EFTA00593235.pdf

MOLLC C807(2013 324 PM Fo„„ 1065 COporlment al the Tree:try Irterrol Revenue Santa A Pit coral btrzro2.- =trete RESEARCH B Pomo,' patrol or seroco BIOMARKERS C ElusineSS code number 541700 U.S. Return of Partnership Income Fo calenclai year 2012, 0 lax yea( Weenie; . ending ti Information about Form 1065 and Its separate instructions Is at ynneirs.goWlionn1065. Name ce partner:hp Print ANDROCYTE LLC or type. ry a Wilt erri ZIP Code AVENTURA FL 33180 G Check applicable boxes: (1) (6) H Check accounting method: (1) I Number of Schedules K.I . Attach one for each person who was a partner at any time during the tax year a J Check if Schedules C and M3 are attached OMB No 154.40099 2012 D Employer identification number E F 45-1804323 Dego bustross aged 05/01/2011 TOUll e$691$ (We the entruCtOnig $ 50,843 Initial return (2) 0 Final return (3) 0 Name change (4) D Address change (5) 9 Amended return Technical termination • also check (1) or (2) Cash (2) 9 Accrual (3) 9 Other (specify a 5 9 Caution. Include only trade or business income and expenses on lines to through 22 below. See the instructions for more information. Income is Gross receipts or sales 1a b Returns and allowances 1b c Balance. Subtract line lb from line la 2 Cost of goods sold (attach Form 1125-A) 3 Gross profit. Subtract line 2 from line lc 4 Ordinary income doss) frcm other partnerships, estates. and trusts (attach statement) 5 Net farm profit (loss) (attach Schedule F (Form 1040)) 6 Net gain (loss) from Form 4797. Part II, We 17 (Math Form 4797) 7 Other income (loss) (attach statement) 8 Total Income (foss). Combine lines 3 through 7 lc 2 3 4 5 6 7 8 lir 1 .0 I. 1 I 0 O t 3 g 20 9 Salaries and wages (other than to partrwrs) (less employment credits) 10 Guaranteed payments to partners 11 Repairs and maintenance 12 Bad dads 13 Rent 14 Taxes and loenses 15 Interest 16a Depreciation (i1 required. attach Form 4562) 1,888 I l es i 9 10 11 12 13 2,771 14 15 16c 1,888 b Less depreciation reported on Form 1125-A and elsewhere on return 17 Depletion (Do not deduct oil and gas depletion.) 18 Retirement plans, etc. 19 Employee benefit programs Other deductions (attach statement) See Statement 1 21 Total deductions. Add the amounts shown in the far right column for lines 9 through 20 17 18 19 20 200,454 21 205,113 22 Ordinary business Income (loss). Subtract line 21 from line 8 22 —205,113 Sign Here Under PeDebeS Cr PerIrty. I declare tel I have erainred Phi return. isCludIng ett001)(Myhe reeduleS and SlaternentS. and 03 Me bosi Or my knoWedge and WW1. Cis ins. ewer( and compote Docinnon or paperer tome, than WOW/ canner or ImtE4 hablIty company Meatier mragel 8 based on al reonnaton elution mower ms ary knows*, My Me IRS rISCuSS the realm MT the MEM shown below (We astumnsi, QYes Ill No r sr.,. 01 04)Peral garner cc Wiled Ilablty COMperhy rrern...ef ', r..) Date Paid Preparer Use Only PORDYPe [Mere.% name Lunen Pfeiffer, CPA am: ret- alb 08/07/13 Int R sottorrobyai Pug P01201727 flays name t i WOLFE FINANCIAL GROUP Rads IN 1.1 26-0010294 rimy: an o= t, LAKE MARY, FL 32746 Phone rot For Paperwork Reduction Act Notice, see separate instructions. Form 1065 00121 EFTA00593235 ANOLLC C607(2013 124 PM Form 1065 (2012) ANDROCYTE LLC 45-1804323 Page 2 Schedule B Other Information 1 a c e What _ X type of entity is fikng this return? Check the applicable Domestic general partnership b Domestic limited liabilty company Foreign ownership f box: _ Domestic limited partnership _ Domestic limited liability partnership Other u Yes No 2 At any time during the tax year. was any partner in the partnership a disregarded entity. a partnership (including an entity treated as a partnership). a trust an S corporation, an estate (other than an estate of a deceased partner). or a nominee or similar person? 3 a b At the end of the tax year: Did any foreign or domestic corporation, partnership (inducing any entity treated as a partnership), trust. or tax-exempt organization. or any foreign government own. directly or indirectly. an interest of 50% or more in the profit loss. or capital of the partnership? For rules of constructive ownership, see instructions. It -Yes: attach Schedule 8-1. Information on Partners Owning 50% or More of the Partnership Did any individual or estate own. directly or indirectly, an interest of 50% or more in the profit, loss, or capital of the partnership? For rules of constructive ownership. see instructions. If -Yes," attadi Schedule B-1. Information on Partners Owning 50% or More of the Partnership 4 a At the end of the tax year. did the partnership: Own directly 20% or more, or own. directly or indirectly. 50% or more of the total voting power of al classes of stock entitled to vote of any foreign or domestic corporation? For rules of constructive ownership, see instructions. If 'Yes." complete (i) through (iv) below X (I) Name ol CCreben 00 EmNow Icler441CMC0 Nmibef Id anti 0I0 00tay ol InCerperalOn (1.0 Perceniage fmned in VON( Sexk b Own directly an interest of 20% or more, or own. directly or indirectly. an interest of 50% or more in the profit, loss. or capital in any foreign or domestic partnership (Including an entity treated as a partnership) or in the beneficial interest of a trust? For rules of constructive ovmership see instructions. If Wes,- complete (I) through (v) below (1) Nemo el ENO 00 &MM. Identficatim Number (4 arm (III) Type el EAR,/ ON COurOy of OrgenZet/M (vi ‘14,,,,,r( Percermr Ownee in kali, Lee- or Gyrs 5 Did the partnership file Form 8893, Election of Partnership Level Tax Treatment, or an election statement under section 6231(a)(1)(8)(ii) for partnership-level tax treatment, that is in effect for this tax year? See Form 8893 for more details Yes No 6 a b e d Does the partnership satisfy all four of the following conditions? The partnership's total receipts for the tax year were less than $250.000. The partnership's total assets at the end of the tax year were less than $1 million. Schedules K-1 are filed with the return and furnished to the partners on or before the due date (inducing extensions) for the partnership return. The partnership is not filing and is not required to file Schedule M-3 II 'Yes: the partnership is not required to complete Schedules L M-1, and M-2: Item F on page 1 of Form 1065. or Item L on Schedule K-1 7 Is this partnership a publicly traded partnership as defined in section 469(k)(2)? 8 During the tax year. did the partnership have any debt that was cancelled. was forgiven. Or had the terms modified so as to reduce the principal amount of the debt? 9 Has this partnership filed. or is it required to file. Form 8918. Material Advisor Disclosure Statement, to provide information on any reportable transaction? 10 At any time during calendar year 2012. did the partnership have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account. or other financial account)? See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bath and Financial A000unts. If "Yes: enter the name of the foreign country. u X 1065 EFTA00593236 MOLLC C607(2013 124 PM Form 1065 (2012) ANDROCYTE LLC 45-1804323 Page 3 Schedule B Other Information (continued 11 At any time during the tax year, did the partnership receive a distribution from, or was it the grantor of. or transferor to. a foreign trust? II 'Yes." the partnership may have to Ne Form 3520. Annual Return To Report Transactions With Foreign mists and Receipt of Certain Foreign Gifts. See instructions Yes No X 12a b c Is the partnership making, or had it previously made (and not revoked). a section 754 election? . See instructions for details regarding a section 754 election. Did the partnership make for this tax year an optional basis adjustment under section 743(b) or 734(3)? II 'Yes," attach a statement showing the computation and allocation of the basis adjustment. See Instructions Is the partitership required to adust the basis of partnership assets under sec ion 743(b) or 734(b) because of a substantial bilt.in loss (as defined under sedan 743(d)) or substantial basis reduction (as defined under section 734(d))? If 'Yes.' attach a statement showing the ccanutatisn and atocalisn of the basis adjustment. See instructions. X X X 13 Check this box if. during the current or prior tax year. the partnership distributed any property received in a like.kind exchange or contrbuted such property to another entity (other than disregarded entities whoily.owned by the partnership throughout the tax year) P. K 14 At ally time during the tax year. did the partnership (attribute to any partner a tenancy•Incommon or other undivided interest in partnership property? X 15 If the partnershb is required to file Form 8858. Information Return of U.S. Persons With Respect To Foreign Disregarded Entities. enter the number of Forms 8858 attached. See instructions u 16 Does the partnership have any foreign partners? II 'Yes.' enter the number of Forms 8805. Foreign Partners Information Statement of Section 1446 Withholding Tax. Ned for this partnershb. u X 17 Enter the number of Forms 8865. Return of U.S. Persons With Respect to Certain Foreign Partnerships. attached to this return u 18a b Did you make any payments in 2012 that would require you to fie Form(s) 1099? See instructions If "Yes' did you or will you file required FOIRUS 1099? X 19 Enter the number of Form(s) 5471, Information Return of U.S. Persons With Respect To Certain Foreign Co adorn. attached to the return u 0 20 Enter the number of partners that are foreign garemments under section 892. is 0 Designation of Tax Matters Partner (see instructions) Enter below the general partner or member-manager designated as the tax matters partner (TMP) for the tax year of this return: Name Of designaled TMP II me IMP pa an entsty. name of TLIP rooto:onlatfro AOctOSS decignaled TMP ANDROCYTE MANAGEMENT LLC 100611)400 ouster of ThIP 45-2038037 JAMES CLEMEN of IMP MY* nuMW FOrn 1065!20.21 EFTA00593237 AtIDLLC 06072013 324 PM Form 1065 (2012) ANDROCYTE LLC 45-1804323 Page 4 Schedule K Partners' Distributive Share Items Total amount Income (Loss) 1 Ordinary business income (loss) (page 1. line 22) 2 Net rental real estate income (loss) (attach Form 8825) 3a Other gross rental income (loss) b Expenses from other rental aconites (attach statement) c Other net rental income (loss). Subtract line 3b from line 3a 1 —205,113 2 3c 3b 4 Guaranteed payments 4 5 Interest Income 5 6 Dividends: a Ordinary dividends 6a b Qualified dividends 1 6b I 7 Royalties 7 8 Net short-term capital gain (loss) (attach Schedule D (Form 1065)) 8 9a Net long-term capital gain (loss) (attach Schedule D (Form 1065)) b Collectibles (28%) gain (loss) 9b 9a C Urrecaphired section 1250 gain (roach maximeno 9c 10 Net section 1231 gain (loss) (attach Form 4797) 10 11 Other income (loss) (see instructions) Type u 11 m c oo vi9 12 Section 179 deduction (attach Form 4562) 13a Contributions Investment interest expense c Section 59(e)(2) expenditures: 12 0 13a 13b OS (1) Type u (2) Amount u d Other deductions (see instructions) Type u 'um 13d o 1.C. Lug 14a Net earnings (loss) from self-employment b Gross farming or fishing income c Gross nonfarm income 14a 14b 14c Credits 15a Low-income housing credit (section 42Q)(5)) b Low-income housing credit (other) c Cualified rehabilitation expenditures (rental real estate) (attach Form 3468) d Other rental real estate credits (see instructions) Type u e Other rental credits (see instructions) Type u 15a 15b 15c 15d 15e I Other credits (see instructions) Type a 151 Foreign Transactions 16a Name of country or U.S. possession a b Gross income from all sources c Gross income sourced at partner level 16b 16c Foreign gross income sourced at partnership level d Passke category u e General category u 1 Other a 16f Deductions allocated and apportioned at partner level g Interest expense a h Other a 16h Deduction allocated and apportioned at partnership level to foreign scam income I Passive category u I General category u k Other a 16k I Total foreign taxes (check one): a Paid p Accrued 0 m Reduction in taxes available for credit (attach statement) n Other foreign tax information (attach statement) 161 16m Alternative Minimum Tax (AMT) Items 17a Post-1986 depreciation adjustment b Adjusted gain or loss c Depletion (other than oil and gas) d Oil, gas. and geothermal properties — gross Income .... . e Oil, gas, and geothermal properties — deductions 17a 124 17b 17c 17d 17e 1 Other AMT items (attach statement) 17f Other Information 18a Tax-exempt interest income b Other tax-exempt Income 18a 18b C Nondeductible expenses See Statement 2 18c 128 19a Distributions of cash and marketable securities b Distributions of other property 19a 35,800 19b 20a Investment income b Investment expenses c Other Items and amounts (attach statement) 20a 20b ram 1065 oir. EFTA00593238 MELLO C8072013 324 PM Form 1065 (2012) ANDROCYTE LLC Analysis of Net Income (Loss) 45-1804323 Page 5 1 Not income (loss). C 2 Anatysis by partner type: a General partners b Limited partners 1 —205,113 (I) Corporate (II) Individual (active) (III) Individual (passive) (Iv) Partnership (v) Exempt organization (99 NominesOther —15,001 —118,211 —71,901 Schedule L Balance Sheets per Books Beginning of tax year End of tax year Assets (a) b) (c) (d) 1 Cash 47,122 9,631 2a b Trade notes and armints receivable Less allowance for bad debts 3 Inventories 4 U.S. government obligations 5 Tax-exempt securities 6 Other CtiffOrt assets warn statement) 7a b 8 Loans to partners (or persons related to partners) Mortgage and real estate loans over rnewneas warn statement) 9a Buildings and other depreciable assets 12,412 b Less accumulated depreciation 1.888 10,524 10a b Deptetable assets Less accumulated depletion 11 Land (net of any amortization) 12a Intangible assets (amortizable only) 32,880 32,880 b Less accumulated amortization 32,880 2,192 30,688 13 Omar assets PCACA alatemerv3 80,002 50,843 14 Total assets Liabilities and Capital 15 Accounts payable 16 Mortgages. notes. bonds payable in less than 1 year 17 Omer current labiate team statement) 18 AI mama:curse loans 19a b Loans from partners (or persons related to partners) //alpaca. roles. bards payable in I yea or more 23,871 20 Caw Itablees See Stmt 3 iscach statement) 35,911 56,131 14,932 21 Paints' caps accounts 22 Total frablities and capital 80,002 50,843 Schedule M-1 Reconciliation of Income (Loss) per Books With Income (Loss) per Return Note. Schedule M-3 may be required instead of Schedule M.1 (see instructions). 1 Net income (loss) per books 2 Income included on Schedule K. finest. Z 5. 6a. 7. 8. 9a. 10, and 11. not recorded on books this year (rtem9e): 3 Guaranted parent Other ten heath raurwce) 4 recorded on backs this year not Fncil sdeson Schedule K. Ines 1 through 13d. and 161 (dente): a CCINOCCOCI1 b Travel and eotertenreeni $ 128 5 Add Ines 1 through 4 -205,241 6 Income recorded on books this year not included on Schedule K, lines 1 through 11 (itemize): a Tax-exempt interest $ 7 Deduction included on Schethe K Ines I hough 130. and 161. rat charged event hook income tie yaw tioritey a Depredation $ 8 Add lines 6 and 7 9 Income (loss) (Analysis of Net Income (Loss). line 1). Subtract mite 8 from Ina 5 128 -205,113 —205,113 Schedule M-2 Analysis of Partners' Capital Accounts 1 Balance at beginning of year 2 Capital contributed: a Cash b Property 3 Net income (loss) per books 4 oOKr Irceasee Monte 5 Add Ines I through 4 56,131 6 Distributions a Cash b Property 7 Other decreases (itemize): 8 Add lines 6 and 7 9 Balance at end of year. Subtract line 8 from Ilne 5 35,800 199,842 —205,241 35,800 50,732 14,932 can ron, 1065 2012, EFTA00593239 ANOLLC 06072013 324 PM SCHEDULE B-1 (Form 1065) Information on Partners Owning 50% or (Rev. December 2011) Drearier% 01 Ole Treasury More of the Partnership u Attach to Form 1065. See instructions on back. 0/A0 N,. 1545 0739 Internal Revert* Service Name d canner-hp Employer identification number (EIN) ANDROCYTE LLC 45-1804323 Part I Entities Owning 50% or More of the Partnership (Form 1065, Schedule B, Question 3a) Complete columns (0 through (v) below for any foreign or domestic corporation. partnership (including any entity treated as a partnership). trust, tax•exempt organization. or any foreign government that owns. directly or indirectly. an interest of 50% or more in the profit. loss. or capital of the partnership (see instructions). III Name Or Elea 11) &Oyer kgralcaare Weber d any) (10 NY? 01 Entry Pe Gouty of Omani:men (vl Maxon= Porterage exiled En Prof I. LOss. or Capeal ANDROCYTE MANAGEMENT LLC 45-2038037 Partnership United States 82.610000 ZASIS, LLC 20-4637772 Partnership United States 53.549000 Part II Individuals or Estates Owning 50% or More of the Partnership (Form 1065. Schedule B. Question 3b) Complete columns (I) through (iv) below for any individual or estate that owns. directly or indirectly. an interest of 50% or more in the profit, loss. or capital of the pannership (see instructions). liv) tleamum Porcertage Owned m MNamedWvIclualcrEVW lilt 10,ntrog Ym-09, Rap OI Country 01 Mao*le lee. inshvonah Prolt. LOBS. a Calilel For Paperwork Reduction Act Notice. see the Instructions for Form 1065. Schedule B. (Fern 10135) (Rev. 122011) EFTA00593240 MOLLC 0107(2013 324 PM D Fnal K.1 K Arnero.:1x.i OW la)1 5.0)99 Schedule K-1 2012 I Part IIII Partners Share of Current Year Income, (Form 1065) Deductions, Credits, and Other Items Department S the Treasury For calendar year 2012. or tax Internal Revenue Sever) year IX/MN 1 Ordinary business income (oss) 15 Creche ending 2 Net rental real WOG r1CCene NMI Partner's Share of Income, Deductions, Credits, etc. ki See back of form and separate instructions. 3 Other net metal Income (loss) IS Fortin barbaclons I Part I I Information About the Partnership 4 Guaranteed payments A Pannersties *mob'', derirlearan rumba 45 - 1804323 s Wawa 'erne B Pannershp's name. address. Cty. KM. and DP code ANDROCYTE LLC 6a Ordnary dullards 66 OnHad dvidends C IRS Center whom partnership Red retro Ogden, UT 7 Royabes I) EI Check itels IS a pubic& eaaecl PantSit IPTP) 0 Nel 8bOrtbarrn MCP pan OW 'Alert HI Information About the Partner 9a Net loneterm capital gain go :l 17 Mambo m nrtum tax 'NATI earns E Partners pen-Myna ma'am A 103 45 - 2038037 96 Colrabbbs '28%) pan (loss) F Pannera 'wile. b:Uress. eky. state. and ZIP rode ANDROCYTE MANAGEMENT LLC 9c Unrocapturod section 1250 gain to Net section 1231 gain 110551 us Tax.exanal income and nradroxtise overate 0 11 Other WOMB 00381 C * 107 G X Cenral partner or LLC K United partner or other LLC meaborManeiper member H ID Omuta K Poiegn partrrta partner H Wel bee 01 trot' IS This woe.? Partnership 19 Drsinct.ten: 12 II Ins wince Is a reuernerrt plan (11i/bSEPK0091191C). CI100 Wee u 12 179 do Semen slimen A 35,800 MOO Insrtuct1cns) J Partrees share of profit lora. and apial (sea insIncbans): B09inrWKI Ending 13 031st daductbns Profit 84.310000 x 82.610000 - 20 Other MI ban Loss 0.000000 t 0.000000 .,. CaeLl 84.310000 ., 82.610000 - Y * STMT K Penner% snare 01 MEOWS al year end Ibenreceurse S 14 501-ernethYrnerb earnrIP tkes` Dubbed nonrecourse Summing S WOMB 5 L Partners rand aseeunl analysis: 'See attached statement for additional information. Elcumno Capital =Cure 5 - 2,023 Cattedl COMIOuleft donne the year 5 Onent year increase (decree* 5 - 107 ; ' 1.13.0 a Withdrawals & didtbubans $ ( 35,800, '. ,. nitro capital accourrt $ - 37,930 8 . 1 ,1 h i i IN M X Od 0 Tat 09/103 Other texplara on Darner CCIWOUN Yes II 'Yes. attach K X statement OAAP 0 SOCItY1 704(b) book MINA, wen a bUlbM Skin 0f CM? No (see insbudions) e 03 7 0CC a il. I #.5 For Paperwork Reduction MI Notice. see Instructions for Form 1055. DM IRS.9003rM1065 saws K-1 (Form 1065) 2012 EFTA00593241 ANOLLC 06072013 224 PM K era K • 0 anordai a• T OMB to 15450399 Schedule K-1 2012 Part III Partner's Share of Current Year Income, (Form 1065) Deductions, Credits, and Other Items Department oe the Treasury For calendar year 2012. or tax Internal Revenue Sen•Ce year 11090n0:1 1 Ordinary busnms 'recce its) -118,211 IS Geed,: 06(5100 2 Net rental real rotate (COMO (IOSSI Partner's Share of Income, Deductions, Credits, etc. LI see back of form and separate instructions. 3 Oft, rot metal income doss) IS roman earzaclons I Part II Information About the Partnership 4 Guaranteed payments A P inershp's cfrvb)rt 4ertilcabzn rurnter 45-1804323 s totem, income B PartroesnOS Neat address. fly. Stale. and DP code ANDROCYTE LLC 6a Ord nary dycknds IIIIIIII M M IPI II I I0 6b Oeellaci dxtlendr C IRS Center vitae partnership Ned ream Ogden, UT 7 Aoyabes D 0 Check d ale IS a puticR wooed Parewelvo IPTP) 8 Net ShOrt-Serrn Cap99 gan 1109s) I Part III Information About the Partner 9a Net lore-term espial gait lloss) IT Alterative mitimum tax (NAT) dams E PrIners pesnilyna matter A 13 20-4637772 Stp Colecdpbs '28%) gen doss) F Palm's ram*. address. cky. Hate. and DP code ZASIS, LLC Sc Unrocaptured section 1250 gain 10 Net section 1231 gain OM IS Tax.exanal income and nonclectxtiple experees LAKE MARY FL 32795 11 Cther MCCM9 00SSI C * 13 G K General partner or LLC X United partner or other LLC merrbernlane0el member N ID comesic K FOrOgn PareW Ramer 11 VrTel type or entity as MIS COMM/ Partnership 19 Ds-motions /2 II SYS realer IS a relleMere elan (IR&SEREsOareek). check bete 12 Semen IT9 *dnon (See InStrUCOPIS) u J Padre's share of profit. leas. and capbil (see insInctians): Beginnrg Ending 13 Qher deductions PrOtt 15. 690000 x 9.710000 “. 20 MC/ inlrmaban Loss 100.000000 % 53.549000... Caned 15.690000 , 9.710000.. Y* STMT K Pannell Plan) 01 Mimes al year end'. Nanreccurse S 14 uit-erevayreer4 MOW% lIC90l Welded nonrecourse *Fencing S Recourse s 19,230 L Parhers captal anent analy9s: 'See attached statement for additional information. sewn® capital harm s 58,154 Captel COMIOuled dun® Me year $ 80,000 Current year in:tease (decrease) s -118 , 224 VAIN:Meals a distiputens S ( I 2. End® capnal accobn: s 19,930 8 I . I l i 1 M X Dd 0 Tar base Other (expbn) the partner cateThe Yes II 'Yes' attach K progeny X :women, °AAP 0 Settee, 704(b) bock %ad', a bulbul ORR& Inn No (see inskococnb 0CC u. .•I For PapilIVICA Reducuon Act N011ee. see Instructions for Form 1065. DAA IRS409SerM1065 Schedule K-1 (Form 1065) 2012 EFTA00593242 AKOLLG 011372013 224 PM K rv, I , K 1 K Arlifirded K.I Dela Ma 15150799 Schedule K-1 2012 Part Ill Partner's Share of Current Year Income, (Form 1065) Deductions, Credits, and Other Items Department ce the Treasury For calendar yeas 2012. or tax Internal Revenue Sen•CO yeft 11090thrd 1 Ordnary bum= income (oss) —71,901 16 Cat 06(P0 2 NCI rental real estate noon* POW Partner's Share of Income, Deductions, Credits, etc. Li see back of form and separate instructions. 3 Ott*, not rata' moony (loss) IS rarer. tramaclons Part I Information About the Partnership 4 Guarareced payments A P inerstids *mob'', dertrIceopn mentor 45-1804323 5 htereSt income B PartreeStOli MOW O&M. Clay. Stage. and DP COCIO ANDROCYTE LLC 6a Ordnary dytids IIIIIIII IIIIII0 6b Oualliod detlmds C IRS Conk( whoa partnership tied nem Ogden, UT 7 Royabes D 9 Cheek II 7.6 is a putflo0 ba000Park.(100 IPTP) 8 Net ShOrlderrn Gaped gan POO Part lli Information About the Partner 93 Net landterm capital gen llossl IT Manatee mitiniuM MX (NAT) items E Partners identryna mariper A 2 59-1746396 9b Colecbbbs '28%) gen doss) F Partners name. aMress. cey. VA*. and 2LIP code LIFE EXTENSION FOUNDATION, INC. Sc Unrocaptured section 1250 gain 10 No section 1231 gain Poen IS Taxexanal income and rencleobkliko experces FORT LAUDERDALE FL 33309 11 Gther OM* SOSSI C * 2 G 9 General partner or LLD X Owned partner or other LLC morrbomaPaSef member N li DornOSIC K FaeCin I Partrite partner II until typo of entity of Me Wren Exempt Organization 19 Dsinst.ban: U II INS plainer IS a retremerk elan tinnSFP,I(e00600). Check Ise ID 12 Semen 179 do:1nm Mee InSINCOCON J Parber's share of prc6I. loss. and capial (see instructions): IMIOnniKI Ending 13 (tier deductions Prof, % 1.920000 - 20 Oder inlomwban Loss '4 37.762600 ,. Capes % 1. 920000 “ K Palmer's snare of lateen al year end Mann:course S 14 SOI.MOKIYMere earrmin (Ws! Cludiled nonrecourse framing S Recourse s 13,561 L Partners capita asccunl analysis: 'See attached statement for additional information. Eleponne espial account S Capra' COM100100 donna the yeal s 97,426 Current year increase (decrease) S —71,903 I • r on VAllaarals & drolsotons S ( i 2. 1%). Pip 1 t.1 .11/l it Endn2 Capital &novo s 25,523 8 4, it I tit, t • III Im X Dd 0 Tar Nee Other (expbn) tie panne. wan* Yes II 'Yes' attach K properly X :woman, (OAP 0 Soon 7044b) bon path a OuNn earn or OW No (see instructions) 41 7 0 ce LL i A i of . pa n i For Paperwork ReducUon Act N011ee. see InshuctIone for Form 1065. DAA IRS.00xSarn11065 &NOM K-I (Form 1065) 2012 EFTA00593243 ANDLLC 0607.2013 324 PM , , Cale No. I545.0355 Schedule K-1 2012 Part III Partner's Share of Current Year Income, (Form 1065) Deductions, Credits, and Other Items Department cr me Tecamny For calendar year 2012. Cr :Ix Internal Revenue SerrCe year begammO 1 admary bezn= axone (Ws) —10,742 I 5 Credts wain 2 Net feel& real estate (woe Neel Partner's Share of Income, Deductions, Credits, etc. II See back of form and separate instructions. 3 Othal rot mead Irmorro (loss) IS Foregn baimaclons Part I I Information About the Partnership 4 Guaranteed payments A Partnenhes cermbyer demblcalron rumba' 45-1804323 5 WNW income 8 Partrresne's name. acrIM8S. Cry' PPM and DP code ANDROCYTE LLC 6a Crdnary dycknds AVENTU 0 6b Duelled dxtlendr C IRS Cereer wept ocrtrarshe Ned nom O den, UT 7 Rayabes D EI Check OM*, Is a WON& seas Pennwalt IPIP) 8 Net 8nOrleerrn Caeca gan OM) I Part III Information About the Partner sa Net loneferrn Capial gain rlossl 17 AternEdve MiriMuM lax (NAT) darn E Partners ickvellyng minter A 4 Applied For 9b Collecbbbs '28%) gen doss) F Partners melt =then. cry. slam. and 2P cc* GEOFFREY SHMIGELSKY 9c Jima-raptured section 1250 gain 10 Net How 1231 gain 110681 IS 1m/exempt income and rzedeclmtiale expenses VANCOUVER BC V6B E2E ii Claw InCeM9 Neel C* 4 G EI General partner or LLC X Larded pater of Ogle. LLC coorbor-maneed member H D DOMOSIC :5 1_ , orEir padre Plots 11 YAW Tye. 01 entree altars partner? Individual 19 Daeituton: It II INS partners a reoternerg Plan IMAraER'Kealirrelal. fled' rare 0 12 Semen 179 dedeoron Nee IMMACtlene) J Partners share of proil. loss. and opted (see instruction* Erman* 13 Callan deductions 80619. 11 Prou 14 3.840000 . 20 Otter inlamalen Loss % 5.810100 -. Caned % 3.840000 - K Pertnete Owe 01 gadflies al Air end. elanrcoanse 5 14 SErt-ernPraYmer4 0(001339 Ilw$) Wailed nanrecourse *naming ReCOuNe 2,086 L Partners reed =cunt analysis: 'See attached statement for additional information. Boom® espial =cum Gaeta' combined clone ele year 5 14,990 Current year incase (decrease) 5 -10,746 A di YAlhatawals rsbutons 5 ( I ,.• cf.; :4 Bori4phil IWO COSH 84Crear. $ 4,244 rim rr: fm: N X (ad 9 Tar base Other (expbh) the Darner WOWS Yes II 'Yes? attach K X etabinent GAAP 0 semyt 704(b) 00C45 PrOPertY wthabufbin Dam Ce We No (see instil-06km) 7 09 IS u. TI r tk , 4a,ki For Paperwork Reduction Acl Nettie. see InstnictIons tor Form 1069 DAA IRSCpCme3rM1065 Schedule K-1 (Form 1065) 2012 EFTA00593244 ANOLLC 08072013 224 PM K Fro, R 1 K Amerd.)) K.I OMB NV 1545.0)99 Schedule K-1 2012 Part Ill Partner 's Share of Current Year Income, (Form 1065) Deductions, Credits, and Other Items Department et the Treasury For cderdar year 2012. or tax Internal Revenue SSW° year be(nnr13 1 Ordinary been= income its) -4,259 16 Cat wane 2 Nei rental real estate (Keene Coed Partner's Share of Income, Deductions, Credits, etc. u see back of lone and separate instructions. 3 04)111 not metal nerd* (loss) IS Forcer trarbaclons I Part II Information About the Partnership 4 Guararteod payments A P inerstip's cfrebyer dertilcaben nyrnta 45-1804323 6 lamer *ACM. a Partreesnpb name. address. Cty. StMO. and DP Cede ANDROCYTE LLC 6a Cednary dyckn(ds IIIIII M M IF IR I I 0 66 Ouallad d ds C IRS Center %dere partrershp lied rerun Ogden, UT 7 boyabes D 0 Che0t d Ms is a pottery ba000 PannINO 1PTP) 8 Net Sterbeerrn Caeca Pan 1109$) I Part III Information About the Partner Se Net lonsyterrn capital gab Ilessl IT AtkMalve reflreuM lax iiknITI dens E Prince's pee-Myna nwreer A 2 116-40-7597 96 Cdtebbbs '28%) gait doss) F Palm: ram*. address. ccy. oaf*. and ZIP cede JIM GIBBONS Se Unrocaplurod section 1250 gain o Net secten 1231 Wiln 1106/1 IS Taxexanal income and needecletialo expemes OLYMPIA WA 98516 11 Cther WOMB NMI C* 2 G K General partner or LLC X Lmled partner' or other LLC merrixibrilline0er mobber H ID DOMOSIC K Feregn pa0X4 partner 11 YAM lope 01 entity al Ids bodnir? Individual 19 Csvithdan: /2 II Su ;eras is a roltemere plan (IFINSEP4400011`01C I. C110Ch 11(40 0 12 Soden 179 doireice Mee IMMAJCSCOS) J Parker's share of pro% loss. ard odd/ (see instructions): SeSinnigl Ending 13 Met deductions Protil % 1.920000 . 20 Other inlalmaban Loss % 2.878300 z Caned % 1. 920000 - K Pedner'S SAM 01 gadflies Si year Ord Manrecouse S 14 Ser(olcioymere &Imre:, ilinst Curdled nareecourse dancing S ReCOunte $ 1, 034 L Partners captd asccunt analysis: 'See attached statement for additional information. Elepnrog capital aCCCuM $ Capital COrdltruled doting MO year s 7,426 0Jrrent year ireroase (decrease) $ —4,261 . • fr VAlhatayeals & distbutons S ( I 2' . ill II min) capital &cow $ 3,165 8 ki X DO 9 Tar begs Other (expbri) the tar wind Yes If 'Yes' attach K l0 X statement GAAP ID Secito 7040) bock depenienn a Wiwi On llel:697 No (see instrudicre) . . 0CC u. FOr PeperwOrk Reduction Act NOM& see InStruCtionS tor Form 1056 DAA IRS.0003rM1065 Schedule K-1 (Form 1065) 2012 EFTA00593245 MOLLC 06072013 324 PM F. 4562 Dcparencrt el ee Treast.ry Internal Rfterga Servce 139) ftmcisRliom on rehon ANDROCYTE LLC Depreciation and Amortization (Including Information on Listed Property) u See separate Instructions. u Attach to your tax return 0/.4B No. 16454172 2012 tli=1",:mm 179 idenfifyiN number 45-1804323 terms or acthqy le 'Mich the lorm relates Regular Depreciation Part I Election To Expense Certain Property Under Section 179 Note: If you have any listed property. complete Part V before you complete Part I. 1 Maximum amount (see instructions) 2 Total cost of section 179 properly placed in service (see instructions) 3 Threshold cost of section 179 property before reduction in limitation (see instructions) 4 Reduction in limitation. Subtract line 3 from line 2. N zero or less. enter .0. 5 Dollar Imitation for lax year. Subtract ire 4 from foe 1. N zero er less. enter N married Nine separatehr. see instructions 6 (a) pesciimbri of Point/ (b) Cosi tbusness use only) (c) Elet-led coal 1 2 3 4 5 500,000 2,000,000 7 Listed property. Enter the amount from line 29 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 9 Tentative deduction. Enter the smaller of line 5 or line 8 10 Carryover of disallowed deduction from line 13 of your 2011 Form 4562 11 Business income limitation. Enter the smaler of business income (not less than zero) or line 5 (see instructions) 12 Section 179 expense deduction. Add lines 9 and 10. but do not enter more than line 11 .. . . . . 13 Carryover of disallowed deduction to 2013. Add lines 9 and 10. less line 12 ► 13 Note: Do not use Pail II or Part III below for listed property. Instead. use Part V. I 7 8 9 10 11 12 Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions) 14 Special depredation allowance for guabfied property (other than fisted properly) placed in service during the tax year (see instructions) 15 Property subject to section 168)(1) election 16 Other depreciation (including ACRS) 14 1,258 15 16 Part III MACRS Depreciation (Do not include listed property.) (See instructions.) Section A 17 MACRS deductions for assets placed in service in tax years beginning before 2012 17 I 0 18 II you are electMg to group any assets ptaced in service during the tax year rib one or mote geroral asset =cults. check Imo Section B—Assets Placed in Service During 2012 Tax Year Using the General Depreciation System (,) Ctaidilailka Or POPerti MilgoiriaW yep OKK4 M arvce M Beals ler dCONON4I 02w mminueslmeM we ody-meeishwWnl Id/ Rome., proo4 (0) COM:411:0 M PhYMO (9) DepooMm deduction 19a lyear property b 5-year property 1,258 5.0 MQ 200DB 135 c 7.year property d 10.year property e 15.year property f 20-year property g 25.Year property 25 yrs. SA_ h Residential rental property 27.5 yrs. MM SA_ 27.5 yrs. MM SA_ I Nonresidential real property 39 yrs. MM SA_ MM St Section C—Assets Placed in Service During 2012 Tax Year Using the Alternative Depreciation System 20a Class life St b 12.year 12 yrs. St c 40.year 40 yrs. MM St Part IV Summary (See instructions.) 21 Listed property. Enter amount from line 28 22 Total. Add amounts from line 12. lines 14 through 17. Ines 19 and 20 in column (9). and tine 21. Enter here and on the appropriate Ines of your retum. Partnerships and S corporations—see instructions 23 For assets shown above and placed in service during the current year. enter the portion of the basis attributable to section 263A costs 23 21 495 22 1,888 For Paperwork Reduction Act Notice, see separate instructions. DM Form 4562 I.ttl2. EFTA00593246 MELLO C807(2013 324 PM ANDROCYTE LLC Form 4562 (20121 45-1804323 page 2 Part V Listed Property (Include automobiles, certain other vehicles, certain computers. and property used for entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting tease expense. complete only 24a. 24b. columns (a) through (c) of Section A. all of Section B. and Section C if applicable. SectionA--Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.) 24a Do yet nave Selena, to sweat the buorossInvestmert use clamed? n Yes n No 24b If 'Yes: is the evidence written? —1 Yes n No (a) TWO 0? Incerf)/ fsi vehas Ng, (b) Oath 0000 In service (c) Ousthess' investment use Fatentage (0) Cost ix other base (0) liksila Ia ($00reoatlan tbusneseirmastment use °fly) 0) NCO'S'? MVO Ica IA0:630, Convent(On IN cierreoidon cleducton (I) Sens semen 179 0061 25 Special depreciation allowance for qualified Isted property placed in service during the tax year and used more than 50% in a qualified business use (see instructions) 25 26 Probonv used more than 50% in a alified business use: 2004 FORD EXPLORER 12/27/12 100.00. 9,896 9,896 5.0 200DBMQ 495 . 27 Property used 50% or less in a qualified business use: 28 Add amounts in column (h) lines 25 through 27. Enter here and on line 21, papa 1 29 Add amounts in column (I). line 26. Enter here and on line 7. page Section B—Informadon on Use of Vehicles Complete this section for vehicles used by a sole proprietor. partner. or other "more than 5% owner." or related person. II you provided vehicles to your employees. first answer Erie questions in becuon u to see it you meet an exception to completing Ems section tor arose venoms. 30 31 32 33 34 35 36 Total business/investment miles driven during the year (do not include commuting mites) Total commuting miles driven during the year Total other personal (noncommuting) miles driven Total miles driven during the year. Add lines 30 through 32 Was the vehicle available for personal use during ofkluty hours? Was the vehicle used primarily by a more than 5% owner or related person? Is another vehicle available for personal use? (a) Veneto 1 lb) I Weide 2 (c) Vehcle 3 Id) Vehicle 4 (a) While 5 (f) Wilde 6 Yes No Yes No Yes No Yes No Yes No Yes No Section C—Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to comp ono Section B for vehicles used by emp oyees who are not more than 5% owners or related persons (see instructions). 37 Do you maintain a written policy statement that prohibits all personal use of vehicles. including commuting, by your employees? 38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, drectors, or 1% or more owners 39 Do you treat al use of vehicles by employees as personal use? 40 Do you provide more than five vehicles to your employees. obtain information from your employees about the use of the vehicles, and retain the information received? 41 Do you meet the requirements concerning quaffed automobile demonstration use? (See instructions.) 29 • . • Note: If yOur answer to 37.38. 39. 40. or 41 is -Yes." do not complete Section B for the covered vehicles. Yes No Part VI Amortization (b) (c) WI (0 Arneelizatlen if) (a) Doscreoen ci costs Date arreehisoon peons Amer.:table amcut Code soden Period a Pacemage Amonzalian kg INs year 42 Amortization of costs that begins during your 2012 tax year (see instructions): 43 Amortization of costs that began before your 2012 tax year 44 Total. Add amounts in column (I). See the instructions for where to report 43 2,192 2,192 44 DM 4562 _rir, EFTA00593247 ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 Federal Statements 817/2013 3:24 PM Statement 1 - Form 1065. Page 1. Line 20 - Other Deductions Description Amount ADVERTISING $ 301 AUTO EXPENSE 7,560 BANK FEES 340 COMPUTER & INTERNET 972 FERRY/SHIP 312 MANAGEMENT FEES 102,000 MISCELLANEOUS EXPENSE 231 OFFICE EXPENSE 2,585 PARKING & TOLLS 1,183 POSTAGE & DELIVERY 1,551 PROFESSIONAL FEES 53,799 REIMBURSEMENTS 3,126 SUPPLIES 473 TRAVEL 23,700 Meals and Entertain (50%) 129 Amortization 2,192 Total $ 200,454 1 EFTA00593248 ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 Federal Statements 817/2013 3:24 PM Statement 2 - Form 1065. Schedule K. Line 18c - Nondeductible Expenses Description Amount Nondeductible Meals and Entertainment $ 128 Total $ 128 2 EFTA00593249 Description DUE TO J CLEMENT DUE TO P MACKEY ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 Federal Statements 817/2013 3:24 PM Statement 3 - Form 1065. Schedule L. Line 20 - Other Liabilities Beginning End of Year of Year $ $ 25,608 10,303 Total 0 $ 35,911 3 EFTA00593250 ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 Federal Statements ANDROCYTE MANAGEMENT LLC 45-2038037 817/2013 3:24 PM Schedule K-1. Line 18 - Tax-Exempt Income and Nondeductible Expenses Code Description Amount C Nondeductible Meals and Entertainment $ 107 Schedule K-1, Line 20Y - Additional Supplemental Information Description Additional Alternative Minimum Tax Information: AMT Total Depreciation ACE Post-1993 Property Depreciation 1,468 1,468 Distribution in Excess of Partner Basis 35,800 EFTA00593251 ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 Federal Statements ZASIS, LLC 20-4637772 817/2013 3:24 PM Schedule K-1. Line 18 - Tax-Exempt Income and Nondeductible Expenses Code Description Amount C Nondeductible Meals and Entertainment S 13 Schedule K-1, Line 20Y - Additional Supplemental Information Description Additional Alternative Minimum Tax Information: AMT Total Depreciation ACE Post-1993 Property Depreciation 180 180 EFTA00593252 ANDLLC ANDROCYTE LLC 45-1804323 Federal Statements FYE: 12/31/2012 LIFE EXTENSION FOUNDATION, INC. 59-1746396 8/7/2013 3:24 PM Schedule K-1, Line 18 - Tax-Exempt Income and Nondeductible Expense8 Code Description Amount C Nondeductible Meals and Entertainment $ 2 EFTA00593253 ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 Federal Statements GEOFFREY SHMIGELSKY Applied For 8/7/2013 3:24 PM Schedule K-1, Line 18 - Tax-Exempt Income and Nondeductible Expenses Code Description Amount C Nondeductible Meals and Entertainment $ 4 EFTA00593254 ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 Federal Statements JIM GIBBONS 116-40-7597 8/7/2013 3:24 PM Schedule K-1, Line 18 - Tax-Exempt Income and Nondeductible Expenses Code Description Amount C Nondeductible Meals and Entertainment $ 2 EFTA00593255 MOLLC 0607(2013 1St PM Schedule Analysis of Partner's K-1, Current Year Increase (Decrease) Worksheet 14:-1 I 2012 for calendar year 2012 or tax year beginning and ending Partnership Name ANDROCYTE LLC Employer Identification Number 45-1804323 Partners Name ANDROCYTE MANAGEMENT LLC Taxpayer Identification Number 45-2038037 Items Included In Current Year Increase (Decrease): Schedule M-1 Subtractions: Meals and Entertainment 107 Subtotal 107 Total per Schedule K-1, Current Year Increase (Decrease) -107 Page 1 of 1 EFTA00593256 MOLLC 011072013 324 PM Schedule Analysis of Partner's KA, Current Year Increase (Decrease) Worksheet Ic1 I 2012 for calendar year 2012 or tax year beginnog and ending Partnership Name ANDROCYTE LLC Empoyer Identification Number 45-1804323 Partners Name ZASIS, LLC Taxpayer Identification Number 20-4637772 Items Included in Current Year Increase (Decrease): Schedule K Additions: Ordinary Income/Loss -118,211 Subtotal -118,211 Schedule M-1 Subtractions: Meals and Entertainment 13 Subtotal 13 Total per Schedule K-1, Current Year Increase (Decrease) -118,224 Page 1 of 1 EFTA00593257 MOLLC 0607(2013 124 PM Schedule Analysis of Partner's K-1, Current Year Increase (Decrease) Worksheet K-1 I 2012 For calendar year 2012 or tax year begiming and ending Partnership Name ANDROCYTE LLC Empoyer Identification Number 45-1804323 Partner's Name LIFE EXTENSION FOUNDATION, INC. Taxpayer Identification Number 59-1746396 Items Included In Current Year Increase (Decrease): Schedule K Additions: Ordinary Income/Loss -71,901 Subtotal -71,901 Schedule M-1 Subtractions: Meals and Entertainment 2 Subtotal 2 Total per Schedule K-1, Current Year Increase (Decrease) -71,903 Page 1 of 1 EFTA00593258 MOLLC 0607(2013 124 PM Schedule Analysis of Partner's K-1, Current Year Increase (Decrease) Worksheet 14:-1 I 2012 for calendar year 2012 or tax year beginning and ending Partnership Name ANDROCYTE LLC Empoyer Identification Number 45-1804323 Partners Name GEOFFREY SHMIGELSKY Items Included in Current Year Increase (Decrease): Schedule K Additions: Ordinary Income/Loss Taxpayer Identification Number Applied For -10,742 Subtotal -10,742 Schedule M-1 Subtractions: Meals and Entertainment 4 Subtotal 4 Total per Schedule K-1, Current Year Increase (Decrease) -10,746 Page 1 of 1 EFTA00593259 MOLLC 011072013 324 PM Schedule Analysis of Partner's K-1, Current Year Increase (Decrease) Worksheet Ic1 I 2012 for calendar year 2012 or tax year beginning and ending Partnership Name ANDROCYTE LLC Employer Identification Number 45-1804323 Partner's Name JIM GIBBONS Taxpayer Identification Number 116-40-7597 hems Included in Current Year Increase (Decrease): Schedule K Additions: Ordinary Income/Loss -4,259 Subtotal -4,259 Schedule M-1 Subtractions: Meals and Entertainment 2 Subtotal 2 Total per Schedule K-1, Current Year Increase (Decrease) -4,261 Page 1 of 1 EFTA00593260 MOLLC 06072013 324 PM schedule K-1 Partner's Basis Worksheet, Page 1 2012 For calendar year 2012. or tax year beginning and ending Partnership Name ANDROCYTE LLC Partners Name ANDROCYTE MANAGEMENT LLC Employer Identification Number 45-1804323 Taxpayer Identification Number 45-2038037 Beginning of year 0 Increases: Capital contributions: Cash Property (adjusted basis) 'Excess' depletion Income items: Ordinary Income Other increases: Net income from rental real estate activates Net income from other rental activities Interest Dividends Royalties Net shon•term capital gain Net long-term capital gain Other portfolio income Net gain under section 1231 Other income Tax•exempi interest and other income Transfer of capital Gain (loss) on disposition of section 179 assets Distributions: Cash 35,800 Property (adjusted basis) 35,800 Increase (decrease) in share of partnership liabilities PN Subtotal CN Distribution in excess of partner basis Decreases: Noncap items: Loss items: Depletion Nondeductible expenses Charitable oontrbutions Foreign taxes Ordinary loss Net loss from rental real estate activities Net loss from other rental activities Royalties Net shore enn capital loss . Net longterm capital loss Other portfolio loss Net toss under section 1231 Other losses Section 179 expense Deductions related to portfolio income Other deductions Interest expense on kwestment debts Section 59(0)(2) expendtures Other decreases: End of year —35,800 35,800 0 Note to partner: This worksheet was prepared based on partnership records. Please consult with your tax advisor for adjustments. EFTA00593261 MOLLC 01107f2013 324 PM Schedule K-1 Partner's Basis Worksheet, Page 2 For calendar year 2012 or tax year beginning and endi Partnership Name ANDROCYTE LW 2012 Employer Wen ification Number 45-1804323 Partners Name ANDROCYTE MANAGEMENT LLC Taxpayer Iden Station Number 45-2038037 Suspended Amount Current Year Total Loss Percent Allowed Loss Disallowed Loss Nondeductible noncapital exps: Nondeductble expenses Charitable contributions Foreign taxes Total nonded noncapital exps Losses and deductions: Ordinary loss Rental real estate loss Other rental activity loss Royalties Short-term capital loss Long-term capital loss Other portfolio loss Section 1231 loss Other losses Section 179 expense Portfolio income deductions Other deductions Investment debt interest Sect 59(e)(2) expenditures Depletion Total losses and deductions 107 107 100.00 107 107 107 107 'Note to partner: This worksheet was prepared based on partnership records. Please consult with your tax advisor for adjustments. EFTA00593262 AKOLLC 011072013 324 PM schedule K-1 Partner's Basis Worksheet, Page 1 2012 For calendar year 2012. or tax year beginning Partnership Name ANDROCYTE LLC Partners Name ZASIS , LLC and ending Employer Identification Number 45-1804323 Taxpayer Identification Number 20-4637772 Beginning of year Increases: Capital contributions: Cash 'Excess' depletion Income items: Ordinary Income Other increases: 80,000 Property (adjusted basis) Net income from rental real estate activities Net income from other rental activities Interest Dividends Royalties Net short-term capital gain Net long-term capital gain Other portfolio income Net gain under section 1231 Other income Tax•exempi interest and other income Transfer of capital Gain (loss) on disposition of section 179 assets Distributions: Cash Increase (decrease) in share of partnership liabilities PN Subtotal Properly (adjusted basis) CA' 58,154 80,000 19,230 19,230 Distribution in excess of partner basis Decreases: Noncap items: Nondeductible expenses Charitable oontri3ubons Foreign taxes Loss items: Ordinary loss Depletion Net loss from rental real estate acuvrties Net loss from other rental activities Royalties Net short-term capital loss Net long-term capital loss Other portfolio loss Net toss under section 1231 Other losses Section 179 expense Deductions related to portfolio income Other deductions Interest expense on investment debts Section 59(0)(2) expendtures Other decreases: End of year 13 118,211 157,384 13 118,211 39,160 Note to partner: This worksheet was prepared based on partnership records. Please consult with your tax advisor for adjustments. EFTA00593263 MOLLC 06072013 324 PM schedule K-1 Partner's Basis Worksheet, Page 1 2012 For calendar year 2012. or tax year beginning and ending Partnership Name ANDROCYTE LLC Partners Name LIFE EXTENSION FOUNDATION, INC. Employer Identification Number 45-1804323 Taxpayer Identification Number 59-1746396 Beginning of year 0 Increases: Capital contributions: Cash 97,426 Property (adjusted basis) 97,426 'Excess" depletion Income items: Ordinary Income Other increases: Net income from rental real estate activates Net income from other rental activities Interest Dividends Royalties Net short-term capital gain Net long-term capital gain Other portfolio income Net gain under section 1231 Other income Tax-exempt interest and other income Transfer of capital Gain (loss) on disposition of section 179 assets Distributions: Cash Increase (decrease) in share of partnership liabilities PIY Subtotal Distribution in excess of partner basis Decreases: Noncap items: Properly (adjusted basis) CPI 13,561 13,561 Nondeductible expenses Charitable oontrioubons Foreign taxes Loss items: Ordinary loss Depletion Net loss from rental real estate activities Net loss from other rental activities Royalties Net short-term capital loss Net long-term capital loss Other portfolio loss Net toss under section 1231 Other losses Section 179 expense Deductions related to portfolio Income Other deductions Interest expense on investment debts Section 59(0(2) expendtures Other decreases: End of year 2 71,901 110,987 2 71,901 39,084 Note to partner: This worksheet was prepared based on partnership records. Please consult with your tax advisor for adjustments. EFTA00593264 MOLLC 06072013 324 PM schedule K-1 Partner's Basis Worksheet, Page 1 2012 For calendar year 2012. or tax year beginning and ending Partnership Name ANDROCYTE LLC Partners Name GEOFFREY SHMIGELSKY Employer Identification Number 45-1804323 Taxpayer Identification Number Applied For Beginning of year Increases: Capital contributions: Cash 'Excess" depletion 0 14,990 Property (adjusted basis) 14,990 Income items: Ordinary Income Other increases: Net income from rental real estate activities Net income from other rental activities Interest Dividends Royalties Net short-term capital gain Net long-term capital gain Other portfolio income Net gain under section 1231 Other income Tax•exempi interest and other income Transfer of capital Gain (loss) on disposition of section 179 assets Distributions: Cash Increase (decrease) in share of partnership liabilities PN Property (adjusted basis) Cry 2,086 2,086 Subtotal 17,076 Distribution in excess of partner basis Decreases: Noncap items: Nondeductible expenses , , , ,, , , , , , , , , , , , ,, , , , , , , , , , , , ,, , 4 Charitable oontrioutions , , , ,, , , , , , , , , , , , ,, , , , , , , , , , , , ,, . Foreign taxes Loss items: Ordinary loss 10,742 Net loss from rental real estate activities , , , , , , , ,, , , , , , , , , , , , ,, Net loss from other rental activities , , , , , , , , , , ,, , , , , , , , , , , , ,, , Royalties Net short-term capital loss ,, , ,, , , , , , , , , , , , ,, , , , , , , , , , , , ,, Net long-term capital loss Other portfolio loss Net toss under section 1231 Other losses Section 179 expense Deductions related to midi° income Other deductions Interest expense on investment debts Section 59(e)(2) expendtures Depletion Other decreases: End of year 4 10,742 6,330 Note to partner: This worksheet was prepared based on partnership records. Please consult with your tax advisor for adjustments. EFTA00593265 MOLLC 06072013 324 PM schedule K-1 Partner's Basis Worksheet, Page 1 2012 For calendar year 2012. or tax year beginning and ending Partnership Name ANDROCYTE LLC Partners Name JIM GIBBONS Employer Identification Number 45-1804323 Taxpayer Identification Number 116-40-7597 Beginning of year 0 Increases: Capital contributions: Cash 7,426 Property (adjusted basis) 7,426 'Excess' depletion Income items: Ordinary Income Other increases: Net income from rental real estate acuviues Net income from other rental activities Interest Dividends Royalties Net short-term capital gain Net long-term capital gain Other portfolio income Net gain under section 1231 Other income Tax•exempt interest and other income Transfer of capital Gain (loss) on disposition of section 179 assets Distributions: Cash Increase (decrease) in share of partnership liabilities PN Properly (adjusted basis) CN 1,034 1,034 Subtotal 8,460 Distribution in excess of partner basis Decreases: Noncap items: Nondeductible expenses , , , ,, , , , , , , , , , , , ,, , , , , , , , , , , , ,, , 2 Charitable contributions , , , ,, , , , , , , , , , , , ,, , , , , , , , , , , , ,, . Foreign taxes Loss items: Ordinary loss 4,259 Net loss from rental real estate activities , , , , , , , ,, , , , , , , , , , , , ,, Net loss from other rental activities , , , , , , , , , , ,, , , , , , , , , , , , ,, , Royalties Net short-term capital loss ,, , ,, , , , , , , , , , , , ,, , , , , , , , , , , , ,, Net long-term capital loss Other portfolio loss Net toss under section 1231 Other losses Section 179 expense Deductions related to poitoio Income Other deductions Interest expense on investment debts Section 59(e)(2) expenditures Depletion Other decreases: End of year 2 4,259 4,199 Note to partner: This worksheet was prepared based on partnership records. Please consult with your tax advisor for adjustments. EFTA00593266 ANOLLC 06072013 3,21 PM Schedule K-1 Summary Worksheet 1065 2012 For calendar year 2012. or tax year beginning . and ending Partnership Name Empoyer Identification Number ANDROCYTE LLC 45-1804323 Column A Column 8 Column C Column D Partner Name ANDROCYTE MANAGEMENT LLC ZASIS, LLC LIFE EXTENSION FOUNDATION, INC. GEOFFREY SHMIGELSKY SSM EIN 45-2038037 20-4637772 59-1746396 Applied For Schedule K Items 1 Ordinary income 2 Net 'ncome•rent 3c Net inc-oth rent 4 Guaranteed pmts 5 Interest Income 6a Ordinary dividends 6b Oval eividends 7 Royalties 8 Net ST capital gain 9a Net LT capital gain 9b Collectbles 28% gain 9c Unrecap sec 1250 10 Net sec 1231 gain 11 Other Income 12 Sec 179 deduction 13a Contrbutions 13b Invest interest exp 13c Sec 59(e)(2) exp 13d Other deductions 14a Net SE earnings 14b Gross farming inc 14c Gross nonfarm ine 15a Low-inc house 42j5 15b Low-inc house other 15c Ckialif rehab exp 15d Rental RE credits 15e Other rental credits 151 Other credits 16b Gross inc al src 16c4 Tot foreign income 16q-kTot foreign deds 161•4nTotal foreign taxes 17a Depr adjustment 103 17b Adj gain or loss 17c Depletion 17d Inc-oitgastgeoth lie Ded-ortrgasigeoth 17f Other AMT items 18a Tax-exempt int 18b Other tax-exempt 18c Nonded expense 19a Cash disinbulions 19b Property distributions 20a Invest income Column A Column B Column C Column D —118,211 -71,901 Subtotal -10,742 -200,854 13 2 4 122 107 13 2 4 126 35,800 35,800 20b Invest expense Page 1 of 2 EFTA00593267 ANOLLC C6072013 124 PM Schedule K-1 Summary Worksheet Form 1065 2012 For calendar year 2012. or tax year beginning . and ending Partnership Name Employer Identification Number ANDROCYTE LLC 45-1804323 Column A Column B Column C Column D Partner Name SSNEIN JIM GIBBONS 116-40-7597 Schedule K Items 1 Ordinary income 2 Net income•rent 3c Net inc-oth rent 4 Guaranteed pmts 5 Interest Income 6a Ordinary dividends 6b Ckial dividends 7 Royalties 8 Net ST capital gain 9a Net LT capital gain 9b Collecttles 28% gain 9c Unrecap sec 1250 10 Net sec 1231 gain 11 Other income 12 Sec 179 deduction 13a Contri3utions 1313 Invest interest exp 13c Sec 59(e)(2) exp 13d Other deductions 14a Net SE earnings 14b Gross farming inc 14c Gross nonfarm ine 15a Low-inc house 4215 15b Low-inc house other 15c Ckialif rehab exp 15d Rental RE credits 15e Other rental credits 151 Other credits 16b Gross inc al src 16c-1 Tot foreign income 16g-kTot foreign dads 161-mTotal foreign taxes 17a Depr adjustment 2 17b AM gain or loss 17c Depletion 17d Incogrgasigeoth 17e 00d-oil/gas/geed) 17f Other AMT items 18a Tax-exempt int 18b Other tax-exempt 18c Nonded expense 19a Cash distributions 19b Property distributions 20a Invest income Column A Column B -4,259 Column C Column D Sch K Total -205,113 124 2 128 35,800 20b Invest expense Page 2 of 2 EFTA00593268 ANOr.LC 08 072313 324 pm Reconciliation of Partners' Basis Worksheet Form 1065 For calendar year 2012, or tax year begrnilaul Partnership Name ANDROCYTE LLC 2012 EmpMyst identification Number 45-1804323 Partner Number Partner Name Beginning Basis Increases Distribution in Excess of Basis Allowed Decreases Ending Basis 1 ANDROCYTE MANAGEMENT LLC 0 —35,800 35,800 0 0 2 ZASIS, LLC 58,154 99,230 0 118,224 39,160 3 LIFE EXTENSION FOUNDATION, INC. 0 110,987 0 71,903 39,084 4 GEOFFREY SHMIGELSKY 0 17,076 0 10,746 6,330 5 JIM GIBBONS 0 8,460 0 4,261 4,199 Taal this page 58,154 199,953 35,800 205,134 88,773 foal as pages 58,154 199,953 35,800 205,134 88,773 Page 1 of 1 EFTA00593269 ANMOO 0807,2013 3:24 Form 1065 Reconciliation of Partners' Capital Accounts Worksheet For calendar year 2012, or tax year beginning and ending 2012 Partnership Name ANDROCYTE LLC Employer Identification Number 45-1804323 Partner Beginning Capital Lines 3, 4. & 7 Withdrawals & Ending Number Partner Name Capital Contributed Schedule M-2 Distributions Capital 1 ANDROCYTE MANAGEMENT LLC —2,023 0 —107 35,800 —37,930 2 ZASIS, LLC 58,154 80,000 -118,224 0 19,930 3 LIFE EXTENSION FOUNDATION, INC. 0 97,426 -71,903 0 25,523 4 GEOFFREY SHMIGELSKY 0 14,990 -10,746 0 4,244 5 JIM GIBBONS 0 7,426 —4,261 0 3,165 Total this page 56,131 199,842 —205,241 35,800 14,932 Total all pages 56,131 199,842 —205,241 35,800 14,932 Page 1 of 1 EFTA00593270 ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 Federal Asset Report Form 1065, Page 1 08/07/2013 3:24 PM Date Asset Description In Service Cost Bus Sec % 179 Bonus Basis for Depr PerConv Meth Prior Current 5-year GDS Property: 2 TRAILER 9/12/12 1.422 X 711 5 MQ200DB 0 818 4 LAPTOP 10/04/12 1.094 X 547 5 MQ200DB 0 575 2.516 1.258 0 1.393 Listed Property: I 2004 FORD EXPLORER 12/27/12 9.896 9.896 5 MQ200DB 0 495 9.896 9.896 0 495 Amortization: 3 DATA AND SAMPLES 5/01/11 32.880 32.880 15 MOAmort 0 2.192 32.880 32.880 0 2.192 Grand Totals 45,292 44,034 0 4.080 Leas: Dispositions and Transfers 0 0 0 0 Less: Start-up/Org Expense 0 0 0 0 Net Grand Totals 45.292 44.034 0 4.080 EFTA00593271 ANDLLC ANDROCYTE LLC 45-1804323 Bonus Depreciation Report FYE: 12/31/2012 08/07/2013 3:24 PM Date In Tax Bus Tax Sec Current Prior Tax - Basis Asset Property Description Service Cost Pct 179 Exp Bonus Bonus for Depr Arthiv: Form 106; Page 1 2 TRAILER 9/12112 1.422 0 711 0 711 4 LAPTOP 10/04/12 1.094 0 547 0 547 Form 1065. Page 1 2.516 0 1.258 0 1.258 Grand Total 2.516 0 1.258 0 1.258 EFTA00593272 ANDLLC ANDROCYTE LLC 45-1804323 FYE: 12/31/2012 AMT Asset Report Form 1065, Page 1 08/07/2013 3:24 PM Date Asset Description In Service Cost Bus Sec % 179 Bonus Basis for Depr PerConv Meth Prior Current 5-year GUS Property: 2 TRAILER 9/12/12 1.422 X 711 5 MQ200DB 0 818 4 LAPTOP 10/04/12 1.094 X 547 5 MQ200DB 0 575 2.516 1.258 () 1.393 Listed Property: I 2004 FORD EXPLORER 12/27/12 9.896 9.8% 5 MQI50DB 0 371 9.896 9.8% 0 371 Grand Totais 12.412 11.154 0 1.7(4 Lem: Dispositions and Transfers 0 0 0 0 Net Grand Totals 12.412 1 1.154 0 1.764 EFTA00593273