PARTNER FILING INSTRUCTIONS AMOUNT DUES & FEES PROFESSIONAL FEES TOTAL TO SCHEDULE BOX 13, CODE W 3. 19. 22. SCHEDULE K-1 CURRENT YEAR INCREASES (DECREASES) DESCRIPTION AMOUNT TOTALS RENTAL REAL ESTATE INCOME (LOSS) -14,807. SCHEDULE K-1 INCOME SUBTOTAL -14,807. OTHER DEDUCTIONS -22. SCHEDULE K-1 DEDUCTIONS SUBTOTAL -22. NET INCOME (LOSS) PER SCHEDULE K-1 -14,829. MADISON - PREPAID RENTS - CY -66. MADISON - PREPAID RENTS - PY 132. WILLOW BROOK - PREPAID RENT CY -24. WILLOW BROOK - PREPAID RENT PY 34. OTHER INCREASES OR DECREASES SUBTOTAL 76. TOTAL TO SCHEDULE K-1, ITEM L -14,753. 13060311 758241 21146.212 PARTNER NUMBER 5 2012.03011 MIDWAY TRIAD, LLC 21146_B1 CONFIDENTIAL SONY_GM_00033167 EF1'A_00143780 EFTA01280298 5 .c.119C1110 K-1 (Form 1355) 2012 Page 2 T n is Ilst Identifies the codes used on Schedule K-1 for all partners and provides summarized reporting Information for partners who file Form 1040. For detailed reporting and filing information. see the separate Partners instructions ter Schedule K-1 and the Instructions for your Income tax return. Omlery tans -avr. Coat 01norrnno Melee 0 issOoS Plena 1Draosa rc oar of ION 'Sr in &Oa 2. t 4 St ea T. So. OP 11. 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S,• So Far 1044 e, 9b SeocaF, .I•I• Sciesul• 0. Oat, PAWS O. Ilar 12 nas Rea GSii Woria4 Ins 4 fad/ea D menoloal Fa Tai traes lecicebis Soo 114 Potreo keouetno SOD IN /4~ • ritawfcve Soo the Panne • wavolons Fam 0781.11m1 Soo NO 630 Foe 12.40. 1r4 21 a Rs 942 • tNKKetrat• [nersions Sea ens Peres Iran/mon 1 Soo Ow Parl*Ner Morita ore Tan 4412. Sno 1 SdedJ.4 Pro 19 Boo Poittoto lamathro 58110.40 A, lbw 22 edad.411. 25 Sow0444 las 1 or Form 1040. lano 20 130.010PeatWo Rom 2441. Inv 12 Sala PRenoto ehk-tkno 34*Fr 2682 to uctr asno Pttn'. Vstr.ctono Soo eo Parlret• letycolono 5the. From, aal 4,47sotao Fr 0903 Ivo 7, Form 0903, Ire '7 S,. 114. P•ertmes Tol/LCOOTO 14 901.4roiloymal atnIngo pool Plots era Nov • actor 179 Csa I or pry pOr leas SSAa • so, 0', Prfers ma..cbons oda conor400 weal%€ A Not onIngo ):.f Rte ar.erpoym O Cmoo Iry co Ilsd*Q ran O rol-Irm 'non 15. 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CalpreY 300hCbril •ECC•30 eV aPootrod at par Ulo, ate o lane ammo 14 Otte Delvotono accobio red Kocrolcr nal id ortatilp I Nave alfloY Goeld nay K Ott Obw ofomatrOg L Tofu bee BARR OW M lee Into ea venue! irognomo, Iva gala* aeo,t O ':0•091 Pang o.00 P Ea.t.vws :tate accaon O Oterbirolan ITOODSCTII IT Artometho Mfaran out 1AM0Porro A Pr.44.12011doome11/101 WeiuseAM 8 AoIaolse ale or nos C Comae (one, tan logs o Cl, sec gooTorral • crow Income • Or. Le. a noun,vmag - *axe env F Gee AMT inns tash•PPIIicornesno noncloa xi bio weed A la-sornpt ,bat lawns O One boxeSTP1 Man • NaddailbIliocareos 10. C/Walbotkno A Canal rnotaboolo ae•-•41a B 0644140os sajoo:Io mete 73) O Colnorpoopely 20. 00wleternsta A Mears mare B Immanent seines o Fo0 prooM1rbrObal O Ot.0 Vitilesetrietpeltne• Paw to , reel AS elits116 E Oath Of Inn/ 0.0pry F !Yeepa-no ev.Ircomonowirg *rat (cocboa 42an • Pecootse sow-Tecate Va/112 eIret (Ma) H Fleenbao *Pant/rat 5,91 I FIetoftro olOIEW ben J Leak-bile. Iltrea • crying iong.tonr cram K loolt-bock Waal • knots Wee! rated L Deletions of 'ropey Mm mike '79 <waxer:ea 14 Kocoptve &sector '010.0.iclon 11 Moira: tirant60 o Sacco 403f)% WIrrr ghee P Soctkr 46.1A10 rrVomeloo o OKolvt 'MO) Non.= • MIMIC el 0004 ID oraceze apnea* • COF reValtled **damn 1 Opedon Ithrooca • cl rod sr U Arwilleor "Anita", aide V .:,•ffeatacl Wawa mar. won. W .Imoorwlo.Iet goInte4.0 X Sego,. 01)0I femur  071a1nloreKol 2012.03011 MIDWAY TRIAD, LLC Fro 11, t Pet rin IVI, Pt I Faun 11,11k Put &M an @WM } Four 11119 Prig Form lilt Pitll Fr 1111 Pair Fan 11141, 12 Fan an ForntS73 Eats Panto Inamolles 1 Ea Om Needs tresuotono are no roop,..i.ono tor Pr 0201 Fr 1010, no do Soo To 'nye,' •ootscel000 Ere to Pees monactorta } S.a to !Imes/ a Ireeltb ,.• Form 4852. Ire 4. Form 41252 Ines Foe 4135 Sr Me Peer. inn:CO:al Bev. Potato Inatnttcoo Foe 5611. Ole a Fameel1.IMS Soo Foe 42E6 Soo Cre Pelee. IrsoncRoa Ea Fr RSV Soo Fan BM Soo se PrOw's ▪ otrtelca 5 21146_81 CONFIDENTIAL SDNY_GM_00033168 EFTA_0014378 I EFTA01280299 SCHEDULE NJK-1 (Form NJ-1065) 2012 STATE OF NEW JERSEY PARTNER'S SHARE OF INCOME For Calendar Year 2012, or Fiscal Year Beginning 2012 end train; 1019 PART I General Information r Pietwe's 99 t et FPS EN 20-3161309 Patinerip's F000rs RN 45-2929589/000 Puma/.Nor BLUE CHIP CAPITAL LLC ParawsNces Nino MIDWAY TRIAD, LLC aMeriArkInse 27 HIGH TECH BOULEVARD PortnIpre Sine Ars 270 LAFAYETTE STREET, SUIT 409 as, sem asses THOMASVILLE, NC 27360 14City *a Te Coq EW YORK, NY 10012 Mg type of *say is partner? NP Eder Partners percentage of (see Instructions) Code Date Partnar's interest in Partnership began: 08/05/2011 (I) Before Owens (I) End of Year or Termination Profit Sharing 1.1346999% 1.1346999% Monti Off Var loss Shamir 1.4641288% 1.4641288% C Final NJIC-1 I= Hedge Fund Capital Oanershlp 1.4641288% 1.4641288% Cl Amended htlif.t 1 "lifter Of ComPoSIe PALM PART II Income Information Income Classifications A. Total MatrIbullon NJ.1040 Films Etter Amounts on Line Shown Below B. Net Jersey Source amounts NJ.1013NR Fliers 1. ParWershio income Ora) —14,669. I 2. Nel Guaranteed Payrnenb _____ 3 Partners 4010s) Contribution r ___,.... 4. Oistnbutive Share of Partnership Income (loss) (ate I pus Line 2 minus Una 3) —14,669. us. 20, Page 2 I t Fr a 22. Papa 1 I S. Pansbn Lite 19, Page 2 ,, 6. NO Gain (loss) from Oispostion of Assets as a Result of a o L.Liquidation Une 18. Page 2 I 1 Line Ia. Page I l PART III Partner's Information 1. Nonresident Partners Share of NJ Tax _ 1 Lew 19a. Page 1 CBT-100 Line 10a, Pap 1 CBT-100S Lbw 8, PART-100 line 46, NJ-1C40118 lire 22. NJ-1080C tine 3m NJ-1041 la ll4.474el4?.- 2. Partner's KZ Deduction 3. Partners Sheltered Workshop Tax Credit . PART IV SuPplomental Information (Attach Schedule) THIS FORM MAY DE REPRODUCED aaaan 1241-it 13060311 758241 21146.212 2012.03011 MIDWAY TRIAD, LLC 21146_81 CONFIDENTIAL SDNY_GM_00033169 EFTA_ 00143782 EFTA01280300 MIDWAY TRIAD, LLC 45-2.929589 NJ NJK-1 GIT-DEP PRO-RATA SHARE DESCRIPTION AMOUNT TOTAL FEDERAL DEPRECIATION 0. NJ SECTION 179 DEDUCTION ALLOWABLE 0. NJ DEPRECIATION ALLOWABLE 0. SUBTOTAL 0. NJ ADJUSTMENT TO FEDERAL 179 RECAPTURE INCOME 0. NJ ADJUSTMENT TO FEDERAL GAIN (LOSS) ON DISPOSITION OF ASSET(S) 0. SUBTOTAL 0. NEW JERSEY DEPRECIATION ADJUSTMENT 160. 13060311 758241 21146.212 PARTNER NUMBER 5 2012.03011 MIDWAY TRIAD, LLC 21146 B1 CONFIDENTIAL SDNY_GM_00033170 EFTA_00 143783 EFTA01280301 New York State Department of Taxation ar.d Finance 2012 New York Partner's Schedule K-1 Tax Law • Article 22 (Personal Income Tax) 5 Final K-1 For calendar year 2012 or tax year beginning 01-01-2012 and ending 12-31-2012 Amended K-1 Partners: Before competing your floor* tax return. see Form Partners Instructions for Form IT-204-IP (available at iwne.tex.ny.gov). Partnership's InforTnetien (see insatickm) Partnership's name (as shown on Form IT204) Partnere/10's EIN MIDWAY TRIAD, LLC 45-2929589 IT-204-IP A Mark an ,K In the box if ether applies to your entity ED Publcly traded pi:entire-lip i Portfolio Investment partnership B Tax shelter ratintratrdn number, if any c Business ollmatior percentage . Partner's information (see AriefrVetion9) Partner's name BLUE CHIP CAPITAL LLC Partner's address 27 HIGH TECH BOULEVARD City State THOMASVILLE NC DP code 27360 Partners tdentrhing number 20-3161309 D The partrer Is a war. in X in re noiontria as4 0 General partner or LLC membermanager riu Limited partner or other LLC member E What is the tax tlIrng status of the partner? raw an X In int onnnopaaaa OWL w -.) C Individual p EstateArest ila Pennant*, F If the partner is a disregarded entity or grilmtor twat, enter the tax ID of the entity or individual repotting the Income. If known F G Did the partner sell its enure interest during the tax year? a Yee — Ending No I] Beginning H Pertnet's shored profit. 1011, and OWNS 1) Prolh H1 1 . 1 34 7 % 1.1347 % 2) Lees 142 1.4641 % 1.4641 % 3/ Capital H3 H3 1.4641 % % 1 Partner's share of bailie* at the end of the year 1) tionrecourse It 2) OuaThed nonrecouree Manning 12 13 3,652. 5,488. 3) Recourse 13 J Partners capital account analysis 1) Beginning capitaitcount JI 45,696. 2) Capital contributed during the year -cash J2 3) Capital contributed during tee year • Pronely J3 4) Cuntmt year increase (decrease) J4 —14,753. 6) Withdrawals end attributions • cash ,15 7,510. 6) Withdrawals and chatrIbutions • property Jo 7) Ending caPhal account . .. . .. J7 23,433. 8) Method of accounting (ne& an XS, the appropriate COX) Cr Tax beets 0 GMP E l, Book L__J Otter (submit excianadcn) K Resident status (ma* in X in a' boxes that apply) I NYS ruttiest resident Li Yonkers full-year resident El NYC full/war resident L'71 NYS puttee, resident 0 Yorkers pert-year resident C WC pert-year resident [Xi NYS nonresident 0 Yonkers nonresident L It the partner wee included In a group return, enter the special NYS Identification number, If Imown L 118 0 0112 1019 2Sa2S1 CONFIDENTIAL SDNY_GM_00033171 EFTA_00143784 EFTA01280302 Page 2 of 4 IT :204-IP (2012) M 1) Was Form IT•28584 Med vnth the partnership? M1 msEi No Li 2) Wee Form MTA-406E fled with the pertnemhip? M2 "a El No 0 N NYS estimated tax paid on behalf c4 partner (from Form 17.2668) Dale Amount 1) First installment N1 2) Second Installment N2 3) Third instansen1 143 4) Fcurit. Installment N4 Total NYS estimated tax paid on behalf of partner (add Ides NI through I44) N 0 Estimated MCTMT Pall on beta d miner (from Form 147;4405) Date Amount 1) First Installment 01 2) Second installment 02 3) Third Installment 03 4) Fourth installment 04 Total erelmated MCTMT paid on behalf of partner (add Ones 01 through 04) 0 Partner's share of Income, deductions, etc. A - Partnels distnbctive share items B • Federal MI amount C - Now York State amount 1 Ordinary business Income (loss) 1 2 Net rental real estate Income (lose) 2 -14,807. 2 3 Other net rental income (loss) 3 3 4 Guaranteed payments 4 4 5 Interest income 5 8 8 Ordinary dividends 6 6 7 Royalties 7 7 0 Net short-term capital gain (ices) 8 8 9 Net longterm capital pain aces) 9 9 10 Net section 1231 gab 03 so) 10 10 11 Other Income Goss) kaivir* 11 11 12 Section 179 deduction . . ..................... .... 12 12 13 Other decbctions identify: SEE STATEMENT 13 22. 13 14 Tax OfelefenCe Items for minlmam tax 14 2, 554 . 14 Identify: 15 Net eamnge (oss) from selfernployment . . 18 15 16 Tax-exempt Income and nondeductbie expenses 17 Cistnbutions • cash and markelatie *Kuria., . . 18 17 7, 510 . 18 17 I8 Di:urban:Ons • other property 18 18 19 Other items not Included above that are required to be reported separately to partners identify: 19 19 Partner's share of New York modifications (see instructions) 20 New York State addilixis Number A - Total amount B - New York State allocated amount 20a EA- 16 425. 425. 20b EA- 20c EA- 20d EA- 20e EA- 20f EA- 21 Total Pilaw modifications (total of column A Ones 20a through 209 . . 21 BIIIII 1112112111 II III 425. 2aaba2 190 CONFIDENTIAL SDNY_GM_00033172 EFTA_00143785 EFTA01280303 IT-204-IP 00: c. Pao* 3 of 4 Partner's share of New York modifications (ton tE,et) 22 New Yam State sub:rad:cr. u Number A- Total amount B • New York State allocated amount 22a ES- 21 265. 265. 22b ES- 22c ES 22d ES- 22o ES- 22f ES- 23 Total subtracthoP mollfIcationa (total of coJuron A, fines 22a through 221) 24 Addition to tederol Itemized deductions Letter Amount 24a 24b 24o 24d 24e 248 23 265. 25 Total additions to federeJ rtemled deductions (add Naas 24a through 241) 25 26 Subtractions from Mears) :tented deductions Letter Amount 26e 266 26c 26d 26. 268 27 Total subtractions bent federal itemized deductions (mid lines 26a tnrough 260 213 New York noluot mania to lax pretererce items 26 Partner's other information 29a Partner's share of New York source gross Income 208 29b MCTD allocation percentage (see Instructions) Partner's credit Information Part 1 - Flow-through credit bases and factors Brownfield redevelopment tax credit (Porn IT-671 or1T-611.1) 30 Site preparation credit component 31 Tangible property credit component 32 Onelte grour.dwater remediation credit component 141111112111il 29b Wei A - Form IT-611 B - Form IT-611.1 30 31 32 30 31 32 2tISSI i 1, 912 CONFIDENTIAL SDNY_GM_00033173 EFTA_00143786 EFTA01280304 Page • of 4 IT-204-IP (2012) Partner's credit information (continued) EZ capital tax credit (Form IT-602) 33 ContnbutIons of money to EZoommunIty development projects 33 34 Recapture of credt for Investments In certified EZliceineeses 34 36 Recapture of credt for contnixidoca of money to EZ community development projects. 35 OEZE tax reduction credit (Form (7.604) 36 CUE employment Increase factor 36 37 OEZE zone allocation factor 37 38 OEZE benefit period factor 38 Excelsior jobs program tax credit (Form IT-607) 39 Excelsior jobs tax credit component 39 40 Excelsior investment tax credit component .. .. .. . . 40 41 Excelsior research and development tax credit component 41 42 Excelsior real property tax credt component 42 Farmers' school tax credit (Form 17--217) 43 Acres of qualified agricultural property 43 44 Acres of qualified conwystion property 44 45 Eligible school district property taxes paid 45 46 Acres of quaffed apiculture' property converted to nanquairfled use 46 Other flow-through credit bases and factors Credit bases Code Amount Code Amount 47a 47d 47b 47e 47c 47f Credit lectors Code Factor Code Factor Code Factor 47g 471 41k 47h 47j 471 Part 2 - Flow-through credits, addbacks and recaptures 48 Long-term care Insurance credit (Fern IT-249) 48 49 Investment credit (Including employment incentive crock aid historic ban rehabeitation credit; Form IT-212)49 60 Research and development • investment credit (Form IT-212) 50 61 Other flovnthrough credits Code Amount Code Amount 61a 61e 51b 511 510 51g 51d 51h 52 Addbacks of credits and recaptures Cods Amount Code Amount 52. 52d 62b 52e 52o 62f 11&o: 21013 Ill 2M842 I M0.12 CONFIDENTIAL SDNY_GM_00033174 EFTA_00143787 EFTA01280305 MIDWAY TRIAD, LLC 45-2929589 NY IT-204-IP OTHER DEDUCTIONS DESCRIPTION AMOUNT FROM NEW YORK FEDERAL STATE SCHEDULE K-1 AMOUNT DUES St FEES 3. O. PROFESSIONAL FEES 19. O. TOTAL TO FORM IT-204-IP, PAGE 2, LINE 13 22. 0. PARTNER NUMBER 5 CONFIDENTIAL SON V_GM_00033175 EFTA_00143788 EFTA01280306 NC K21 (39). (D-403) 10.11.12 2012 Partner's Share of N.C. Income, Adjustments, and Credits WM Carcdir4 Deparlinert of Revenue For retarder year vilsca I year beginning 01 01 12 ant ending 12 31 12 ParMeta identifying Number Federal Employer PO Number 203161309 ParInes Name, Address, and ZIP Code BLUE CHIP CAPITAL LLC 27 HIGH TECH BOULEVARD THOMASVILLE NC 27360 452929589 PartnershlAs Namt, Address, and ZIP Code MIDWAY TRIAD LLC 270 LAFAYETTE STREET SUIT 409 NEW YORK NY 10012 Partnership's Pro Rata Share items All Partners 1. Share cf partnership income (loss) 2. Additions to Income (ots) a. Addition for bonus depredation b. Other addtions to Income (loss) 3. Deductions horn Income (loss) a. Deduction for bonus depreciation STMT b. 011ter deductions from income (loss) STMT 4. Share of taxcredds 5. Slum of tax withheld tromnonwage compensation pail for personal services performed in ND Nonresidents Only 6 Nonresident's share of N C. taxable Income (loss) 7. Nonresident's share of net tax paid by the manager of be partneronfO Amount Individuals FIIIng Form 0-400 Enter Amount on: —14807 425 Page 2. Une 35 0 Page 2, Une 38 265 Page 2, Une 44e 22 Page 2, line 49 0 Form D•4C0TC 0 Page 2, l ine 23 0 Par 2, Line 51 0 Page 2. Une 24c 284201 20-12 CONFIDENTIAL SDNY_GM_00033176 EFTA_0011 43789 EFTA01280307 MIDWAY TRIAD, LLC 45-2929589 NC SCH K-1 DEDUCTIONS FROM FEDERAL TAXABLE INCOME DESCRIPTION AMOUNT PROFESSIONAL FEES 19 DUES AND FEES 3 TOTAL TO SCHEDULE K-1, LINE 38 22 NC SCH K-1 DEDUCTIONS FOR BONUS DEPRECIATION DESCRIPTION AMOUNT ADJMNT FOR 1ST-YEAR DEPRECIATION ADDED BACK IN 2011 265. TOTAL TO SCHEDULE K-1, LINE 3A 265. PARTNER NUMBER 5 CONFIDENTIAL SDNY_GM_00033177 EFTA_00143790 EFTA01280308