Form Ar1000adj - Individual Income Tax - Schedule Of Other Adjustments - 2012 Page 2
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1
2INSTRUCTIONS FOR
LINE 4. This line is used to report your allowable
LINE 8. Employees and self-employed persons
contribution to an Archer Medical Savings account
(including partners) can deduct certain moving
AR1000ADJ
(MSA). An MSA is a trust or custodial account that
expenses. Expenses incurred in 2012 are de-
is created or organized exclusively for the purpose
ducted on this line as an adjustment to income.
LINE 1. To claim the Texarkana exemption, you
of paying the qualified medical expenses of the
must file a return and report all Arkansas income
taxpayer (account holder) as well as the taxpayer’s
You can only take this deduction if you moved in
you received during the year. Attach AR-TX Form.
spouse and/or dependents. In order to be eligible, a
connection with your job or business and your
(AR-TX Form is supplied by your employer.)
taxpayer must have had insurance coverage under
change in job location has added at least fifty (50)
a high deductible health plan (HDHP) only. A HDHP
miles to the distance from your old home to your
The AR-TX Form is not required for non wage
will have the following deductions and limitations:
workplace. If you had no former workplace, your
income such as interest, dividends, Schedule C
(1) for self-only coverage, the minimum deductible
new workplace must be at least fifty (50) miles
(sole proprietor), Schedule F (farm), Schedule
is $2,100, maximum deductible is $3,150 and the
from your old home. You must attach a completed
maximum out of pocket expense is $4,200, and
copy of federal Form 3903.
E (rents, royalties, partnerships, etc.) or retire-
(2) for family coverage, the minimum deductible
ment. Additional information may be required for
verification if an adjustment for these types of
is $4,200, maximum deductible is $6,300 and the
If you were reimbursed for any part of your mov-
income is allowed.
maximum out of pocket expense is $7,650. The
ing expenses and the amount was included on
contribution limitation for any month is the amount
your W-2, report this amount as income on Form
NOTE: Taxpayers who claim this exemption
equal to 1/12 of 65% of the annual deductible for an
AR1/NR1, Line 8. If the amount was not included
must file using their street address in Texarkana,
individual with self-only coverage and 1/12 of 75%
on your W-2, include the amount on Form AR1/
Arkansas or Texarkana, Texas. If you use a Post
of the annual deductible for family coverage. New
NR1, Line 20, Other Income.
Office Box, this exemption will not be allowed.
Archer MSAs may not be established after 2007 but
LINE 9. If you were self-employed and had a
contributions can be made to existing accounts.
net profit for the year, you may be able to deduct
If you lived within the city limits of Texarkana,
LINE 5. This line is used to report your allowable
part of the amount paid for health insurance on
Arkansas, you are allowed a full exemption
contribution to a Health Savings Account (HSA).
behalf of yourself, your spouse, and/or depen-
from Arkansas income taxation. Part year Tex-
arkana residents claim the exemption only on
In order to be eligible, a taxpayer must have had
dents. Complete the worksheet on page 22 of
income earned while a resident of Texarkana,
insurance coverage under a HDHP only. A HDHP
the booklet to determine your deduction.
Arkansas.
will have the following deductions and limitations:
LINE 10. If you were self-employed and contrib-
(1) for self-only coverage, the minimum deductible
If you lived within the city limits of Texarkana,
is $1,200 and the maximum out of pocket expense
uted to a “Keogh”, H.R. 10 retirement plan, or a
Texas, you are allowed to deduct the income you
is $6,050, and (2) for family coverage, the minimum
SIMPLE plan, enter the total amount of your con-
earned in the city limits of Texarkana, Arkansas.
deductible is $2,400 and the maximum out of pocket
tributions in the space provided. The amount of
All other Arkansas income is taxable to you.
expense is $12,100. You can make pre-tax contribu-
the deduction depends upon the type of plan.
tions of up to $3,100 each year ($6,250 for families)
LINE 11. Enter the total interest penalties paid
LINE 2. If you made contributions to a tuition
to cover health care costs. Individuals who reached
savings account established under the Arkansas
age 55 by the end of the tax year can increase their
for premature or early withdrawal of certificates
Tax Deferred Tuition Savings Program enter
annual contribution by $1,000 for 2012. Maximum
of deposit.
the amount here. Contributions to plans es-
contributions allowed to an HSA are reduced by any
LINE 12. If you paid alimony or separate main-
tablished in states other than Arkansas are not
contributions made to an Archer MSA.
deductible. The deductible contribution cannot
tenance as the result of a court order, enter the
LINE 6. You may take an adjustment for inter-
exceed $5,000 per taxpayer per tax year. Quali-
total amount in the space provided. You must
fied withdrawals from a tuition savings account
est paid on student loans if all of the following
enter the name and Social Security Number of
established under the Arkansas Tax Deferred
apply:
the person you paid.
Tuition Savings Program or a tax-deferred tuition
LINE 13. If you have an individual with disabili-
1.You paid interest in 2012 on a qualified stu-
savings program established by another state will
dent loan.
ties who qualifies for the deduction you can take
be exempt from Arkansas income tax with respect
to the designated beneficiary’s income.
2.Your filing status is any status other than married
an adjustment from income of $500 for each indi-
filing separately on different returns (Status 5).
vidual with disabilities. Attach Form AR1000DC.
LINE 3. This line is used to report your allow-
3.Your AGI is less than: $75,000 if filing Status 1,
LINE 14. If you paid unreimbursed expenses
able contribution to an Individual Retirement Ac-
3, or 6; $150,000 if filing Status 2 or 4. Status 4
count (IRA). If you contributed to your own IRA,
filers, please note that this is a combined income
for yourself or one of your dependents related to
certain limitations may apply to the amount you
amount.
the donation of an organ (part of a liver, pancreas,
may use as an adjustment to income. If neither
4.You are not claimed as a dependent on another
kidney, intestine, lung or bone marrow) you may
you nor your spouse was covered by an employer
taxpayer’s 2012 tax return.
take an income tax deduction of up to $10,000.
The deduction must be claimed for the taxable
provided retirement plan, the entire contribution is
Figure your allowable deduction using the work-
year in which the transplantation of the organ oc-
deductible up to $5,000 each for all filing statuses.
If either you or your spouse was covered by such
sheet on page 21 of the booklet.
curs. Allowable expenses include travel, lodging,
a plan, the amount of the deduction depends
medical expenses and lost wages that are related
LINE 7. You may take an adjustment from
on the amount of your Adjusted Gross Income
to the organ donation. An individual may claim the
(AGI) before the IRA deduction, as shown in the
income for contributions made to a long-term
deduction only once in his or her lifetime. This
table on
page 21 of the booklet.
Use this table
intergenerational trust. This is a trust established
deduction does not apply to organs harvested from
along with your Arkansas AGI to determine your
for an individual under the age of 18 in order to
a deceased donor. Attach Form AR1000-OD.
allowable deduction. Catch up Contributions -
provide funds for the minor’s retirement. The
LINE 15. Total Other Adjustments. Add Lines
Individuals who turned 50 before the close of the
trustee must be a resident of Arkansas and can-
not distribute any of the trust funds to the benefi-
1 through 14 and enter on this line and on Forms
tax year may increase the maximum permitted
ciary until the beneficiary reaches the age of 55.
AR1000F or AR1000NR, Line 23.
annual contribution by up to $1,000.
Contributions are limited to $4,000 per year.
AR1000ADJ (R 8/13/12)
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