Page 1 of 3
Fidelity Institutional (CUST-FI-001) Statement Date:
as agent for Fidelity Institutional Tax Information
Menlo Park, CA 94025 Account 2026
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 2026 1099-DIV INTEREST INCOME 2026 1099-INT
1a- Total ordinary dividends 1,435.56 1- Interest income 1,048.40
1b- Qualified dividends 1,148.45 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 1,066.80 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 123,180.00 105,180.00 0.00 0.00 18,000.00
Grand total 123,180.00 105,180.00 0.00 0.00 18,000.00
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

Page 2 of 3
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: 2026
Securities: UECIY, IDEIY, UCBIX, UTIPX, MUNIX, STBIX
Box Detail
Box 1a — Total Ordinary Dividends $1,435.56
Box 1b — Qualified Dividends (subset of 1a) $1,148.45
Box 2a — Total Capital Gain Distributions $0.00
Box 5 — Section 199A Dividends $0.00
Box 12 — Exempt-Interest Dividends (state/local tax-exempt) $1,066.80
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

Page 3 of 3
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
UECIY 2,800 2026-02-26 $47,600.00 $39,200.00 $8,400.00 Q1 equity rebalancing — steady growth
IDEIY 1,600 2026-04-14 $21,600.00 $19,040.00 $2,560.00 Q2 international rebalancing
UCBIX 1,800 2026-06-10 $18,450.00 $16,974.00 $1,476.00 Q2 bond trim
MUNIX 1,300 2026-09-08 $13,780.00 $12,038.00 $1,742.00 Q3 muni rebalancing — bucket 2 top-up
UTIPX 1,100 2026-10-15 $11,660.00 $8,690.00 $2,970.00 Q4 TIPS trim
STBIX 1,000 2026-12-10 $10,090.00 $9,238.00 $852.00 Year-end sweep — 10yr relationship milestone
LONG-TERM Subtotal $123,180.00 $105,180.00 $18,000.00
NET REALIZED GAIN / (LOSS): $18,000.00
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
