Schedule J (Form N-11/n-12/n-15/n-40) - Supplemental Annuities Schedule

SCHEDULE J (FORM N-11/N-12/N-15/N-40) INSTRUCTIONS

Line 4b. Employee’s contributions which were NOT previously

Further information regarding this exclusion may be found in Internal

taxed — The portion of the cost you paid for with money not previously

Revenue Service Publications 575 and 939.

taxed may not be deductible, but is included as part of your cost.

PART II — COMPUTATION OF HAWAII TAXABLE ANNUITY

Line 4c. Total employee’s contributions — Add the amounts on lines

—

Use this Part to compute the taxable portion of pension and annuity

4a and 4b. If the total is zero (i.e., there were no employee contributions),

payments you received this year.

do not complete this form unless you are using this form to determine the

Line 14. Annual pension exclusion — Enter the amount from line 10.

taxable amount of a lump-sum distribution to be reported on Form N-152.

If the beginning date of your annuity is a date other than the first day of

See “WHO SHOULD NOT USE THIS FORM” in the general instructions.

the year, however, the exclusion allowed for the first and last years will

You do not have to complete the rest of this form. Enter the total amount

be the annual pension exclusion multiplied by the ratio of months the

received this year on Form N-12, line 15a, and zero on line 15b or on

annuity is received to the total number of months in the year.

Form N-15, line 16, Column A. If there were no employee contributions

and the payments received do not qualify as a pension, the entire amount

Line 16. Amount of annuity dividends received this year — Enter the

received is taxable. Enter the total amount received on Form N-12, lines

amount of any variable or indefinite amounts you received from your

15a and 15b or on Form N-15, line 16, Column A. If you are filing Form

pension or annuity this year in excess of the fixed, definite amount shown

N-11, the taxable amount should have already been included in the

on line 1.

amount reported as federal adjusted gross income on line 7.

Line 17. Portion of annuity attributable to employee’s contribution

Line 5. Employer’s contributions — Enter the amount paid by the

— Enter the amount from line 8, but if this annuity or distribution is not

employer for the contract. If there were no employer contributions, enter

part of an employer’s pension plan or is received for a reason other than

zero on line 5, skip lines 6 through 13, enter zero on line 14, and continue

retirement, death, or disability, enter 1.00 (100%).

on line 15. Check with your employer or plan administrator for the

amounts.

Line 20. Annual recovery of employee’s investment. — Enter the

amount from line 11. If the beginning date of your annuity is a date other

Line 11. Annual exclusion of the employee’s previously taxed

than the first day of the year, the exclusion allowed for the first and last

investment in the annuity contract — Divide the amount on line 4a by

years will be the annual amount multiplied by the ratio of months the

the multiple on line 2. This is the portion of your cost which is excluded

annuity is received to the total number of months in the year.

from taxation each year. The tax-free part remains the same even if the

total payment increases or you outlive the life expectancy factor used. If

If the employee’s total investment in the contract has been recovered

your annuity starting date is after 1986, however, the tax-free part cannot

and the annuity starting date is after 1986, do not include any amount on

exceed the unrecovered cost of the contract.

this line for the recovery of the employee’s investment in the contract.

Line 12. Death benefit exclusion — Note: Pursuant to Act 297, Session

Line 21. Taxable annuity or distribution before adjustment for the

Laws of Hawaii 1997, the employer-provided death benefit exclusion is

death benefit exclusion — If you are using this form to determine the

repealed with respect to decedents dying after August 20, 1996.

taxable amount of a lump-sum distribution to be reported on Form N-152,

enter this amount on Part III, line 14 of Form N-152. You do not have to

If you are the beneficiary of a deceased employee or a deceased former

complete the rest of this form.

employee, the pension or annuity you get because of that person’s death

may qualify for a death benefit exclusion. This exclusion is limited to a

Line 23. Total taxable annuity — Subtract the amount on line 22 from

the amount on line 21. Enter the result on Form N-12, line 15b, on Form

maximum of $5,000 regardless of the number of employers paying death

benefits or the number of beneficiaries.

N-15, line 16, Column A, or on Form N-40, line 8.

The death benefit exclusion does not apply to amounts that the

PART

III

—

COMPUTATION

PENSION

employee had, immediately before death, a nonforfeitable right to receive

ADJUSTMENT

HAWAII

ADJUSTED

GROSS

while living. It may apply to lump-sum distributions from a qualified

INCOME

— Use this part to compute the amount included in the

pension, annuity, stock bonus, or profit-sharing plan or from certain

federal adjusted gross income, Form N-11, line 7, that is NOT taxable

tax-sheltered annuities. If you are the survivor under a joint and survivor

for Hawaii.

annuity, the exclusion only applies if the deceased had received no

Line 24. Federal taxable amount — Enter the amount attributable to

retirement pension or annuity payments, or the deceased had received

the taxable portion of this contract that is included in your federal adjusted

disability income payments that were not treated as pension or annuity

gross income.

income.

Line 25. Pension adjustment to Hawaii adjusted gross income —

Even if the employee dies after the annuity starting date, the death

Subtract the amount on line 23 from the amount on line 24. This is the

benefit exclusion applies to amounts received by a beneficiary if the

amount that is NOT taxed by Hawaii. Enter the result on Form N-11, line

amounts are received other than as the survivor under a joint and survivor

13.

annuity.

If more than one person is entitled to a survivor annuity, the annuitants

generally must allocate the allowable death benefit among themselves

in proportion to the relative value of their benefits under the contract.

Schedule J (Form N-11/n-12/n-15/n-40) - Supplemental Annuities Schedule - 1999 Page 3

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