Instructions For Form 1040-A - U.s. Individual Income Tax Return - 2016 Page 28
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922017 Form 1040A—Lines 12a and 12b
Insurance premiums for retired public safety officers. If
Annuity starting date. Your annuity starting date is the later
you are an eligible retired public safety officer (law enforce-
of the first day of the first period for which you received a pay-
ment officer, firefighter, chaplain, or member of a rescue squad
ment or the date the plan's obligations became fixed.
or ambulance crew), you can elect to exclude from income dis-
Age (or combined ages) at annuity starting date. If you are
tributions made from your eligible retirement plan that are used
the retiree, use your age on the annuity starting date. If you are
to pay the premiums for coverage by an accident or health plan
the survivor of a retiree, use the retiree's age on his or her an-
or a long-term care insurance contract. You can do this only if
nuity starting date. But if your annuity starting date was after
you retired because of disability or because you reached nor-
1997 and the payments are for your life and that of your benefi-
mal retirement age. The premiums can be for coverage for you,
ciary, use your combined ages on the annuity starting date.
your spouse, or dependents. The distribution must be from a
If you are the beneficiary of an employee who died, see Pub.
plan maintained by the employer from which you retired as a
575. If there is more than one beneficiary, see Pub. 575 or Pub.
public safety officer. Also, the distribution must be made di-
721 to figure each beneficiary's taxable amount.
rectly from the plan to the provider of the accident or health
Cost. Your cost is generally your net investment in the plan as
plan or long-term care insurance contract. You can exclude
of the annuity starting date. It doesn't include pre-tax contribu-
from income the smaller of the amount of the premiums or
tions. Your net investment may be shown in box 9b of Form
$3,000. You can only make this election for amounts that
1099-R.
would otherwise be included in your income.
An eligible retirement plan is a governmental plan that is:
Rollovers. Generally, a rollover is a tax-free distribution of
a qualified trust,
cash or other assets from one retirement plan that is contributed
a section 403(a) plan,
to another plan within 60 days of receiving the distribution.
a section 403(b) plan, or
However, a rollover to a Roth IRA or a designated Roth ac-
a section 457(b) plan.
count is generally not a tax-free distribution. Use lines 12a and
12b to report a rollover, including a direct rollover, from one
If you make this election, reduce the otherwise taxable
qualified employer's plan to another or to an IRA or SEP.
amount of your pension or annuity by the amount excluded.
The amount shown in box 2a of Form 1099-R doesn't reflect
Enter on line 12a the distribution from Form 1099-R, box 1.
the exclusion. Report your total distributions on line 12a and
From this amount, subtract any contributions (usually shown in
the taxable amount on line 12b. Enter “PSO” next to line 12b.
box 5) that were taxable to you when made. From that result,
subtract the amount of the rollover. Enter the remaining
If you are retired on disability and reporting your disability
amount on line 12b. If the remaining amount is zero and you
pension on line 7, include only the taxable amount on that line
have no other distribution to report on line 12b, enter -0- on
and enter “PSO” and the amount excluded in the space to the
left of line 7.
line 12b. Also, enter “Rollover” next to line 12b.
Simplified Method. You must use the Simplified Method if
See Pub. 575 for more details on rollovers, including special
rules that apply to rollovers from designated Roth accounts,
either of the following applies.
partial rollovers of property, and distributions under qualified
1. Your annuity starting date was after July 1, 1986, and
domestic relations orders.
you used this method last year to figure the taxable part.
2. Your annuity starting date was after November 18,
Lump-sum distributions. If you received a lump-sum distri-
1996, and both of the following apply.
bution from a profit-sharing or retirement plan, your Form
1099-R should have the “Total distribution” box in box 2b
a. The payments are from a qualified employee plan, a
checked. You must use Form 1040 if you owe additional tax
qualified employee annuity, or a tax-sheltered annuity.
because you received an early distribution from a qualified re-
b. On your annuity starting date, either you were under age
tirement plan and the total amount wasn't rolled over. See Pub.
75 or the number of years of guaranteed payments was fewer
575 to find out if you owe this tax.
than 5. See Pub. 575 for the definition of guaranteed payments.
Enter the total distribution on line 12a and the taxable part
If you must use the Simplified Method, complete the Sim-
on line 12b. For details, see Pub. 575.
plified Method Worksheet in these instructions to figure the
You may be able to pay less tax on the distribution if
taxable part of your pension or annuity. For more details on the
you were born before January 2, 1936, or you are the
TIP
Simplified Method, see Pub. 575 or Pub. 721 for U.S. Civil
beneficiary of a deceased employee who was born be-
Service retirement benefits.
fore January 2, 1936. But you must use Form 1040 to do so.
If you received U.S. Civil Service retirement benefits
For details, see Form 4972.
!
and you chose the alternative annuity option, see Pub.
721 to figure the taxable part of your annuity. Don't
CAUTION
use the Simplified Method Worksheet in these instructions.
-28-
Need more information or forms? Visit IRS.gov.
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