f1099r

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Attention:

This form is provided for informational purposes only. Copy A appears in red, similar to the

official IRS form. Do notfile copy A downloaded from this website. The official printed

version of this IRS form is scannable, but the online version of it, printed from this website,

is not. A penalty may be imposed for filing forms that cant be scanned. See part O in thecurrent General Instructions for Certain Information Returns for more information about

penalties.

To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order Information

Returns and Employer Returns Online, and well mail you the scannable forms and other

products.

See IRS Publications 1141, 1167, 1179 and other IRS resources for information about

printing these tax forms.
http://www.irs.gov/businesses/page/0,,id=23108,00.htmlhttp://www.irs.gov/businesses/page/0,,id=23108,00.htmlhttp://www.irs.gov/businesses/page/0,,id=23108,00.htmlhttp://www.irs.gov/businesses/page/0,,id=23108,00.html

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Form 1099-R

2014

Cat. No. 14436Q

Distributions FromPensions, Annuities

Retirement oProfit-Sharing

Plans, IRAsInsurance

Contracts, etc

Copy A

FoInternal Revenue

Service Center

File with Form 1096

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0119

For Privacy Acand PaperworkReduction Ac

Notice, see the2014 Genera

Instructions foCertain

InformationReturns

9898 VOID CORRECTEDPAYERS name, street address, city or town, state or province,country, and ZIP or foreign postal code

PAYERS federal identificationnumber

RECIPIENTS identificationnumber

RECIPIENTS name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

10 Amount allocable to IRR

within 5 years

$

11 1st year of desig. Roth contrib.

Account number (see instructions)

1 Gross distribution

$2a Taxable amount

$2b Taxable amount

not determinedTotaldistribution

3 Capital gain (includedin box 2a)

$

4 Federal income taxwithheld

$5 Employee contributions

/Designated Rothcontributions orinsurance premiums

$

6 Net unrealizedappreciation inemployers securities

$7 Distribution

code(s)

IRA/SEP/

SIMPLE

8 Other

$ %9a Your percentage of total

distribution %

9b Total employee contributions$

12 State tax withheld

$$

13 State/Payers state no. 14 State distribution

$$

15 Local tax withheld

$$

16 Name of locality 17 Local distribution

$$

Form 1099-R www.irs.gov/form1099r

Do Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This Page

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Form 1099-R

2014




Contracts, etc

Copy 1

FoState, City

or LocaTax Department


OMB No. 1545-0119

VOID CORRECTEDPAYERS name, street address, city or town, state or province,country, and ZIP or foreign postal code



RECIPIENTS name




within 5 years

$




$2a Taxable amount

$2b Taxable amount



$




$


$7 Distribution

code(s)

IRA/SEP/

SIMPLE

8 Other


distribution %



$$


$$


$$


$$


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Form 1099-R

2014


Retirement orProfit-Sharing


Contracts, etc

Copy BReport this

income on yourfederal tax

return. If thisform shows

federal incometax withheld in

box 4, attachthis copy toyour return


This information isbeing furnished to

the InternaRevenue Service

OMB No. 1545-0119

CORRECTED (if checked)PAYERS name, street address, city or town, state or province,country, and ZIP or foreign postal code



RECIPIENTS name




within 5 years

$




$2a Taxable amount

$2b Taxable amount



$




$


$7 Distribution

code(s)

IRA/SEP/

SIMPLE

8 Other


distribution %



$$


$$


$$


$$


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Instructions for RecipientGenerally, distributions from pensions, annuities, profit-sharing andretirement plans (including section 457 state and local governmentplans), IRAs, insurance contracts, etc., are reported to recipients onForm 1099-R.

Qualified plans. If your annuity starting date is after 1997, youmustuse the simplified method to figure your taxable amount if your payerdid not show the taxable amount in box 2a. See the instructions forForm 1040 or 1040A.

IRAs. For distributions from a traditional individual retirementarrangement (IRA), simplified employee pension (SEP), or savingsincentive match plan for employees (SIMPLE), generally thepayer isnot required to compute the taxable amount. See theForm 1040 or1040A instructions to determine the taxableamount. If you are at leastage 70, you must take minimum distributions from your IRA (otherthan a Roth IRA). If you do not, you may be subject to a 50% excisetax on the amount that should have been distributed. See Pub. 590 formore information on IRAs.

Roth IRAs. For distributions from a Roth IRA, generally thepayer isnot required to compute the taxable amount. You mustcompute anytaxable amount on Form 8606. An amount shownin box 2a may betaxable earnings on an excess contribution.

Loans treated as distributions. If you borrow money from aqualifiedplan, section 403(b) plan, or governmental section 457(b) plan, youmayhave to treat the loan as a distribution and include all or part of the amount borrowed in your income. There are exceptions tothisrule. If your loan is taxable, Code L will be shown in box 7.SeePub. 575.

Recipient's identification number.For your protection, this formmay show only the last four digits of your social security number(SSN), individual taxpayer identification number (ITIN), or adoptiontaxpayer identification number (ATIN). However, the issuer hasreported your complete identification number to the IRS and, whereapplicable, to state and/or local governments.

Account number. May show an account or other uniquenumber thepayer assigned to distinguish your account.

Box 1. Shows the total amount you received this year. Theamountmay have been a direct rollover, a transfer or conversionto a RothIRA, a recharacterized IRA contribution; or you mayhave received itas periodic payments, as nonperiodic payments,or as a totaldistribution. Report the amount on Form 1040 or1040A on the line forIRA distributions or Pensions andannuities (or the line forTaxable amount), and on Form 8606,as applicable. However, if thisis a lump-sum distribution, seeForm 4972. If you have not reachedminimum retirement age,report your disability payments on the linefor Wages, salaries,tips, etc. on your tax return. Also report on that

line permissiblewithdrawals from eligible automatic contributionarrangementsand corrective distributions of excess deferrals, excesscontributions, or excess aggregate contributions except if youareself-employed.

If a life insurance, annuity, qualified long-term care, or endowmentcontract 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 box7. If a charge or payment was made against the cash value of anannuity contract or the cash surrender value of a life insurancecontract for the purchase of qualified long-term care insurance, anamount 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.

Box 2a. This part of the distribution is generally taxable. If thereis noentry in this box, the payer may not have all the factsneeded to figurethe taxable amount. In that case, the first box inbox 2b should bechecked. You may want to get one of the freepublications from theIRS to help you figure the taxable amount.SeeAdditional information

on the back of Copy 2. For an IRAdistribution, see IRAsand RothIRAson this page. For a direct rollover, other than from a qualifiedplan to a Roth IRA, zero should be shown, and you must enter zero(-0-) on the Taxable amount line of your tax return.

(Continued on the back of Copy C.

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Form 1099-R

2014




Contracts, etc

Copy C

For Recipient'sRecords


This information isbeing furnished to

the InternaRevenue Service

OMB No. 1545-0119




RECIPIENTS name




within 5 years

$




$2a Taxable amount

$2b Taxable amount



$




$


$7 Distribution

code(s)

IRA/SEP/

SIMPLE

8 Other


distribution %



$$


$$


$$


$$

Form 1099-R (keep for your records) www.irs.gov/form1099r

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Instructions for Recipient (Continued) If this is a total distribution from a qualified plan and you were bornbefore January 2, 1936 (or you are the beneficiary of someone bornbefore January 2, 1936), you may be eligible for the 10-year taxoption. See the Form 4972 instructions for more information.

If you are an eligible retired public safetyofficer who elected toexclude from income distributions from youreligible plan used to paycertain insurance premiums, theamount shown in box 2a has notbeen reduced by the exclusionamount. See the instructions for Form1040 or 1040A for moreinformation.

Box 2b. If the first box is checked, the payer was unable todeterminethe taxable amount, and box 2a should be blank, except for an IRA. Itis your responsibility to determine the taxable amount. If thesecondbox is checked, the distribution was a total distribution thatclosed outyour account.

Box 3. If you received a lump-sum distribution from a qualified planand were born before January 2, 1936 (or you are the beneficiary ofsomeone born before January 2, 1936), you may be able to elect totreat this amount as a capital gain on Form 4972 (not on Schedule D(Form 1040)). See the Form 4972 instructions. For a charitable giftannuity, report as a long-term capital gain as explained in theinstructions for Form 8949.

Box 4. Shows federal income tax withheld. Include this amount onyour income tax return as tax withheld, and if box 4 shows anamount(other than zero), attach Copy B to your return. Generally, ifyou willreceive payments next year that are not eligible rolloverdistributions,you can change your withholding or elect not to haveincome taxwithheld by giving the payer Form W-4P.

Box 5. Generally, this shows the employees investment in thecontract (after-tax contributions), if any, recovered tax free this year;the portion that is your basis in a designated Roth account; the partofpremiums paid on commercial annuities or insurance contractsrecovered tax free; or the nontaxable part of a charitable gift annuity.This box does not show any IRA contributions. If the amount shownisyour basis in a designated Roth account, the year you first madecontributions to that account may be entered in box 11.

Box 6. If you received a lump-sum distribution from a qualified planthat includes securities of the employers company, the netunrealizedappreciation (NUA) (any increase in value of suchsecurities while inthe trust) is taxed only when you sell the securitiesunless you chooseto include it in your gross income this year. See Pub. 575 and theForm 4972 instructions. If you did not receive a lump-sumdistributionthe amount shown is the NUA attributable to employeecontributions,which is not taxed until you sell the securities.

Box 7. The following codes identify the distribution you received. Formore information on these distributions, see the instructions for yourtax return. Also, certain distributions may be subject to an additional10% tax. See the instructions for Form 5329.

1Early distribution, no known exception (in most cases, under age59).

2Early distribution, exception applies (under age 59).

3Disability.

4Death.

5Prohibited transaction.

6Section 1035 exchange (a tax-free exchange of life insurance,annuity, qualified long-term care insurance, or endowmentcontracts).

7Normal distribution.

8Excess contributions plus earnings/excess deferrals (and/orearnings) taxable in 2014.

9Cost of current life insurance protection.

AMay be eligible for 10-year tax option (see Form 4972).

BDesignated Roth account distribution.

Note. If Code B is in box 7 and an amount is reported in box 10,see the instructions for Form 5329.

DAnnuity payments from nonqualified annuities that may be subjectto tax under section 1411.

(Continued on the back of Copy 2.

8/12/2019 f1099r

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Form 1099-R

2014




Contracts, etc

Copy 2

File this copywith your state

city, or locaincome taxreturn, when

required


OMB No. 1545-0119




RECIPIENTS name




within 5 years

$




$2a Taxable amount

$2b Taxable amount



$




$


$7 Distribution

code(s)

IRA/SEP/

SIMPLE

8 Other


distribution %



$$


$$


$$


$$


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Instructions for Recipient (Continued)EDistributions under Employee Plans Compliance Resolution

System (EPCRS).FCharitable gift annuity.GDirect rollover of a distribution (other than a designated Roth

account distribution) to a qualified plan, a section 403(b)plan, agovernmental section 457(b) plan, or an IRA.

HDirect rollover of a designated Roth account distribution to aRothIRA.

JEarly distribution from a Roth IRA, no known exception (inmostcases, under age 59).

KDistribution of IRA assets not having a readily available FMV.LLoans treated as distributions.NRecharacterized IRA contribution made for 2014 and

recharacterized in 2014.PExcess contributions plus earnings/excess deferrals (and/or

earnings) taxable in 2013.QQualified distribution from a Roth IRA.RRecharacterized IRA contribution made for 2013 and

recharacterized in 2014.SEarly distribution from a SIMPLE IRA in first 2 years, noknown

exception (under age 59).TRoth IRA distribution, exception applies.UDividend distribution from ESOP under sec. 404(k).

Note. This distribution is not eligible for rollover.WCharges or payments for purchasing qualified long-term care

insurance contracts under combined arrangements. If the IRA/SEP/SIMPLE box is checked, you have received a

traditional IRA, SEP, or SIMPLE distribution.Box 8. If you received an annuity contract as part of adistribution,the value of the contract is shown. It is not taxablewhen you receive itand should not be included in boxes 1 and2a. When you receiveperiodic payments from the annuitycontract, they are taxable at thattime. If the distribution is madeto more than one person, thepercentage of the annuity contractdistributed to you is also shown.

You will need this information ifyou use the 10-year tax option (Form4972). If charges were made for qualified long-term care insurancecontracts under combined arrangements, the amount of the reductionin the investment (but not below zero) in the annuity or life insurancecontract is reported here.Box 9a. If a total distribution was made to more than oneperson, thepercentage you received is shown.Box 9b. For a life annuity from a qualified plan or from a section403(b) plan (with after-tax contributions), an amount may beshown forthe employees total investment in the contract. It is used to computethe 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 1st year you made a contribution to the designated Rothaccount reported on this form is shown in this box.Boxes 1217. If state or local income tax was withheld from thedistribution, boxes 14 and 17 may show the part of thedistributionsubject to state and/or local tax.Future developments. For the latest information about developmentsrelated to Form 1099-R and its instructions, such as legislationenacted after they were published, go to www.irs.gov/form1099r.

Additional information. You may want to see:Form W-4P, Withholding Certificate for Pension or AnnuityPayments,Form 4972, Tax on Lump-Sum Distributions,Form 5329,Additional Taxes on Qualified Plans (Including IRAs)andOther Tax-Favored Accounts,Form 8606, Nondeductible IRAs,Pub. 560, Retirement Plans for Small Business (SEP, SIMPLE,and

Qualified Plans),Pub. 571, Tax-Sheltered Annuity Plans (403(b) Plans),Pub. 575, Pension and Annuity Income,Pub. 590, Individual Retirement Arrangements (IRAs),Pub. 721, Tax Guide to U.S. Civil Service Retirement Benefits,Pub. 939, General Rule for Pensions and Annuities,Pub. 969, Health Savings Accounts and Other Tax-FavoredHealthPlans.

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Instructions for PayerTo complete Form 1099-R, use:

the 2014 General Instructions for CertainInformation Returns, and

the 2014 Instructions for Forms 1099-R and5498.

To order these instructions and additional

forms, go to www.irs.gov/form1099r or call1-800-TAX-FORM (1-800-829-3676).

Caution: Because paper forms are scannedduring processing, you cannot file Forms1096, 1097, 1098, 1099, 3921, 3922, or5498that you print from the IRS website.

Due dates. Furnish Copies B, C, and 2 ofthisform to the recipient by February 2, 2015.

File Copy A of this form with the IRS byMarch 2, 2015. If you file electronically, thedue date is March 31, 2015. To fileelectronically, you must have software thatgenerates a file according to the specificationsin Pub. 1220, Specifications for ElectronicFiling of Forms 1097, 1098, 1099, 3921, 3922,5498, 8935, and W-2G. The IRS does notprovide a fill-in form option.

Need help? If you have questions aboutreporting on Form 1099-R, call theinformationreporting customer service sitetoll free at1-866-455-7438 or 304-263-8700(not tollfree). Persons with a hearing or speechdisability with access to TTY/TDD equipmentcan call304-579-4827 (not toll free).

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