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Fidelity Institutional (CUST-FI-001) Statement Date:
as agent for Fidelity Institutional Tax Information
Menlo Park, CA 94025 Account 2020
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 2020 1099-DIV INTEREST INCOME 2020 1099-INT
1a- Total ordinary dividends 1,104.72 1- Interest income 462.88
1b- Qualified dividends 883.78 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 452.30 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 112,312.00 100,308.00 0.00 0.00 12,004.00
Grand total 112,312.00 100,308.00 0.00 0.00 12,004.00
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: 2020
Securities: UECIX, UCBIX, UTIPX, MUNIX, EMEIX
Box Detail
Box 1a — Total Ordinary Dividends $1,104.72
Box 1b — Qualified Dividends (subset of 1a) $883.78
Box 2a — Total Capital Gain Distributions $0.00
Box 5 — Section 199A Dividends $0.00
Box 12 — Exempt-Interest Dividends (state/local tax-exempt) $452.30
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 3,500 2020-06-16 $45,500.00 $40,600.00 $4,900.00 IPS-2020 reallocation (DecisionID-2020-044...
IDEIX 2,800 2020-06-18 $32,200.00 $28,840.00 $3,360.00 IPS-2020 reallocation — intl equity reduce
EMEIX 1,500 2020-06-22 $16,500.00 $13,650.00 $2,850.00 IPS-2020 reallocation — EM reduce
UCBIX 1,000 2020-06-24 $10,200.00 $9,410.00 $790.00 Minor bond rebalancing
REITX 800 2020-09-14 $7,912.00 $7,808.00 $104.00 Post-COVID trim
LONG-TERM Subtotal $112,312.00 $100,308.00 $12,004.00
NET REALIZED GAIN / (LOSS): $12,004.00
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
