Form W-2as - American Samoa Wage And Tax Statement

Instructions for Employee (continued from

back of Copy B)

R—Employer contributions to your Archer MSA. Report on Form 8853, Archer

Box 12 (continued)

MSAs and Long-Term Care Insurance Contracts.

Note: If a year follows code D through H, S, Y, AA, BB, or EE, you made a make-

S—Employee salary reduction contributions under a section 408(p) SIMPLE plan

up pension contribution for a prior year(s) when you were in military service. To

(not included in box 1)

figure whether you made excess deferrals, consider these amounts for the year

shown, not the current year. If no year is shown, the contributions are for the

T—Adoption benefits (not included in box 1). Complete Form 8839, Qualified

current year.

Adoption Expenses, to figure taxable and nontaxable amounts.

A—Uncollected social security tax on tips. Report on U.S. Form 1040, or on Form

V—Income from exercise of nonstatutory stock option(s) (included in boxes 1, 3

1040-SS if not required to file Form 1040.

(up to social security wage base), and 5). See Pub. 525, Taxable and Nontaxable

Income, for reporting requirements.

B—Uncollected Medicare tax on tips. Report on U.S. Form 1040, or on Form

1040-SS if not required to file Form 1040.

W—Employer contributions (including amounts the employee elected to contribute

using a section 125 (cafeteria) plan) to your health savings account (HSA). Report

C—Taxable cost of group-term life insurance over $50,000 included in boxes 1, 3

on Form 8889, Health Savings Accounts (HSAs).

(up to social security wage base), and 5

Y—Deferrals under a section 409A nonqualified deferred compensation plan

D—Elective deferrals to a section 401(k) cash or deferred arrangement. Also

includes deferrals under a SIMPLE retirement account that is part of a section

Z—Income under a nonqualified deferred compensation plan that fails to satisfy

401(k) arrangement.

section 409A. This amount also is included in box 1. It is subject to an additional

20% tax plus interest. See “Other Taxes” in the instructions for your tax return.

E—Elective deferrals under a section 403(b) salary reduction agreement

AA—Designated Roth contributions under a section 401(k) plan

F—Elective deferrals under a section 408(k)(6) salary reduction SEP

BB—Designated Roth contributions under a section 403(b) plan

G—Elective deferrals and employer contributions (including nonelective deferrals)

to a section 457(b) deferred compensation plan

DD—Cost of employer-sponsored health coverage. The amount reported with

code DD is not taxable.

H—Elective deferrals to a section 501(c)(18)(D) tax-exempt organization plan. (You

may be able to deduct.)

EE—Designated Roth contributions under a governmental section 457(b) plan.

This amount does not apply to contributions under a tax-exempt organization

J—Nontaxable sick pay (information only, not included in box 1, 3, or 5)

section 457(b) plan.

M—Uncollected social security tax on taxable cost of group-term life insurance

FF—Permitted benefits under a qualified small employer health reimbursement

over $50,000 (former employees only). Report on U.S. Form 1040, or on Form

arrangement

1040-SS if not required to file Form 1040.

Box 13. If the “Retirement plan” box is checked, special limits may apply to the

N—Uncollected Medicare tax on taxable cost of group-term life insurance over

amount of traditional IRA contributions that you may deduct. See Pub. 590-A,

$50,000 (former employees only). Report on U.S. Form 1040, or on Form 1040-SS

Contributions to Individual Retirement Arrangements (IRAs).

if not required to file Form 1040.

Note: Keep Copy C of Form W-2AS for at least 3 years after the due date for filing

P—Excludable moving expense reimbursements paid directly to employee (not

your income tax return. However, to help protect your social security benefits,

included in box 1, 3, or 5)

keep Copy C until you begin receiving social security benefits just in case there is

Q—Nontaxable combat pay. See your tax return instructions for details on

a question about your work record and/or earnings in a particular year.

reporting this amount.

Form W-2as - American Samoa Wage And Tax Statement - 2018 Page 7

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