1099-CONSOLIDATED TAX STATEMENT Tax Year 2005 Copy B For Recipient. Department of the Treasury - Internal Revenue Service (Keep for your records)
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1 *00000* JOHN A. DOE 1234 AMERICA WAY TOMN CITY, CO USA 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. IRS FORM 1099-DIV - DIVIDENDS AND DISTRIBUTIONS IRS FORM 1099-INT - INTEREST INCOME BOX OMB NO BOX OMB NO A. TOTAL ORDINARY DIVIDENDS $ INTEREST INCOME NOT INCLUDED IN IRS BOX 3 $ B. QUALIFIED DIVIDENDS $ INTEREST INCOME ON U.S. TREASURY OBLIGATIONS $0.00 2A. TOTAL CAPITAL GAIN DISTRIBUTIONS $0.00 2B. UNRECAP. SEC GAIN $ INVESTMENT EXPENSES $0.00 2C. SECTION 1202 GAIN $ FOREIGN TAX PAID $0.00 2D. COLLECTIBLES (28%) GAIN $ NONTAXABLE DISTRIBUTIONS $ INVESTMENT EXPENSES $ FOREIGN TAX PAID $ CASH LIQUIDATION DISTRIBUTIONS $ NON-CASH LIQUIDATION DISTRIBUTIONS $0.00 IRS FORM 1099-MISC - MISCELLANEOUS INCOME BOX OMB NO ROYALTIES $ OTHER INCOME $ SUBSTITUTE PAYMENTS IN LIEU OF DIVIDENDS OR INTEREST $0.00 Detail relating to this summary information is contained in the following pages. Page 1 of 5
2 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. IRS FORM 1099-B - PROCEEDS FROM BROKER AND BARTER EXCHANGE TRANSACTIONS BOX OMB NO GROSS PROCEEDS LESS COMMISSION ON STOCK, BONDS, ETC $ B PROCEEDS FROM BROKER AND BARTER EXCHANGE TRANSACTIONS TRADE DESCRIPTION CUSIP PRICE QUANTITY DATE NET PROCEEDS ACTIVITY NOTES (Box 7) (Box 1b) (Box 1a) (Box 2) INSMED INC NEW $ /14/05 $ SALE INSMED INC NEW $ /22/05 $ SALE TOTAL PROCEEDS FROM BROKER AND BARTER EXCHANGE (BOX 2) $ Page 2 of 5
3 *00100* The following detailed information is NOT provided to the Internal Revenue Service, but is being provided to you as a courtesy. The IRS box numbers referenced for individual items listed below comprise the totals shown on the 1099 forms from the previous pages DIV DIVIDENDS AND DISTRIBUTIONS EX-DIVIDEND IRS DESCRIPTION CUSIP DATE DATE ACTIVITY AMOUNT BOX COUNTRY NOTES PRIMARY FUND-CLASS R /29/05 DIVIDEND $ A PRIMARY FUND-CLASS R /31/05 DIVIDEND $ A PRIMARY FUND-CLASS R /30/05 DIVIDEND $7.37 1A PRIMARY FUND-CLASS R /29/05 DIVIDEND $3.61 1A PRIMARY FUND-CLASS R /31/05 DIVIDEND $5.94 1A PRIMARY FUND-CLASS R /30/05 DIVIDEND $6.88 1A PRIMARY FUND-CLASS R /31/05 DIVIDEND $7.67 1A PRIMARY FUND-CLASS R /30/05 DIVIDEND $8.74 1A PRIMARY FUND-CLASS R /30/05 DIVIDEND $ A TOTAL DIVIDENDS $ INT INTEREST INCOME IRS DESCRIPTION CUSIP DATE ACTIVITY AMOUNT BOX COUNTRY NOTES CREDIT INTEREST CRDT INTR 03/30/05 INTEREST $ LEGENT INSURED DEPOSIT /31/05 INTEREST $ LEGENT INSURED DEPOSIT /28/05 INTEREST $ LEGENT INSURED DEPOSIT /31/05 INTEREST $ LEGENT INSURED DEPOSIT /06/05 INTEREST $ TOTAL INTEREST INCOME $16.18 Page 3 of 5
4 This section lists non-federally reported activity, which may be useful in helping you prepare your tax return. This activity may or may not be taxable at the state or local level and will NOT be furnished to the Internal Revenue Service. Please review this information with your tax advisor. NON-FEDERALLY REPORTED ACTIVITY BOX TOTALS FOR TAX YEAR MARGIN INTEREST $ EXEMPT MUNICIPAL INTEREST $ EXEMPT DIVIDENDS $ RETURN OF CAPITAL OR PRINCIPAL $ INCOME SUBJECT TO ALT MIN TAX $ EXEMPT INTEREST $ EXEMPT ACCRUED INTEREST $ PARTNERSHIP (MLP) DISTRIBUTIONS $ ACCRUED INTEREST ON PURCHASES $ PURCHASES $2, OPTION TRANSACTIONS $4, PURCHASES DESCRIPTION CUSIP DATE ACTIVITY QUANTITY PRICE AMOUNT NOTES INSMED INC NEW /21/05 PURCHASE 1, $ $1, PHARMOS CRP PAR $.03 NEW /29/05 PURCHASE $ $ TOTAL PURCHASES $2, OPTION TRANSACTIONS DESCRIPTION SYMBOL DATE ACTIVITY QUANTITY PRICE AMOUNT NOTES PUT BANK AMER CORP /17/05 OPTION SALE $ $(285.03) PUT BANK AMER CORP /13/05 OPTION BUY $ $ CONTINUED ON NEXT PAGE Page 4 of 5
5 *00110* This section lists non-federally reported activity, which may be useful in helping you prepare your tax return. This activity may or may not be taxable at the state or local level and will NOT be furnished to the Internal Revenue Service. Please review this information with your tax advisor. OPTION TRANSACTIONS (continued) DESCRIPTION SYMBOL DATE ACTIVITY QUANTITY PRICE AMOUNT NOTES PUT BANK AMER CORP VBAMW 08/05/05 OPTION SALE $ $(1,784.97) PUT BANK AMER CORP VBAMW 06/17/05 OPTION BUY $ $1, PUT BEAR STEARNS CO BSCVS 08/10/05 OPTION SALE $ $(345.03) PUT BEAR STEARNS CO BSCVS 07/01/05 OPTION BUY $ $ PUT INTEL CORP /29/05 OPTION BUY $ $ CALL CHECK POINT SOFTWAR VCWAX 12/28/05 OPTION BUY $ $ PUT NASDAQ 100 TR VCQML 06/17/05 OPTION BUY $ $ CALL STANDARD & POORS SPYIT 08/10/05 OPTION BUY $ $ CALL NORTHWEST AIRLINES WAWAU 01/21/05 OPTION BUY $ $2, TOTAL OPTION TRANSACTIONS $4, Page 5 of 5
Recipient s Tax Identification Number: Account Number: Corrected on MM/DD/YY
1AC 2 D 1 A 15789 * C 009!080217456309! 1099 DIV 1AC 2 D 1 A 15789 * C 009 Page 1 of xxx IRS BOX FORM 1099-DIV - DIVIDENDS AND DISTRIBUTIONS OMB #1545-0110 1A. TOTAL ORDINARY DIVIDENDS. $495.44 1B. QUALIFIED
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