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

Instructions for Employee (continued from

back of Copy B)

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

Box 12 (continued)

reporting this amount.

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

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

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

MSAs and Long-Term Care Insurance Contracts.

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

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

current year.

(not included in box 1)

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

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

1040-SS if not required to file Form 1040.

Adoption Expenses, to figure taxable and nontaxable amounts.

B—Uncollected Medicare 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.

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

(up to social security wage base), and 5

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

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

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

on Form 8889, Health Savings Accounts (HSAs).

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

401(k) arrangement.

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

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

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

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

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

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

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

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

to a section 457(b) deferred compensation plan

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

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

may be able to deduct.)

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

code DD is not taxable.

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

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

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

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

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

section 457(b) plan.

1040-SS if not required to file Form 1040.

FF—Permitted benefits under a qualified small employer health reimbursement

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

arrangement.

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

if not required to file Form 1040.

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

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

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

Contributions to Individual Retirement Arrangements (IRAs).

included in boxes 1, 3, or 5)

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

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

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

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

Form W-2as - American Samoa Wage And Tax Statement - 2017 Page 7

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