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Fidelity Institutional (CUST-FI-001) Statement Date:
as agent for Fidelity Institutional Tax Information
Menlo Park, CA 94025 Account 2019
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 2019 1099-DIV INTEREST INCOME 2019 1099-INT
1a- Total ordinary dividends 1,401.12 1- Interest income 448.50
1b- Qualified dividends 1,120.90 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 438.60 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 38,224.00 30,723.00 0.00 0.00 7,501.00
Grand total 38,224.00 30,723.00 0.00 0.00 7,501.00
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: 2019
Securities: UECIX, IDEIX, MUNIX, NLTK, REITX
Box Detail
Box 1a — Total Ordinary Dividends $1,401.12
Box 1b — Qualified Dividends (subset of 1a) $1,120.90
Box 2a — Total Capital Gain Distributions $0.00
Box 5 — Section 199A Dividends $0.00
Box 12 — Exempt-Interest Dividends (state/local tax-exempt) $438.60
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
NLTK 200 2019-04-12 $14,800.00 $10,200.00 $4,600.00 Partial NLTK trim — trust planning (EventI...
UECIX 900 2019-06-20 $11,700.00 $10,350.00 $1,350.00 Rebalancing — mid-year equity trim
IDEIX 450 2019-09-16 $5,670.00 $4,545.00 $1,125.00 Rebalancing
STBIX 600 2019-12-10 $6,054.00 $5,628.00 $426.00 Year-end sweep
LONG-TERM Subtotal $38,224.00 $30,723.00 $7,501.00
NET REALIZED GAIN / (LOSS): $7,501.00
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
