Form 1099-R - 2015 (Page 2 of 2) in pdf

2015 Form 1099-R

Instructions for Recipient

Page X of X

T. Rowe Price Trust Co.

you do not, you may be subject to a 50%

If a charge or payment was made against the

Box 4

P.O. Box 17302

excise tax on the amount that should have

cash value of an annuity contract or the cash

Shows federal income tax withheld. Include

Baltimore, MD 21297-1302

Pub. 590-B

been distributed. See

surrender value of a life insurance contract for

this amount on your income tax return as

1-800-225-5132

Distributions from Individual Retirement

the purchase of qualified long-term care

tax withheld, and if Box 4 shows an

Arrangements (IRAs), for more information

insurance, an amount will be shown in this

amount (other than zero), attach Copy B

on IRAs.

box and Code W will be shown in Box 7. You

to your return. Generally, if you will

Payer's ID: 52-1309931

need not report these amounts on your tax

receive payments next year that are not

Roth IRAs

return.

eligible rollover distributions, you can

For distributions from a Roth IRA, generally

change your withholding or elect not to have

we are not required to compute the taxable

Box 2a

income tax withheld by giving us Form

This part of the distribution is generally

amount. You must compute any taxable

W-4P, Withholding Certificate for Pension

taxable. If there is no entry in this box, we

amount on Form 8606, Nondeductible IRAs.

or Annuity Payments.

may not have all the facts needed to figure the

An amount shown in Box 2a may be taxable

Taxpayer ID: XXX-XX-XXXX

earnings on an excess contribution.

taxable amount. In that case, the first box in

Box 5

Box 2b should be marked. You may want to

Shows the portion that is your basis in a

Loans treated as distributions

refer to one of the free publications from the

designated Roth account. This box does not

If you borrow money from a qualified plan,

IRS to help you figure the taxable amount:

show any IRA contributions. The year you

Form 1099-R reports the distributions you

section 403(b) plan, or governmental section

Pub. 560, Retirement Plans for Small

received from pensions, annuities, profit-

first made contributions to the designated

457(b) plan, you may have to treat the loan as

Business (SEP, SIMPLE, and Qualified

sharing and other retirement plans

Roth account may be entered in Box 11.

a distribution and include all or part of the

Plans);

Pub. 571

, Tax-Sheltered Annuity

(including section 457 state and local

amount borrowed in your income. There are

Pub. 575 Pub. 590-B

Plans (403(b) Plans);

;

Box 7

government plans), IRAs, insurance

exceptions to this rule. If your loan is taxable,

Pub. 721, Tax Guide to U.S. Civil Service

Explanations for the types of distributions

contracts, etc. To help you with your tax

Code L will be shown in Box 7. See Pub.

Retirement Benefits; or

Pub. 939

, General

you received appear on the face of Form

filing, we are providing the relevant IRS

575, Pension and Annuity Income.

Rule for Pensions and Annuities. For an IRA

1099-R. Certain distributions may be subject

instructions for the enclosed Form 1099-R.

distribution, see

and

on this

IRAs

Roth IRAs

to an additional 10% tax. See the

Box 1

page. For a direct rollover, other than from a

Recipient's identification number

Shows the total amount you received this year.

instructions for Forms 5329, Additional

For your protection, this form may show

qualified plan to a Roth IRA, zero should be

The amount may have been a direct rollover, a

Taxes on Qualified Plans (Including IRAs)

only the last four digits of your social

shown, and you must enter zero (-0-) on the

transfer or conversion to a Roth IRA, a

and Other Tax-Favored Accounts.

security number (SSN), individual taxpayer

“Taxable amount” line of your tax return.

recharacterized IRA contribution; or you may

If the IRA/SEP/SIMPLE box is marked, you

identification number (ITIN), adoption

have received it as periodic payments, as

If this is a total distribution from a qualified

taxpayer identification number (ATIN), or

have received a Traditional IRA, SEP, or

nonperiodic payments, or as a total

plan and you were born before January 2,

employer identification number (EIN).

SIMPLE IRA distribution.

distribution. Report the amount on Form 1040

1936 (or you are the beneficiary of someone

However, we have reported your complete

or 1040A on the line for “IRA distributions”

born before January 2, 1936), you may be

Box 10

identification number to the IRS.

or “Pensions and annuities” (or the line for

eligible for the 10-year tax option. See the

If an amount is reported in this box, see the

“Taxable amount”), and on Form 8606,

Form 4972 instructions for more information.

Qualified plans

instructions for Form 5329 and

Pub. 575

Nondeductible IRAs, as applicable. However,

If your annuity starting date is after 1997,

If you are an eligible retired public safety

Box 11

if this is a lump-sum distribution, see Form

you must use the simplified method to

officer who elected to exclude from income

The 1st year you made a contribution to the

4972, Tax on Lump-Sum Distributions. If you

figure your taxable amount if we did not

distributions from your eligible plan used to

designated Roth account reported on this

have not reached minimum retirement age,

show the taxable amount in Box 2a. See the

pay certain insurance premiums, the amount

form is shown in this box.

report your disability payments on the line for

instructions for Form 1040 or 1040A.

shown in Box 2a has not been reduced by the

“Wages, salaries, tips, etc.” on your tax

Boxes 12 - 13

exclusion amount. See the instructions for

IRAs

return. Also report on that line permissible

If state income tax was withheld from the

For distributions from a traditional

Form 1040 or Form 1040A for more

withdrawals from eligible automatic

distribution, these boxes may be completed.

individual retirement arrangement (IRA),

information.

contribution arrangements and corrective

simplified employee pension (SEP), or

distributions of excess deferrals, excess

Future developments

Box 2b

savings incentive match plan for employees

For the latest information about

contributions, or excess aggregate

If the first box is marked, we were unable to

(SIMPLE), generally we are not required to

developments related to Form 1099-R and its

contributions except if you are self-employed.

determine the taxable amount, and Box 2a

compute the taxable amount. See the Form

instructions, go to

should be blank, except for an IRA. It is your

1040 or 1040A instructions to determine

If a life insurance, annuity, qualified

responsibility to determine the taxable

long-term care, or endowment contract was

the taxable amount. If you are at least age

amount. If the second box is marked, the

70½, you must take minimum distributions

transferred tax free to another trustee or

distribution was a total distribution that

from your IRA (other than a Roth IRA). If

contract issuer, an amount will be shown in

closed out your account.

this box and Code 6 will be shown in Box 7.

Form 1099-R - 2015 Page 2

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