Form 99-T PUBLIC DISCLOSURE COPY Exempt Organization Business Income Tax Return (and proxy tax under section 633(e)) OMB No. 1545-687 215 For calendar year 215 or other tax year beginning 7/1, 215, and ending 6/3, 2 16. Department of the Treasury Information about Form 99-T and its instructions is available at www.irs.gov/form99t. Open to Public Inspection for Internal Revenue Service Do not enter SSN numbers on this form as it may be made public if your organization is a 51(c)(3). 51(c)(3) Organizations Only Check box if Name of organization ( Check box if name changed and see instructions.) A address changed D Employer identification number (Employees trust, see instructions.) B Exempt under section UNIVERSITY OF THE PACIFIC Print 51( C ) ( 3 ) Number, street, and room or suite no. If a P.O. box, see instructions. 94-1156266 or 48(e) 22(e) Type 361 PACIFIC AVENUE E Unrelated business activity codes (See instructions.) 48A 53(a) City or town, state or province, country, and ZIP or foreign postal code 529(a) STOCKTON, CA 95211 5418 532 C Book value of all assets F Group exemption number (See instructions.) at end of year 986,383,62 G Check organization type 51(c) corporation 51(c) trust 41(a) trust Other trust H Describe the organization s primary unrelated business activity. ADVERTISING & RENTALS I During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group?.. Yes No If Yes, enter the name and identifying number of the parent corporation. J The books are in care of KENNETH M. MULLEN Telephone number (29) 946-7372 Part I Unrelated Trade or Business Income (A) Income (B) Expenses (C) Net 1a Gross receipts or sales 78,439 b Less returns and allowances c Balance 1c 78,439 2 Cost of goods sold (Schedule A, line 7)....... 2 18,83 3 Gross profit. Subtract line 2 from line 1c....... 3 59,636 59,636 4a Capital gain net income (attach Schedule D)..... 4a 1,64 1,64 b Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797) 4b c Capital loss deduction for trusts......... 4c 5 Income (loss) from partnerships and S corporations (attach statement) 5 (192,236) (192,236) 6 Rent income (Schedule C)........... 6 227,696 116,673 111,23 7 Unrelated debt-financed income (Schedule E)..... 7 8 Interest, annuities, royalties, and rents from controlled organizations (Schedule F) 8 9 Investment income of a section 51(c)(7), (9), or (17) organization (Schedule G) 9 1 Exploited exempt activity income (Schedule I)..... 1 11 Advertising income (Schedule J)......... 11 387,28 155,492 231,788 12 Other income (See instructions; attach schedule)..... 12 91,335 91,335 13 Total. Combine lines 3 through 12........ 13 575,351 272,165 33,186 Part II Deductions Not Taken Elsewhere (See instructions for limitations on deductions.) (Except for contributions, deductions must be directly connected with the unrelated business income.) 14 Compensation of officers, directors, and trustees (Schedule K)............ 14 15 Salaries and wages.......................... 15 16 Repairs and maintenance........................ 16 17 Bad debts............................. 17 18 Interest (attach schedule)........................ 18 19 Taxes and licenses........................... 19 2 Charitable contributions (See instructions for limitation rules)............. 2 21 Depreciation (attach Form 4562)............. 21 22 Less depreciation claimed on Schedule A and elsewhere on return.. 22a 22b 23 Depletion.............................. 23 24 Contributions to deferred compensation plans................. 24 25 Employee benefit programs........................ 25 26 Excess exempt expenses (Schedule I).................... 26 27 Excess readership costs (Schedule J).................... 27 28 Other deductions (attach schedule)..................... 28 154,433 29 Total deductions. Add lines 14 through 28.................. 29 154,433 3 Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13 3 148,753 31 Net operating loss deduction (limited to the amount on line 3)............ 31 148,753 32 Unrelated business taxable income before specific deduction. Subtract line 31 from line 3... 32 33 Specific deduction (Generally $1,, but see line 33 instructions for exceptions)...... 33 34 Unrelated business taxable income. Subtract line 33 from line 32. If line 33 is greater than line 32, enter the smaller of zero or line 32...................... 34 For Paperwork Reduction Act Notice, see instructions. Cat. No. 11291J Form 99-T (215)
Form 8868 Application for Extension of Time To File an (Rev. January 214) Exempt Organization Return I OMB No. 1545-179 Department of the Treasury File a separate application for each return. Internal Revenue Service Information about Form 8868 and its instructions is at www.irs.gov/form8868. % I m m m m m m m m m m m m m m m m m If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II (on page 2 of this form). Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 8868. Electronic filing (e-file). You can electronically file Form 8868 if you need a 3-month automatic extension of time to file (6 months for a corporation required to file Form 99-T), or an additional (not automatic) 3-month extension of time. You can electronically file Form 8868 to request an extension of time to file any of the forms listed in Part I or Part II with the exception of Form 887, Information Return for Transfers Associated With Certain Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form, visit www.irs.gov/efile and click on e-file for Charities & Nonprofits. Part I Automatic 3-Month Extension of Time. Only submit original (no copies needed). A corporation required to file Form 99-T and requesting an automatic 6-month extension - check this box and complete Part I only m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m I X All other corporations (including 112-C filers), partnerships, REMICs, and trusts must use Form 74 to request an extension of time to file income tax returns. Enter filer's identifying number, see instructions Type or print File by the due date for filing your return. See instructions. Name of exempt organization or other filer, see instructions. Number, street, and room or suite no. If a P.O. box, see instructions. City, town or post office, state, and ZIP code. For a foreign address, see instructions. Enter the Return code for the return that this application is for (file a separate application for each return) Application Is For Form 99 or Form 99-EZ Form 99-BL Form 472 (individual) Form 99-PF Form 99-T (sec. 41(a) or 48(a) trust) Form 99-T (trust other than above) % The books are in the care of I Telephone No. I Return Code 1 2 3 4 5 6 Application Is For Form 99-T (corporation) Form 141-A Form 472 (other than individual) Form 5227 Form 669 Form 887 Employer identification number (EIN) or Social security number (SSN) m m m m m m m m m m m m I m m m m m m m m m m m m m m m m m m m m m I m m m m m m m I I Return Code 29 946-7372 FAX No. If the organization does not have an office or place of business in the United States, check this box I % If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN). If this is for the whole group, check this box. If it is for part of the group, check this box and attach a list with the names and EINs of all members the extension is for. 1 I request an automatic 3-month (6 months for a corporation required to file Form 99-T) extension of time until 5/15, 2 17, to file the exempt organization return for the organization named above. The extension is I for the organization's return for: calendar year 2 or X tax year beginning 7/1, 2 15, and ending 6/3, 2 16. 2 If the tax year entered in line 1 is for less than 12 months, check reason: Initial return Final return Change in accounting period 3a If this application is for Form 99-BL, 99-PF, 99-T, 472, or 669, enter the tentative tax, less any nonrefundable credits. See instructions. 3a $. b If this application is for Form 99-PF, 99-T, 472, or 669, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit. 3b $. c Balance due. Subtract line 3b from line 3a. Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. 3c $. Caution. If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions. For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8868 (Rev. 1-214) JSA 5F854 1. UNIVERSITY OF THE PACIFIC 94-1156266 361 PACIFIC AVENUE STOCKTON, CA 95211 KENNETH M MULLEN 361 PACIFIC AVENUE STOCKTON, CA 95211 7494IV 22 6837466 7 7 8 9 1 11 12
Form 99-T (215) Page 3 Schedule C Rent Income (From Real Property and Personal Property Leased With Real Property) (see instructions) 1. Description of property (1) RENTAL OF MORRIS CHAPEL FOR WEDDINGS (INCLUDING WEDDING ASSISTANT) (2) ATHLETIC STADIUM, CONSERVATORY OF MUSIC FACILITIES, POOL RENTAL (3) ATHLETIC PARKING (1) (2) (3) (a) From personal property (if the percentage of rent for personal property is more than 1% but not more than 5%) Total 2. Rent received or accrued (b) From real and personal property (if the percentage of rent for personal property exceeds 5% or if the rent is based on profit or income) Total 227,696 (c) Total income. Add totals of columns 2(a) and 2(b). Enter here and on page 1, Part I, line 6, column (A)... Schedule E Unrelated Debt-Financed Income (see instructions) (1) (2) (3) 1. Description of debt-financed property 4. Amount of average acquisition debt on or allocable to debt-financed property (attach schedule) 5. Average adjusted basis of or allocable to debt-financed property (attach schedule) 2. Gross income from or allocable to debt-financed property 6. Column 4 divided by column 5 (1) % (2) % (3) % % 3(a) Deductions directly connected with the income in columns 2(a) and 2(b) (attach schedule) (b) Total deductions. Enter here and on page 1, Part I, line 6, column (B) 3. Deductions directly connected with or allocable to debt-financed property (a) Straight line depreciation (attach schedule) 7. Gross income reportable (column 2 column 6) Enter here and on page 1, Part I, line 7, column (A). (b) Other deductions (attach schedule) 8. Allocable deductions (column 6 total of columns 3(a) and 3(b)) Enter here and on page 1, Part I, line 7, column (B). Totals......................... Total dividends-received deductions included in column 8................. Schedule F Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions) Exempt Controlled Organizations 1. Name of controlled organization (1) (2) (3) Nonexempt Controlled Organizations 2. Employer identification number 3. Net unrelated income (loss) (see instructions) 117,88 64,76 45,812 227,696 4. Total of specified payments made 5. Part of column 4 that is included in the controlling organization s gross income 65,336 42,175 9,162 116,673 6. Deductions directly connected with income in column 5 7. Taxable Income 8. Net unrelated income (loss) (see instructions) 9. Total of specified payments made 1. Part of column 9 that is included in the controlling organization s gross income 11. Deductions directly connected with income in column 1 (1) (2) (3) Add columns 5 and 1. Enter here and on page 1, Part I, line 8, column (A). Add columns 6 and 11. Enter here and on page 1, Part I, line 8, column (B). Totals.......................... Form 99-T (215)
Form 99-T (215) Page 4 Schedule G Investment Income of a Section 51(c)(7), (9), or (17) Organization (see instructions) (1) (2) (3) 1. Description of income 2. Amount of income Enter here and on page 1, Part I, line 9, column (A). 3. Deductions directly connected (attach schedule) 4. Set-asides (attach schedule) 5. Total deductions and set-asides (col. 3 plus col. 4) Enter here and on page 1, Part I, line 9, column (B). Totals........ Schedule I Exploited Exempt Activity Income, Other Than Advertising Income (see instructions) (1) (2) (3) 1. Description of exploited activity 2. Gross unrelated business income from trade or business Enter here and on page 1, Part I, line 1, col. (A). 3. Expenses directly connected with production of unrelated business income Enter here and on page 1, Part I, line 1, col. (B). 4. Net income (loss) from unrelated trade or business (column 2 minus column 3). If a gain, compute cols. 5 through 7. 5. Gross income from activity that is not unrelated business income 6. Expenses attributable to column 5 7. Excess exempt expenses (column 6 minus column 5, but not more than column 4). Enter here and on page 1, Part II, line 26. Totals......... Schedule J Advertising Income (see instructions) Part I Income From Periodicals Reported on a Consolidated Basis (1) (2) (3) 1. Name of periodical 2. Gross advertising income 3. Direct advertising costs 4. Advertising gain or (loss) (col. 2 minus col. 3). If a gain, compute cols. 5 through 7. 5. Circulation income 6. Readership costs 7. Excess readership costs (column 6 minus column 5, but not more than column 4). Totals (carry to Part II, line (5)).. Part II Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns 2 through 7 on a line-by-line basis.) 1. Name of periodical 2. Gross advertising income 3. Direct advertising costs 4. Advertising gain or (loss) (col. 2 minus col. 3). If a gain, compute cols. 5 through 7. 5. Circulation income 6. Readership costs 7. Excess readership costs (column 6 minus column 5, but not more than column 4). (1) (2) (3) ATHLETIC MEDIA DENTISTRY PUBLICATIONS 373,35 13,975 152,697 2,795 22,68 11,18 Totals from Part I...... Enter here and on page 1, Part I, line 11, col. (A). Enter here and on page 1, Part I, line 11, col. (B). Enter here and on page 1, Part II, line 27. Totals, Part II (lines 1-5).... 387,28 155,492 Schedule K Compensation of Officers, Directors, and Trustees (see instructions) 1. Name 2. Title 3. Percent of 4. Compensation attributable to time devoted to business unrelated business (1) % (2) % (3) % % Total. Enter here and on page 1, Part II, line 14................... Form 99-T (215)
Form 99T Part I, Line 5 Income (loss) from partnerships and S corporations Name of Partnership EIN Amount Activity 1 (1) AG Realty Fund VIII, LP 27-2996434 789 (2) Industry Ventures Partnership Holdings III, LP 46-398818 -81 (3) Kayne Anderson Energy Fund IV (QP), LP 2-5659373 -65,95 Montauk Triguard Fund IV, LP 26-1969234 -27,789 (5) Montauk Triguard Fund V LP 9-66126 -83,1 (6) Montauk Triguard Fund III-A LP 2-2967745 -17,856 (7) Northgate Venture Patners II, LP 76-742261 -618 (8) New Mountain Partners IV, LP 46-122173 -1,771 (9) Silver Lake Partners IV DE (AIV), L.P. 38-394485 2,493 (1) Sigular Guff Bric Opportunities Fund II, LP 26-1412879 2,38 (11) Silver Lake Partners IV DE (AIV II), LP 47-4589432 -733 Total for Part I, Line 5-192,236
Form 99T Part I, Line 12 Other Income Description Amount Activity 1 (1) Clinical Services provided by School of Dentistry to external parties 64,234 (2) Commissions related to Alumni sales transactions with affiliated 3rd party vendors 27,11 Total 91,335 Total for Part I, Line 12 91,335
215 Form 99 T, Part II, Line 2 Charitable Contribution Carryover University of the Pacific EIN: 94 1156266 CA Corp. No.: 24688 Form 99 T Year Ended: June 3, 216 Tax Year Total Charitable Contributions UBTI for reporting year Utilized in Prior Yr. Year Utilized Amount Utilized on Current Return Converted to NOL* Amount Remaining 213 (FYE 6/3/214) 125,228 (81,551) N/A 125,228 214 (FYE 6/3/215) 155,495 559,68 N/A 55,968 99,527 215 (FYE 6/3/216) 166,53 148,753 N/A 14,875 151,178 Total 446,776 375,933 *AMOUNTS IN THIS COLUMN REPRESENT CHARITABLE CONTRIBUTIONS CARRYOVERS COVERTED TO NOLS PURSUANT TO REGULATION SECTION 1.17a 11(c)(2).
Form 99T Part II, Line 28 Other Deductions Description Amount Activity 1 (1) Athletic Sales & School of Dentistry College Store-Operating Expenses 28,783 (2) Athletic Sales & School of Dentistry College Store-General & Adm. Expenses 13,267 (3) Clinical Services provided by the School of Dentistry-General & Adm. Expenses 12,847 Clinical Services provided by the School of Dentistry-Operating Expenses 64,938 (5) Commissions on Alumni related 3rd party sales-operating Expenses 6,862 (6) Commissions on Alumni related 3rd party sales-general & Adm. Expenses 5,42 (7) 99-T Tax Preparation Fees 22,316 Total 154,433 Total for Part II, Line 28 154,433
215 Form 99 T Net Operating Loss Carryforward for Part II, Line 31 University of the Pacific EIN: 94 1156266 Year Ended: June 3, 216 Loss Year Amount Generated Amount Used in Prior Years Amount Used in Current Year Amount Carryforward Final Year Availabe for Use 22 (FYE 6/3/23) 247,835 185,866 61,969 222 24 (FYE 6/3/25) 3,638 3,638 224 25 (FYE 6/3/26) 81,361 56,146 25,215 225 26 (FYE 6/3/27) 74,297 74,297 226 27 (FYE 6/3/28) 2,552 2,552 227 28 (FYE 6/3/29) 17,364 17,364 228 29 (FYE 6/3/21) 1,71 1,71 229 21 (FYE 6/3/211) 38,744 38,744 23 212 (FYE 6/3/213) 149,747 149,747 232 213 (FYE 6/3/214) 81,551 81,551 233 214 (FYE 6/3/215) * 55,968 55,968 234 215 (FYE 6/3/216) * 14,875 14,875 235 Total 823,633 185,866 148,753 489,14 *AMOUNT REPRESENTS CHARITABLE CONTRIBUTION CARRYOVERS CONVERTED TO NOLS PURSUANT TO REGULATION SECTION 1.17A 11(c)(2).
Schedule C, Line 3(a) Deductions directly connected with the income in columns 2(a) and 2(b) Activity 1 1 Rental of Morris Chapel for weddings (including wedding assistant) 2 Athletic Stadium, Conservatory of Music Facilities, Pool Rental Description Salaries & Benefits 24,538 Operating Expenses 17,236 General & Administrative 23,562 Description Total 65,336 Salaries & Benefits 17,151 Operating Expenses 12,29 General & Administrative 12,815 Total 42,175 Amount Amount 3 Athletic Parking Description Amount Total for Schedule C, Line 3(a), Deductions directly connected with the income in columns 2(a) and 2(b) 116,673 General & Administrative 9,162
SCHEDULE D (Form 112) Department of the Treasury Internal Revenue Service Capital Gains and Losses OMB No. 1545-123 216 Attach to Form 112, 112-C, 112-F, 112-FSC, 112-H, 112-IC-DISC, 112-L, 112-ND, 112-PC, 112-POL, 112-REIT, 112-RIC, 112-SF, or certain Forms 99-T. Information about Schedule D (Form 112) and its separate instructions is at www.irs.gov/form112. Employer identification number Name University of the Pacific 94-1156266 Part I Short-Term Capital Gains and Losses Assets Held One Year or Less See instructions for how to figure the amounts to enter on the lines below. This form may be easier to complete if you round off cents to whole dollars. 1a Totals for all short-term transactions reported on Form 199-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 1b...... 1b Totals for all transactions reported on Form(s) 8949 with Box A checked.......... 2 Totals for all transactions reported on Form(s) 8949 with Box B checked.......... 3 Totals for all transactions reported on Form(s) 8949 with Box C checked.......... (d) Proceeds (sales price) (e) Cost (or other basis) (g) Adjustments to gain or loss from Form(s) 8949, Part I, line 2, column (g) 4 Short-term capital gain from installment sales from Form 6252, line 26 or 37.......... 4 (h) Gain or (loss) Subtract column (e) from column (d) and combine the result with column (g) 5 Short-term capital gain or (loss) from like-kind exchanges from Form 8824.......... 5 6 Unused capital loss carryover (attach computation)................. 6 ( ) 7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column h.......... 7 Part II Long-Term Capital Gains and Losses Assets Held More Than One Year See instructions for how to figure the amounts to enter on the lines below. This form may be easier to complete if you round off cents to whole dollars. 8a Totals for all long-term transactions reported on Form 199-B for which basis was reported to the IRS and for which you have no adjustments (see instructions). However, if you choose to report all these transactions on Form 8949, leave this line blank and go to line 8b...... 8b Totals for all transactions reported on Form(s) 8949 with Box D checked........... 9 Totals for all transactions reported on Form(s) 8949 with Box E checked.......... 1 Totals for all transactions reported on Form(s) 8949 with Box F checked.......... (d) Proceeds (sales price) (e) Cost (or other basis) (g) Adjustments to gain or loss from Form(s) 8949, Part II, line 2, column (g) 11 Enter gain from Form 4797, line 7 or 9...................... 11 (h) Gain or (loss) Subtract column (e) from column (d) and combine the result with column (g) 1,64 1,64 12 Long-term capital gain from installment sales from Form 6252, line 26 or 37.......... 12 13 Long-term capital gain or (loss) from like-kind exchanges from Form 8824.......... 13 14 Capital gain distributions (see instructions).................... 14 15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column h......... 15 Part III Summary of Parts I and II 1,64 16 Enter excess of net short-term capital gain (line 7) over net long-term capital loss (line 15)..... 16 17 Net capital gain. Enter excess of net long-term capital gain (line 15) over net short-term capital loss (line 7) 17 1,64 18 Add lines 16 and 17. Enter here and on Form 112, page 1, line 8, or the proper line on other returns. If the corporation has qualified timber gain, also complete Part IV.............. 18 1,64 Note: If losses exceed gains, see Capital losses in the instructions. For Paperwork Reduction Act Notice, see the Instructions for Form 112. Cat. No. 1146M Schedule D (Form 112) 216
Schedule D (Form 112) 216 Page 2 Part IV Alternative Tax for Corporations with Qualified Timber Gain. Complete Part IV only if the corporation has qualified timber gain under section 121(b). Skip this part if you are filing Form 112-RIC. See instructions. 19 Enter qualified timber gain (as defined in section 121(b)(2))..... 19 2 Enter taxable income from Form 112, page 1, line 3, or the applicable line of your tax return.................. 2 21 Enter the smallest of: (a) the amount on line 19; (b) the amount on line 2; or (c) the amount on Part III, line 17............. 21 22 Multiply line 21 by 23.8% (.238)....................... 22 23 Subtract line 17 from line 2. If zero or less, enter --....... 23 24 Enter the tax on line 23, figured using the Tax Rate Schedule (or applicable tax rate) appropriate for the return with which Schedule D (Form 112) is being filed.............. 24 25 Add lines 21 and 23................. 25 26 Subtract line 25 from line 2. If zero or less, enter --....... 26 27 Multiply line 26 by 35% (.35)........................ 27 28 Add lines 22, 24, and 27.......................... 28 29 Enter the tax on line 2, figured using the Tax Rate Schedule (or applicable tax rate) appropriate for the return with which Schedule D (Form 112) is being filed................ 29 3 Enter the smaller of line 28 or line 29. Also enter this amount on Form 112, Schedule J, line 2, or the applicable line of your tax return....................... 3 Schedule D (Form 112) 216
Form 8949 Sales and Other Dispositions of Capital Assets Information about Form 8949 and its separate instructions is at www.irs.gov/form8949. Department of the Treasury Internal Revenue Service File with your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 1 of Schedule D. Name(s) shown on return University of the Pacific 94-1156266 OMB No. 1545-74 216 Attachment Sequence No. 12A Social security number or taxpayer identification number Before you check Box A, B, or C below, see whether you received any Form(s) 199-B or substitute statement(s) from your broker. A substitute statement will have the same information as Form 199-B. Either will show whether your basis (usually your cost) was reported to the IRS by your broker and may even tell you which box to check. Part I Short-Term. Transactions involving capital assets you held 1 year or less are short term. For long-term transactions, see page 2. Note: You may aggregate all short-term transactions reported on Form(s) 199-B showing basis was reported to the IRS and for which no adjustments or codes are required. Enter the totals directly on Schedule D, line 1a; you aren't required to report these transactions on Form 8949 (see instructions). You must check Box A, B, or C below. Check only one box. If more than one box applies for your short-term transactions, complete a separate Form 8949, page 1, for each applicable box. If you have more short-term transactions than will fit on this page for one or more of the boxes, complete as many forms with the same box checked as you need. (A) Short-term transactions reported on Form(s) 199-B showing basis was reported to the IRS (see Note above) (B) Short-term transactions reported on Form(s) 199-B showing basis wasn't reported to the IRS (C) Short-term transactions not reported to you on Form 199-B 1 (a) Description of property (Example: 1 sh. XYZ Co.) (b) Date acquired (Mo., day, yr.) (c) Date sold or disposed of (Mo., day, yr.) (d) Proceeds (sales price) (see instructions) (e) Cost or other basis. See the Note below and see Column (e) in the separate instructions Adjustment, if any, to gain or loss. If you enter an amount in column (g), enter a code in column (f). See the separate instructions. (f) Code(s) from instructions (g) Amount of adjustment (h) Gain or (loss). Subtract column (e) from column (d) and combine the result with column (g) 2 Totals. Add the amounts in columns (d), (e), (g), and (h) (subtract negative amounts). Enter each total here and include on your Schedule D, line 1b (if Box A above is checked), line 2 (if Box B above is checked), or line 3 (if Box C above is checked) Note: If you checked Box A above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment. For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37768Z Form 8949 (216)
Form 8949 (216) Attachment Sequence No. 12A Page 2 Name(s) shown on return. Name and SSN or taxpayer identification no. not required if shown on other side Social security number or taxpayer identification number University of the Pacific 94-1156266 Before you check Box D, E, or F below, see whether you received any Form(s) 199-B or substitute statement(s) from your broker. A substitute statement will have the same information as Form 199-B. Either will show whether your basis (usually your cost) was reported to the IRS by your broker and may even tell you which box to check. Part II Long-Term. Transactions involving capital assets you held more than 1 year are long term. For short-term transactions, see page 1. Note: You may aggregate all long-term transactions reported on Form(s) 199-B showing basis was reported to the IRS and for which no adjustments or codes are required. Enter the totals directly on Schedule D, line 8a; you aren't required to report these transactions on Form 8949 (see instructions). You must check Box D, E, or F below. Check only one box. If more than one box applies for your long-term transactions, complete a separate Form 8949, page 2, for each applicable box. If you have more long-term transactions than will fit on this page for one or more of the boxes, complete as many forms with the same box checked as you need. (D) Long-term transactions reported on Form(s) 199-B showing basis was reported to the IRS (see Note above) (E) Long-term transactions reported on Form(s) 199-B showing basis wasn't reported to the IRS (F) Long-term transactions not reported to you on Form 199-B 1 (a) Description of property (Example: 1 sh. XYZ Co.) (b) Date acquired (Mo., day, yr.) (c) Date sold or disposed of (Mo., day, yr.) (d) Proceeds (sales price) (see instructions) (e) Cost or other basis. See the Note below and see Column (e) in the separate instructions Adjustment, if any, to gain or loss. If you enter an amount in column (g), enter a code in column (f). See the separate instructions. (f) Code(s) from instructions (g) Amount of adjustment (h) Gain or (loss). Subtract column (e) from column (d) and combine the result with column (g) Long-Term Gains Partnerships Various Various 1,64 1,64 2 Totals. Add the amounts in columns (d), (e), (g), and (h) (subtract negative amounts). Enter each total here and include on your Schedule D, line 8b (if Box D above is checked), line 9 (if Box E above is checked), or line 1 (if Box F above is checked) 1.64 1,64 Note: If you checked Box D above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment. Form 8949 (216)
University of the Pacific Section 1.263(a)-1(f) de minimis safe harbor election EIN: 94-1156266 Tax Year Ending June 3, 216 Section 1.263(a)-1(f) de minimis safe harbor election statement Taxpayer Name: University of the Pacific ( Taxpayer ) Taxpayer Address: 361 Pacific Avenue, Stockton, CA 95211 EIN: 94-1156266 The above-referenced Taxpayer is making the de minimis safe harbor election under Section 1.263(a)-1(f) for its tax year ending June 3, 216. Attachment 1