Instructions For Forms 1099-R And 5498 - Distributions From Pensions, Annuities, Retirement Or Profit-Sharing Plans, Iras, Insurance Contracts, Etc. And Ira Contribution Information - 2016 Page 15
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24To determine the value of an annuity contract, show the
Box 10. Amount Allocable to IRR Within 5 Years
value as an amount equal to the current actuarial value of
Enter the amount of the distribution allocable to an IRR
the annuity contract, reduced by an amount equal to the
made within the 5-year period beginning with the first day
excess of the employee's contributions over the cash and
of the year in which the rollover was made. Do not
other property (not including the annuity contract)
complete this box if an exception under section 72(t)
distributed.
applies.
If an annuity contract is part of a multiple recipient
For further guidance on determining amounts allocable
lump-sum distribution, enter in box 8, along with the
to an IRR, see Notice 2010-84, Q/A-13.
current actuarial value, the percentage of the total annuity
contract each Form 1099-R represents.
Box 11. 1st Year of Desig. Roth Contrib.
Also, enter in box 8 the amount of the reduction in the
Enter the first year of the 5-taxable-year period. This is the
investment (but not below 0 (zero)) against the cash value
year in which the designated Roth account was first
of an annuity contract or the cash surrender value of a life
established by the recipient.
insurance contract due to charges or payments for
qualified long-term care insurance contracts.
Boxes 12–17. State and Local Information
These boxes and Copies 1 and 2 are provided for your
Box 9a. Your Percentage of Total Distribution
convenience only and need not be completed for the IRS.
If this is a total distribution and it is made to more than one
Use the state and local information boxes to report
person, enter the percentage received by the person
distributions and taxes for up to two states or localities.
whose name appears on Form 1099-R. You need not
Keep the information for each state or locality separated
complete this box for any IRA distributions or for a
by the broken line. If state or local income tax has been
direct rollover.
withheld on this distribution, you may enter it in boxes 12
and 15, as appropriate. In box 13, enter the abbreviated
Box 9b. Total Employee Contributions
name of the state and the payer's state identification
You are not required to enter the total employee
number. The state number is the payer's identification
contributions or designated Roth contributions in box 9b.
number assigned by the individual state. In box 16, enter
However, because this information may be helpful to the
the name of the locality. In boxes 14 and 17, you may
recipient, you may choose to report them.
enter the amount of the state or local distribution. Copy 1
If you choose to report the total employee contributions
may be used to provide information to the state or local
or designated Roth contributions, do not include any
tax department. Copy 2 may be used as the recipient's
amounts recovered tax free in prior years. For a total
copy in filing a state or local income tax return.
distribution, report the total employee contributions or
designated Roth contributions in box 5 rather than in
box 9b.
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Instructions for Forms 1099-R and 5498 (2016)
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