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Fidelity Institutional (CUST-FI-001) Statement Date:
as agent for Fidelity Institutional Tax Information
Menlo Park, CA 94025 Account 2017
Customer Service: 800-555-0199
PAYER'S EIN: 61-4327891 RECIPIENT'S SSN: XXX-XX-4444 / XXX-XX-8888
RECIPIENT: Alex & Sam Chen Household ID: HH-CHEN-001
3215 Lakeview Circle, Wayzata, MN 55391 Account: ACCT-TX01 ...7412
DIVIDENDS AND DISTRIBUTIONS 2017 1099-DIV INTEREST INCOME 2017 1099-INT
1a- Total ordinary dividends 975.18 1- Interest income 348.90
1b- Qualified dividends 780.14 3- Interest on U.S. Savings Bonds 0.00
2a- Total capital gain distributions 0.00 4- Federal income tax withheld 0.00
5- Section 199A dividends 0.00 8- Tax-exempt interest 0.00
12- Exempt-interest dividends 316.22 11- Bond premium 0.00
14- State tax withheld 0.00
SUMMARY OF PROCEEDS, GAINS & LOSSES, AND WITHHOLDING
Term Proceeds Cost basis Market discount Wash sale loss disallowed Net gain or loss(-)
Long 43,231.00 39,427.00 0.00 0.00 3,804.00
Grand total 43,231.00 39,427.00 0.00 0.00 3,804.00
Withholding
Federal income tax withheld 0.00
*This is important tax information and is being furnished to the Internal Revenue Service.
If you are required to file a return, a negligence penalty or other sanction may be imposed on
you if this income is taxable and the IRS determines that it has not been reported.
Fidelity Institutional (Synthetic) — Chen Household HH-CHEN-001 | CONFIDENTIAL | Synthetic Demo Data Only — Not Investment or Tax Advice | Page 1

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FORM 1099-DIV — DIVIDENDS & DISTRIBUTIONS
PAYER: Fidelity Institutional (CUST-FI-001) RECIPIENT: Alex & Sam Chen
EIN: 61-4327891 SSN: XXX-XX-4444 / XXX-XX-8888
Account: ACCT-TX01 ...7412 Tax Year: 2017
Securities: UECIX, IDEIX, MUNIX, NLTK
Box Detail
Box 1a — Total Ordinary Dividends $975.18
Box 1b — Qualified Dividends (subset of 1a) $780.14
Box 2a — Total Capital Gain Distributions $0.00
Box 5 — Section 199A Dividends $0.00
Box 12 — Exempt-Interest Dividends (state/local tax-exempt) $316.22
Box 14 — State Tax Withheld $0.00
Qualified dividend eligibility based on required holding periods met for all equity index positions.
Exempt-interest dividends from MUNIX (MN Municipal Bond Fund) are exempt from federal and MN state income tax.
Fidelity Institutional (Synthetic) — Chen Household HH-CHEN-001 | CONFIDENTIAL | Synthetic Demo Data Only — Not Investment or Tax Advice | Page 2

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FORM 1099-B — PROCEEDS FROM BROKER TRANSACTIONS
Payer: Fidelity Institutional (CUST-FI-001) EIN: 61-4327891 Account: ACCT-TX01 ...7412
LONG-TERM Transactions — Basis Reported to IRS
Security Qty Date Sold Proceeds Cost Basis Gain / (Loss) Notes
UECIX 800 2017-03-22 $9,760.00 $8,800.00 $960.00 Annual rebalancing
UCBIX 1,500 2017-06-14 $15,225.00 $14,400.00 $825.00 Annual rebalancing
IDEIX 600 2017-09-29 $7,500.00 $6,900.00 $600.00 Rebalancing — FI trim
NLTK 100 2017-11-15 $6,210.00 $4,995.00 $1,215.00 Partial RSU sale — see W-2 for vest income
STBIX 450 2017-12-18 $4,536.00 $4,332.00 $204.00 Year-end sweep
LONG-TERM Subtotal $43,231.00 $39,427.00 $3,804.00
NET REALIZED GAIN / (LOSS): $3,804.00
All transactions in ACCT-TX01 (Joint Taxable Brokerage). Covered security — cost basis reported to IRS.
Noncovered transactions: none for this account in this tax year. Wash sale rules applied where applicable.
Synthetic demo data — consult your tax advisor.
Fidelity Institutional (Synthetic) — Chen Household HH-CHEN-001 | CONFIDENTIAL | Synthetic Demo Data Only — Not Investment or Tax Advice | Page 3

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FORM 1099-R — DISTRIBUTIONS FROM PENSIONS, ANNUITIES & RETIREMENT PLANS
Payer: Alex's Former Employer 401(k) Plan (via Recordkeeper) Payer EIN: 38-1829400
Recipient: Alex Chen SSN: XXX-XX-4444
Account: ACCT-401R / ACCT-IRA1 (Rollover) Tax Year: 2017
Box Detail
Box 1 — Gross Distribution $47,250.00
Box 2a — Taxable Amount $0.00
Box 2b — Taxable Amount Not Determined No
Box 4 — Federal Income Tax Withheld $0.00
Box 7 — Distribution Code G (Direct rollover to qualified plan/IRA)
Box 12 — State Tax Withheld $0.00
Box 15 — State/Payer's State No. MN / 38-1829400
DIRECT ROLLOVER — NO TAX DUE: Distribution Code G applies. Taxable amount is $0.00.
Direct rollover to Fidelity Institutional Rollover IRA (ACCT-401R). No income tax withholding applies to a direct rollover.
Fidelity Institutional (Synthetic) — Chen Household HH-CHEN-001 | CONFIDENTIAL | Synthetic Demo Data Only — Not Investment or Tax Advice | Page 4
