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Click here or scroll down to respond to this candidateBox 5. Generally, this shows the employees investment in the contract (after-taxcontributions), if any, recovered tax free this year; the portion thats your basis in a designated Roth account; the part of premiums paid on commercial annuities or insurance contracts recovered tax free; the nontaxable part of a charitable gift annuity; or the investment in a life insurance contract reportable under section Street Address Y. This box doesnt show any IRA contributions. If the amount shown is your basis in a designated Roth account, the year you first made contributions to that account may be entered in box 11.Candidate's Name
Generally,distributionsfromretirementplans(IRAs, qualified plans,section Street Address (b) plans, and governmentalsection457(b) plans), insurance contracts, etc., are reported to recipients on Form 1099-R.Qualified plans and section Street Address (b) plans. If your annuity starting date is after 1997, you must use the simplifiedmethodtofigureyourtaxableamountifyour payer didnt show the taxable amount in box 2a. See the instructions for your tax return. Box 6. If you received a lump-sumdistributionfromaqualifiedplanthat includes securities of the employerscompany,the net unrealized appreciation (NUA) (any increase in value of such securities while in the trust) is taxed only when you sell the securities unless you choose to include it in your gross income this year. See Pub. 575 and Form 4972. If you roll over the distributiontoa designated Roth account in the same plan or to a Roth IRA, see the instructions for box 2a. For a direct rollover to a designated Roth account in the same plan or to a Roth IRA, the NUA is included in box 2a. If you didnt receive a lump-sumdistribution,the amount shown is the NUA attributable to employee contributions,which isnt taxed until you sell the securities. IRAs. For distributionsfroma traditional individualretirementarrangement(IRA), simplifiedemployeepension(SEP), or savings incentive match plan for employees(SIMPLE), generally the payer isnt required to compute the taxable amount. See the instructions for your tax return to determine the taxable amount. If youre at least age Street Address , you must take minimumdistributionsfromyourIRA (other than a Roth IRA). If you dont, youre subject to a 50% excise tax on the amount that shouldvebeendistributed.See Pub. 590-A and Pub. 590-B for more information on IRAs.Roth IRAs. For distributionsfroma Roth IRA, generally the payer isnt required to compute the taxable amount. You must compute any taxable amount on Form 8606. An amount shown in box 2a may be taxable earnings on an excess contribution.Box 7. The following codes identify the distributionyoureceived.For more information on these distributions,see the instructions for your tax return. Also, certain distributions may be subject to an additional 10% tax. See the Instructions for Form 5329. 1-Early distribution,no known exception (in most cases, under age 591/2). 2-Early distribution, exception applies (under age 591/2). 3-Disability. 4-Death. 5-Prohibited transaction. 6-Section 1035 exchange (a tax-free exchange of life insurance, annuity, qualified long-termcare insurance, or endowment contracts). 7-Normal distribution.8-Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2022. 9-Cost of current life insurance protection. A-May be eligible for 10-year tax option (see Form 4972). B-Designated Roth account distribution.Note: If Code B is in box 7 and an amount is reported in box 11, see the Instructions for Form 5329. C-Reportable death benefits under section 6050Y. D-Annuity payments from nonqualifiedannuitiesthat may be subject to tax under section 1411. E-DistributionsunderEmployeePlans Compliance ResolutionSystem(EPCRS). F-Charitable gift annuity. G-Direct rolloverofa distributiontoa qualified plan, a section 403(b) plan, a governmental section 457(b) plan, or an IRA. H-Direct rolloverofadesignatedRothaccount distributiontoa Roth IRA. J-Early distributionfroma Roth IRA, no known exception (in most cases, under age 591/2). K-DistributionoftraditionalIRAassetsnothavingareadilyavailableFMV. L-Loans treated as distributions.M-Qualified plan loan offset. N-Recharacterized IRA contributionmadefor2022 and recharacterized in 2022. P-Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2021. Q-Qualified distribution from a Roth IRA. R-Recharacterized IRA contributionmadefor2021 and recharacte- rized in 2022. S-Early distribution from a SIMPLE IRA in first 2 years, no known exception (under age 591/2). T-Roth IRA distribution,exception applies. U-Dividend distribution from ESOP under section 404(k). Note: This distribution isnt eligible for rollover. W-Charges or payments for purchasing qualified long-termcare insurance contracts under combined arrangements.Loans treated as distributions. If you borrow money from a qualified plan, section 403(b) plan, or governmentalsection457(b) plan, you may have to treat the loan as a distributionandincludeallorpartof the amount borrowed in your income. There are exceptions to this rule. If your loan is taxable, code L will be shown in box 7. See Pub. 575.Recipients taxpayer identification number (TIN). For your protection, this form may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). However, the payer has reported your complete TIN to the IRS. Account number. May show an account, policy, or other unique number the payer assigned to distinguishyouraccount.Box 1. Shows the total amount distributed this year. The amount may have been a direct rollover,a transfer or conversion to a Roth IRA, a recharacterized IRA contribution; or you may have received it as periodic payments, nonperiodic payments, or a total distribution.Report the amount on Form 1040, 1040-SR, or 1040-NR on the line for "IRA distributions"or "Pensions and annuities" (or the line for "Taxable amount") and on Form 8606, as applicable. However, if this is a lump-sumdistribution,see Form 4972. If you havent reached minimum retirement age, report your disabilitypaymentsonthelinefor"Wages, salaries, tips, etc." on your tax return. Also report on that line permissiblewithdrawals from eligible automatic contribution arrangements and corrective distributionsof excess deferrals, excess contributions, or excess aggregate contributions except if the distributionisof designated Roth contributions or your after-tax contributions or if youre self-employed.If a life insurance, annuity, qualified long-termcare,or endowment contract was transferred tax free to another trustee or contract issuer, an amount will be shown in this box and code 6 will be shown in box 7. If a charge or payment was made against the cash value of an annuity contract or the cash surrender value of a life insurance contract for the purchase of qualified long-termcare insurance, an amount will be shown in this box and code W will be shown in box 7. You need not report these amounts on your tax return. If code C is shown in box 7, the amount shown in box 1 is a receipt of reportable death benefits that is taxable in part.If the IRA/SEP/SIMPLE box is checked, youve received a traditional IRA, SEP, or SIMPLE distribution.Box 8. If you received an annuity contract as part of a distribution,the value of the contract is shown. It isnt taxable when you receive it and shouldnt be included in boxes 1 and 2a. When you receive periodic payments from the annuity contract, theyre taxable at that time. If the distributionismadetomorethanoneperson,the percentage of the annuity contract distributed to you is also shown. Youll need this information if you use the 10-year tax option (Form 4972). If charges were made for qualified long- term care insurance contracts under combined arrangements, the amount of the reduction in the investment (but not below zero) in the annuity or life insurance contract is reported here.Box 2a. This part of the distributionisgenerallytaxable.If there is no entry in this box, the payer may not have all the facts needed to figure the taxable amount. In that case, the first box in box 2b should be checked. You may want to get one of the free publications from the IRS to help you figure the taxable amount. See Additional information on the back of Copy 2. For an IRA distribution,see IRAs and Roth IRAs, earlier. For a direct rollover,other than from a qualified plan, section 403(b) plan, or governmentalsection457(b) plan to a designated Roth account in the same plan or to a Roth IRA, zero should be shown and you must enter zero (-0-) on the "Taxable amount" line of your tax return. If you roll over a distribution(other than a distributionfroma designated Roth account) from a qualified plan, section 403(b) plan, or governmentalsection457(b) plan to a designated Roth account in the same plan or to a Roth IRA, you must include on the "Taxable amount" line of your tax return the amount shown in this box plus the amount in box 6, if any.Box 9a. If a total distributionwasmadetomorethanoneperson,the percentage you received is shown.Box 9b. For a life annuity from a qualified plan or from a section 403(b) plan (with after-tax contributions), an amount may be shown for the employees total investment in the contract. It is used to compute the taxable part of the distribution.See Pub. 575. Box 10. If an amount is reported in this box, see the Instructions for Form 5329 and Pub. 575.Box 11. The first year you made a contribution to the designated Roth account reported on this form is shown in this box.Box 12. If checked, the payer is reporting on this Form 1099 to satisfy its Internal Revenue Code chapter 4 account reporting requirement under FATCA. You may also If this is a total distributionfroma qualified plan and you were born before have a filing requirement. See the Instructions for Form 8938. January 2, 1936 (or youre the beneficiary of someone born before January 2, 1936), you may be eligible for the 10-year tax option. See the Form 4972 instructions for more information.Box 13. Shows the date of payment for reportable death benefits under section 6050Y. Boxes 14-19. If state or local income tax was withheld from the distribution,boxes 16 and 19 may show the part of the distributionsubject to state and/or local tax. If youre an eligible retired public safety officer who elected to exclude from income distributionsfromyoureligibleplanusedto pay certain insurance premiums, the amount shown in box 2a hasnt been reduced by the exclusion amount. See the instructions for your tax return for more information. Additional information. You may want to see:Form W-4P, Form 4972, Form 5329, Form 8606Pub. 525, Taxable and Nontaxable IncomePub. 560, Retirement Plans for Small BusinessPub. 571, Tax-ShelteredAnnuityPlansPub. 575, Pension and Annuity IncomePub. 590-A, Contributionsto IRAsPub. 590-B, DistributionsfromIRAsPub. 721, U.S. Civil Service Retirement BenefitsPub. 939, General Rule for Pensions and AnnuitiesPub. 969, HSAs and Other Tax-FavoredHealthPlansBox 2b. If the first box is checked, the payer was unable to determine the taxable amount and box 2a should be blank, except for an IRA. Its your responsibilityto determine the taxable amount. If the second box is checked, the distributionwas a total distributionthat closed out your account.Box 3. If you received a lump-sumdistributionfromaqualifiedplanandwere born before January 2, 1936 (or youre the beneficiary of someone born before January 2, 1936), you may be able to elect to treat this amount as a capital gain on Form 4972 (not on Schedule D (Form 1040)). See the Form 4972 instructions. For a charitable gift annuity, report as a long-termcapitalgainasexplainedinthe Instructions for Form 8949.Box 4. Shows federal income tax withheld. Include this amount on your income tax return as tax withheld, and if box 4 shows an amount (other than zero), attach Copy B to your return. Generally, if you receive payments that arent eligible rolloverdistributions,you can change your withholdingorelect not to have income tax withheld by giving the payer Form W-4P. 2H8044 3.00002/06/2023YOU MAY BE ABLE TO VIEW YOUR TAXINFORMATION ONLINE. GO TOWWW.RETIREMENT.PRUDENTIAL.COM/.THIS FORM CAN NOW BE IMPORTED INTO YOUR TAX RETURN IF YOU USE SOFTWARE TO FILE YOUR TAX RETURN.PRUDENTIAL TAX SERVICES LLCEMPOWER30 SCRANTON OFFICE PARKSCRANTON, PA 18507-1796NATHAN EVANS1375 SAYLOR CTZIONSVILLE, IN 46077-1270(Page 1 of 2)CORRECTED (if checked)Distributions FromPensions, Annuities,Retirement orProfit-SharingPlans, IRAs,InsuranceContracts, etc.PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.1 Gross distribution OMB No. 1545-0119$2a Taxable amount
$ Form 1099-RTaxable amount Copy Bnot determined2bReport thisincome on yourfederal taxreturn. If thisform showsfederal incometax withheld inbox 4, attachthis copy toyour return.TotaldistributionPAYERS TIN RECIPIENTS TIN 3 Capital gain (included in box 2a) 4 Federal income tax withheld$ $RECIPIENTS name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code Employee contributions/Designated Rothcontributions or insurance premiums5 Net unrealized appreciation inemployers securities6$ $IRA/SEP/SIMPLE7 Distribution code(s) 8 OtherThis information isbeing furnished tothe IRS.$ %Your percentage of totaldistribution9a 9b Total employee contributions% $10 Amount allocable to IRRwithin 5 years11 1st year of 12 FATCA 14 State tax withheld 15 State/Payers state no. 16 State distribution desig. Roth contrib. filing requirement$ $ $Account number (see instructions) 13 Date of 17 Local tax withheld 18 Name of locality 19 Local distribution Payment$ $Form 1099-R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service CORRECTED (if checked)Distributions FromPensions, Annuities,Retirement orProfit-SharingPlans, IRAs,InsuranceContracts, etc.PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.1 Gross distribution OMB No. 1545-0119$2a Taxable amount
$ Form 1099-RTaxable amountnot determined2bTotaldistributionCopy CFor RecipientsRecordsPAYERS TIN RECIPIENTS TIN 3 Capital gain (included in box 2a) 4 Federal income tax withheld$ $RECIPIENTS name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code Employee contributions/Designated Rothcontributions or insurance premiumsNet unrealized appreciation inemployers securities5 6$ $IRA/SEP/SIMPLE7 Distribution code(s) 8 OtherThis information isbeing furnished tothe IRS.$ %Your percentage of totaldistribution9a 9b Total employee contributions% $10 Amount allocable to IRRwithin 5 years11 1st year of 12 FATCA 14 State tax withheld 15 State/Payers state no. 16 State distribution desig. Roth contrib. filing requirement$ $ $Account number (see instructions) 13 Date of 17 Local tax withheld 18 Name of locality 19 Local distribution Payment$ $Form1099-R (Keep for your records.) www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service CORRECTED (if checked)Distributions FromPensions, Annuities,Retirement orProfit-SharingPlans, IRAs,InsuranceContracts, etc.PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.1 Gross distribution OMB No. 1545-0119$2a Taxable amount
$ Form 1099-RCopy 2File this copywith your state,city, or localincome taxreturn, whenrequired.Taxable amountnot determined2bTotaldistributionPAYERS TIN RECIPIENTS TIN 3 Capital gain (included in box 2a) 4 Federal income tax withheld$ $RECIPIENTS name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code Employee contributions/Designated Rothcontributions or insurance premiumsNet unrealized appreciation inemployers securities5 6$ $IRA/SEP/SIMPLE7 Distribution code(s) 8 Other$ %Your percentage of totaldistribution9a 9b Total employee contributions% $10 Amount allocable to IRR 11 1st year of 12 FATCA within 5 years14 State tax withheld 15 State/Payers state no. 16 State distribution desig. Roth contrib. filing requirement$ $ $Account number (see instructions) 13 Date of 17 Local tax withheld 18 Name of locality 19 Local distribution Payment$ $Form1099-R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service 2H8034 2.0004,063.724,063.72PHONE NUMBER AVAILABLE87-2909830 XXX-XX-8345M2IN / PHONE NUMBER AVAILABLE 4,063.72700231TRACKING #: 92572096T2PRUDENTIAL TAX SERVICES LLCEMPOWER30 SCRANTON OFFICE PARKSCRANTON, PA 18507-1796NATHAN EVANS1375 SAYLOR CTZIONSVILLE, IN 46077-12704,063.724,063.72PHONE NUMBER AVAILABLE87-2909830 XXX-XX-8345M2IN / PHONE NUMBER AVAILABLE 4,063.72700231TRACKING #: 92572096T2PRUDENTIAL TAX SERVICES LLCEMPOWER30 SCRANTON OFFICE PARKSCRANTON, PA 18507-1796NATHAN EVANS1375 SAYLOR CTZIONSVILLE, IN 46077-12704,063.724,063.72PHONE NUMBER AVAILABLE87-2909830 XXX-XX-8345M2IN / PHONE NUMBER AVAILABLE 4,063.72700231TRACKING #: 92572096T2PRUDENTIAL TAX SERVICES LLCEMPOWER30 SCRANTON OFFICE PARKSCRANTON, PA 18507-1796NATHAN EVANS1375 SAYLOR CTZIONSVILLE, IN 46077-1270PLAN NAME: DS SMITH NORTH AMERICA 401(K)(Page 2 of 2) |
