Form 8959 - Additional Medicare Tax - 2013
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18959
Additional Medicare Tax
OMB No. 1545-0074
2013
Form
If any line does not apply to you, leave it blank. See separate instructions.
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Attach to Form 1040, 1040NR, 1040-PR, or 1040-SS.
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Department of the Treasury
Attachment
71
Information about Form 8959 and its instructions is at
Internal Revenue Service
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Sequence No.
Name(s) shown on Form 1040
Your social security number
Part I
Additional Medicare Tax on Medicare Wages
1
Medicare wages and tips from Form W-2, box 5. If you have
more than one Form W-2, enter the total of the amounts
from box 5
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1
2
2
Unreported tips from Form 4137, line 6 .
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3
Wages from Form 8919, line 6 .
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3
4
Add lines 1 through 3 .
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4
5
Enter the following amount for your filing status:
Married filing jointly .
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. $250,000
Married filing separately .
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. $125,000
Single, Head of household, or Qualifying widow(er) $200,000
5
6
Subtract line 5 from line 4. If the result is zero or less, enter -0- .
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6
7
Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (.009). Enter here and
go to Part II .
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7
Part II
Additional Medicare Tax on Self-Employment Income
Self-employment income from Schedule SE
(Form 1040),
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Section A, line 4, or Section B, line 6. If you had a loss, enter
-0- (Form 1040-PR and Form 1040-SS filers, see instructions.)
8
9
Enter the following amount for your filing status:
Married filing jointly .
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. $250,000
Married filing separately .
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. $125,000
Single, Head of household, or Qualifying widow(er) $200,000
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10
Enter the amount from line 4
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10
11
Subtract line 10 from line 9. If zero or less, enter -0- .
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11
12
Subtract line 11 from line 8. If the result is zero or less, enter -0- .
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12
Additional Medicare Tax on self-employment income. Multiply line 12 by 0.9% (.009). Enter
13
here and go to Part III .
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13
Part III
Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation
14
Railroad retirement (RRTA) compensation and tips from
Form(s) W-2, box 14 (see instructions)
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14
15
Enter the following amount for your filing status:
Married filing jointly .
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. $250,000
Married filing separately .
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. $125,000
Single, Head of household, or Qualifying widow(er) $200,000
15
16
Subtract line 15 from line 14. If zero or less, enter -0-
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16
17
Additional Medicare Tax on railroad retirement (RRTA) compensation. Multiply line 16 by
0.9% (.009). Enter here and go to Part IV
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17
Part IV
Total Additional Medicare Tax
18
Add lines 7, 13, and 17. Also include this amount on Form 1040, line 60, (Form 1040NR,
1040-PR, and 1040-SS filers, see instructions) and go to Part V .
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18
Part V
Withholding Reconciliation
19
Medicare tax withheld from Form W-2, box 6. If you have
more than one Form W-2, enter the total of the amounts
from box 6
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19
20
Enter the amount from line 1
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20
21
Multiply line 20 by 1.45% (.0145). This is your regular
Medicare tax withholding on Medicare wages .
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21
22
Subtract line 21 from line 19. This is your Additional Medicare Tax withholding on Medicare
wages .
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22
23
Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form
W-2, box 14 (see instructions) .
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23
24
Total Additional Medicare Tax withholding. Add lines 22 and 23. Also include this
amount with federal income tax withholding on Form 1040, line 62 (Form 1040NR, 1040-PR,
and 1040-SS filers, see instructions) .
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8959
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2013)
Cat. No. 59475X
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