Guide To Your USAA Investment Management Company
Forms 1099-R (mutual fund IRAs), 1099-Q (mutual fund Coverdell ESAs),
USAA529CollegeSavingsPlanaccountsand1099-SA
For Tax Year 2015
We are committed to providing accuracy in reporting tax information related to your mutual fund
account(s) and help in understanding how it is used.
In this guide you will find helpful information regarding your USAA mutual fund account including
a general overview of:
•
a general overview of tax reporting requirements.
•
methods used to determine reported distributions from your investments.
•
the way the IRS treats distributions from your investments.
•
descriptions and explanations of tax forms related to your investments.
If applicable to any of your USAA accounts above, you may have received form(s) 1099-R, 1099-Q
or 1099-SA.
The information in this brochure is not legal or tax advice. We recommend that you consult your
legal and tax advisors if you need advice regarding your specific situation.
If a tax advisor prepares your income tax return, we encourage you to include the instructions for
recipient when providing copies of your form(s) 1099.
Tax Return Assistance on usaa.com
From the usaa.com home page, scroll down to “Documents and Forms” and sign up to receive your
tax forms electronically in the future.
In addition to the information in this guide, on usaa.com/taxes you may:
•
view and print your USAA form(s) 1099.
• learn how to download Form 1099 information into TurboTax®.
• receive a discount on your Federal filing using TurboTax® online.
• read articles on recent tax law changes.
• access other tools and information to answer general tax questions and help you complete
your tax return.
• link to IRS publications and forms.
TurboTax is a registered trademark, and TurboTax Online is a service mark of Intuit Inc. They are used with permission.
This document is not legal, tax, or investment advice. Consult your tax and legal advisers regarding your specific situation.
1
Form 1099-R
�
The Form 1099-R you receive from USAA IMCO provides information
to you and the IRS regarding distributions from your:
Form 1099-R What is it?
• IRAs (Traditional, Roth, SEP and SIMPLE)
• 403(b)(7)s
• Keogh plans
Form 1099-R is delivered to shareholders who had total or partial
distributions throughout the year from these types of accounts.
Conversions and recharacterizations are also shown on Form 1099-R.
Who receives it?
A conversion is a distribution of money from a traditional, SEP or
SIMPLE IRA that is rolled over to a Roth IRA.
Recharacterization refers to the treatment of a contribution
to one type of IRA as having been made to a different type of IRA,
or to the treatment of a conversion to a Roth IRA as though it had
not occurred.
You will use information from Form 1099-R when completing IRS form
1040 or 1040A, and you may also need to report it on one or more of
these IRS forms:
Where is it reported?
�
• Form 8606 (Nondeductible IRAs)
• Form 4972 (Tax on Lump-Sum Distributions)
• Form 5329 (Additional Taxes on Qualified Plans [Including IRAs]
and Other Tax-Favored Accounts)
2
Form 1099-R
�
] 1040
Department of the Treasury-Internal Revenue Service
(99)
U.S. Individual Income Tax Return
For the year Jan. 1-Dec. 31, 2015, or other tax year beginning
Your first name and initial
If a joint return, spouse's first name and initial
Last name
I 2015
, 2015, ending
1 0M B No. 1545-00741 IRS Use Only-Do not write or staple in this
See separate instructions.
Your social security number
, 20
Last name
Spouse's social security number
i
!
1
!
:
Home address (number and street). If you have a P.O. box, see instructions.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Apt. no.
I
:
Make sure the SSN(s) above
and on line 6c are correct.
:
:
Presidential Election Campaign
Check here if you, or your spouse if filing
want$3to go to this fund. Checking
-------------,jointly,
-----------------------Foreign postal code a box below will not change your tax or
Foreign province/state/county
Foreign country name
refund.
I
I
You
Spouse
D Single
D Married filing jointly (even if only one had income)
D Married filing separately. Enter spouse's SSN above
4
D
D
Head of household (with qualifying person). (See instructions.) If
Filing Status
the qualifying person is a child but not your dependent, enter this
child's name here. Check only one
3
box.
and full name here. 5
Qualifying widow(er) with dependent child
Boxes checked
6a
Yourself. If someone can claim you as a dependent, do not check box 6a
.
Exemptions
on 6a and 6b
Department
of the
Treasury-Internal Revenue Service
(99)
b
Spouse
· } No. of children
1 0M B No.
write or staple in this
(4) 1545-00741
.! if child underIRS
ageUse
17 Only-Do
onnot
6cwho:
U.S.
(2) Dependent's
(3) Dependent's
C Individual
Dependents: Income Tax Return
qualifying for child tax credit
• livedwith you
social security number , 2015,
relationship
See separate
instructions.
First name
Last name
For the year Jan. 1-Dec.(1)
31, 2015,
or other tax year beginning
ending to you
, 20
(see instructions)
• did not live
with
duesecurity
to divorce
Your first name and initial
Last name
Your you
social
number
Form 1040
�
1
2
I 2015
D
D
] 1040
D
D
If more than four
dependents, see
If a joint return, spouse's first name and initial
Last name
instructions and
check here Home address (number and
you haveof
a P.O.
box, see instructions.
d street).
TotalIf number
exemptions
claimed
D
D
D
D
D
(seei instructions)
!
:
:
Dependents
on 6c number
Spouse
security
's social
not
entered above
or separation
Apt. no.
D
:
Add: numbers
on
linessure
above
Make
the SSN(s) above
and on line 6c are correct.
!
1
I
7
Ba Presidential Election Campaign
Taxable interest. Attach Schedule B if required
Check here if you, or your spouse if filing
b Tax-exempt interest. Do not include on line 8a
I ab I
- ------------- - - I- --,jointly, want$3to go to this fund. Checking
-----------------------Attach
Foreign postal code 9a
Foreign
province/state/county
ForeignForm(s)
country name 9a Ordinary dividends. Attach Schedule
B if required
a box below will not change your tax or
W-2 here. Also
refund.
I
I
You
Spouse
b Qualified dividends
I 9b I
I
attach Forms
10 person). (See instructions.) If
10
Taxable
W-2G and
1
Single refunds, credits, or offsets of state and local income
4 taxesHead of household (with qualifying
Filing Status
1099-R if tax
11
Alimony
the qualifying person is a child 11
but not your dependent, enter this
Marriedreceived
filing jointly (even if only one had income)
2
was withheld.
child's name here. 12
12
Business
or (loss). Attach
ScheduleSSN
C orabove
C-EZ
Check only one
Marriedincome
filing separately.
Enter spouse's
3
box.
and full
name
here. Attach
5
Qualifying
widow(er)
with dependent
child
13
13
Capital
gain
or (loss).
Schedule D if required. If not required,
check here
If you did not
Boxes checked
14
14
gains orIf(losses).
Attach
Form you
4797
6a Other
Yourself.
someone
can claim
as. a dependent, do not check box 6a
.
Exemptions
get
a W-2,
on 6a and 6b
15b
b Taxable amount
15ab IRA Spouse
distributions
· } No. of children
see instructions.
(4)
.!
if
child
under
age
17
on 6cwho:
16b
16a
Pensions
and
annuities
b
Taxable
amount
(2)
Dependent's
(3)
Dependent's
C Dependents:
qualifying for child tax credit
• livedwith you
social securitySnumber
relationship
to etc.
you Attach
17
Rental real estate,
royalties, partnerships,
corporations,
trusts,
Schedule
E
(1)17First name
Last name
(see
instructions)
• did not live with
you
due to divorce
18
18
Farm income or (loss). Attach Schedule F
7
Wages, salaries, tips, etc. Attach Form(s) W-2
Income
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Ba
D
D
If more than four
dependents, see
instructions and
check here 19
D
Income
Adjusted
Gross
Attach
Form(s)
Income
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a W-2,
see instructions.
20a
21
22d
23
7
24
Ba
b
25
9a
26b
27
10
28
11
29
12
30
13
D
D
D
D
D
I :: I
Unemployment compensation
Social security benefits i 2oa I
D
I I
D
D
D
D
I
I b Taxable amount
D
------------------------------
Other income. List type and amount
Combine
the amounts
in the far claimed
right column for lines 7 through 21. This is your total income
Total
number
of exemptions
Educatorsalaries,
expenses
23
Wages,
tips, etc. Attach Form(s) W-2
Certain
business
expenses
reservists,Bperforming
Taxable
interest.
Attach of
Schedule
if requiredartists, and
The
amount
in
fee-basis government
officials.
Attach
Formon
2106
2106-EZ
24
b I
Tax-exempt
interest.
Do not
include
lineor8a
I a
D
Refer to the IRS
instruction book
for IRS Form
1040 for more
information.
19
20b
21
22
7
(see instructions)
Dependents on 6c
not entered above
or separation
Add numbers on
lines above
D
Ba
I
Health savings
account
deduction.
Attach
Form
8889 Form
251040 or line 11a of IRS
of IRS
Ordinary
dividends.
Attach
Schedule
B if required
9a Form 1040A. (Special reporting
Moving
26 I
9b
Qualifiedexpenses.
dividendsAttach Form 3903
I
I
rules SE
may apply for direct distributions to qualified charities made
Deductible
part of self-employment
tax.ofAttach
Taxable refunds,
credits, or offsets
stateSchedule
and local income27
taxes
10
1
IRS instructions for form 1040
by
taxpayers
Self-employed
SEP, SIMPLE, and qualified plans
28 age 70 /2 or over. See
11
Alimony received
box 1 of Form 1099-R should be reported on line 15a
Account Distributions
31a
14
32
15a
Self-employed
health
insurance
Business income
or (loss).
Attachdeduction
Schedule C or C-EZ
or 1040A.) 29
30
Penalty
on early
withdrawal
savings D
. if required. If not required,
Capital gain
or (loss).
Attachof
Schedule
check here
!
Alimonygains
paid orb(losses).
Recipient's
SSN
4797 .:
31a
Other
Attach
Form
:
b 32
Taxable amount
IRA deduction
distributions
I :: I
I I
D
12
13
14
15b
Student
16b
Pensionsloan
and interest
annuitiesdeduction .
b 33
Taxable amount
34 etc. Attach Schedule E
Tuition
and estate,
fees. Attach
Form
8917 .
17
Rental real
royalties,
partnerships,
S corporations, trusts,
If
the
amount
in
box
1
of
Form
1099-R
is a lump-sum distribution from
Domestic
production
activities
Form 8903
35
18
Farm income
or (loss).
Attachdeduction.
ScheduleAttach
F
a Keogh plan, “Total Distribution”
Add
lines 23 through
35
36
19 should be checked in box 2b. Use IRS
Unemployment
compensation
Subtract
line 36
from linei 222.
is your adjustedI gross income
37
20b
Social
security
benefits
amount
oa This
I
I b Taxable
Form 4972
(Tax on
Lump-Sum Distribution)
to choose the tax treatment
Form 1040 (2014)
For Disclosure, Privacy
and income.
Paperwork
Act Notice,
see separate instructions.
Cat. No. 11320B
21
21 Act,
Other
List Reduction
type and amount
-----------------------------may21.
beThisfavorable
to you, if22you are eligible.
22
Combine the amounts in the far right column for that
lines 7 through
is your total income
33
16a
34
17
35
18
36
19
37
20a
Lump-Sum Distribution
from Keogh Plan
Adjusted
Gross
Income
23
24
25
26
27
Educator expenses
Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
Health savings account deduction. Attach Form 8889
Moving expenses. Attach Form 3903
Deductible part of self-employment tax. Attach Schedule SE
...
23
24
25
26
27
3
Form 1099-R
Form 8606
Form
8606
Nondeductible IRAs
OMB No. 1545-0074
a Information about Form 8606 and its separate instructions is at www.irs.gov/form8606.
Department of the Treasury
Internal Revenue Service (99)
a Attach to Form 1040, Form 1040A, or Form 1040NR.
Name. If married, file a separate form for each spouse required to file Form 8606. See instructions.
7
8
9
10
11
12
g rollovers (see instructio
Enter your distributions from traditional, SEP, and SIMPLE IRAs in
2015. Do not include rollovers, a one-time distribution to fund an HSA,
conversions to a Roth IRA, certain returned contributions, or
recharacterizations of traditional IRA contributions (see instructions)
.
Enter the net amount you converted from traditional, SEP, and SIMPLE
IRAs to Roth IRAs in 2015. Do not include amounts converted that you
later recharacterized (see instructions). Also enter this amount on line 16 .
Add lines 6, 7, and 8 .............................................. 9
Divide line 5 by line 9. Enter the result as a decimal rounded to at least
3 places. If the result is 1.000 or more, enter “1.000”
. . . . . .
Multiply line 8 by line 10. This is the nontaxable portion of the amount
you converted to Roth IRAs. Also enter this amount on line 17 . . .
Multiply line 7 by line 10. This is the nontaxable portion of your
dis ibutions that you did not convert to
. . .
Nondeductible IRA Contributions
2015
Attachment
Sequence No. 48
Your social security number
7
8
10
×
.
11
12
If you made nondeductible IRA contributions for 201 5 or in previous
years, report the amount of these contributions on IRS Form 8606
(Nondeductible IRAs) to determine the taxable portion of your distribution.
Report the distribution amount from box 1 of Form 1099-R on line 7 or 8
of Form 8606.
4
Form 1099-R
�
Form
5329
Department of the Treasury
Internal Revenue Service (99)
Additional Taxes on Qualified Plans
(Including IRAs) and Other Tax-Favored Accounts
a
a
OMB No. 1545-0074
2015
Attach to Form 1040 or Form 1040NR.
Information about Form 5329 and its separate instructions is at www.irs.gov/form5329.
Name of individual subject to additional tax. If married filing jointly, see instructions.
Your social security number
Home address (number and street), or P.O. box if mail is not delivered to your home
Form by Itself and Not
With Your Tax Return
Form
5329
F
Fill in Your Address Only
FormIf5329
You Are Filing This
City, town or post office, state, and ZIP code. If you have a foreign address, also complete
the spaces below (see instructions).
Attachment
Sequence No. 29
Apt. no.
If this is an amended
return, check here a
province/state/county
Foreign postal code
OMB No. 1545-0074
Additional Taxes onForeign
Qualified
Plans
(Including IRAs) and Other Tax-Favored Accounts
Foreign country name
2015
If you only owe the additional 10% tax on early distributions, you may be able to report this tax directly on Form 1040, line 59, or
Form 1040NR, line 57, without filing Form 5329. a
See
the instructions
fororForm
line 59, or for Form 1040NR, line 57.
Attach
to Form 1040
Form1040,
1040NR.
Department of the Treasury
Part
I Service
a Information
Internal
Revenue
(99)
this partinstructions
if you took aistaxable
distribution before you
Additional
Tax
on Earlyabout
Distributions.
Form 5329 Complete
and its separate
at www.irs.gov/form5329.
Attachment
F
Sequence
No. 29
reached
age 59½
from
a qualified
retirement
plan (including
IRA)
or modified endowment contract (unless you are reporting
taxsecurity
directlynumber
on
Name of individual
subject
to additional
tax. If married
filing jointly,an
see
instructions.
Your this
social
Form 1040 or Form 1040NR—see above). You may also have to complete this part to indicate that you qualify for an exception to
the additional tax on early
distributions or for certain Roth IRA distributions (see instructions).
Home address (number and street), or P.O. box if mail is not delivered to your home
Apt. no.
1
Early distributions included in income. For Roth IRA distributions, see instructions . . . . . .
1
Early
distributions
on line 1 that are not subject to the additional tax (see instructions).
Fill in2Your
Address
Only included
City, town or post office, state, and ZIP code. If you have a foreign address, also complete
Enter
the
appropriate
exception
number
from
the instructions:
. . . . . . . . .
2
the
spaces
below (see
instructions).
If You Are Filing This
If this is an amended
Amount
subject
3
Form3by Itself
and
Not to additional tax. Subtract line 2 from line 1 . . . . . . . . . . . . .
return, check here a
With 4YourAdditional
Tax Return
tax. Enter 10% (.10) of line 3. Include this amount on Form 1040, line 59, or Form 1040NR, line 57 .
4
Foreign country name
Foreign province/state/county
Foreign postal code
Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have
to include 25% of that amount
lineForm
4 instead
of 10%
(see instructions).
Box on
7 of
1099-R
identifies
the distribution type. See Instructions for Recipient,
Part
II owe
If you
only
the additional
early distributions,
you
able to report
this
taxAccounts.
directly
onComplete
Form here.
1040,
Additional
Tax on10%
Certain
Distributions
Education
Accounts
and
ABLE
this line
part 59,
if or
Boxtax7, on
of
your
Form From
1099-R
formay
an be
explanation
of the
code(s)
appearing
Form 1040NR,
line
57, without
filing Form
5329.onSee
the1040
instructions
for Form line
1040,
or for Form
1040NR,
line 57.
you
included
an amount
in income,
Form
or Form 1040NR,
21,line
from59,
a Coverdell
education
savings
account
Part I
(ESA), a qualified
tuition
program
(QTP), or anComplete
ABLE account.
Additional
Tax on
Early
Distributions.
thisdistributions
part if you took made
a taxable
distribution
before youage
reached
59½
For example,
code 1 indicates
before
you reached
59 1/age
2
5
Distributions
included
in
income
from
a
Coverdell
ESA,
a
QTP,
or
an
ABLE
account
.
.
.
.
.
5
from a qualified retirement plan (including an IRA) or modified endowment contract (unless you are reporting this tax directly on
and5 that
are,
general,thesubject
to tax
a 10%
additional tax.
as explained
6
Distributions
included
on line
that above).
are
notinsubject
additional
(seethis
instructions)
. . However,
. you
6 qualify
Form 1040
or
Form 1040NR—see
You maytoalso
have to complete
part to indicate
that
for an exception to
Distribution
Type
7
Amount
subject
to
additional
tax.
Subtract
line
6
from
line
5
.
.
.
.
.
.
.
.
.
.
.
.
.
7
in
the
Form
1040
instructions,
certain
exceptions
to
the
additional
tax apply
the additional tax on early distributions or for certain Roth IRA distributions (see instructions).
Additional
tax. Enter
10% (.10)
line 7. Include
this amount
on Form 1040,see
line 59, or Form 1040NR,
1 8 Early
distributions
included
inofincome.
Forto
Roth
IRA distributions,
. .homebuyers’
.line. 57. . 8 expenses,
1
with
respect
qualified
withdrawals instructions
for first-time
higher
Part
III
Additional Tax
on Excess
to Traditional
IRAs. Complete
this part if you contributed more to your
2
Early distributions
included
on line Contributions
1 that
are not subject
to the
additional
tax (see instructions).
education
expenses,
medical
insurance
premiums
and
deductible
medical
expenses.
IRAs for 2015 than is allowable or you had an amount on line 17 of your 2014 Form 5329.
Enter traditional
the appropriate
exception number from the instructions:
. . . . . . . . .
2
Forfrom
further
of5329
exceptions,
see IRS
Publication
9
Enter your excess contributions
line 16clarification
of your 2014 Form
(see instructions).
If zero,
go to line 15 590-B
9 Individual
3
Amount subject to additional tax. Subtract line 2 from line 1 . . . . . . . . . . . . .
3
10
If your traditional IRA contributions
for
2015 are lessdiscussed
than yourin Chapter 1 under Early Distributions.
Retirement
Arrangements
4
Additional tax. Enter 10% (.10)
of line 3. Include
this amount on Form
1040, line 59, or Form 1040NR, line 57 .
4
maximum allowable contribution, see instructions. Otherwise, enter -010
Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have
11
2015 traditional IRA distributions included in income (see instructions) .
11
to include 25% of that amount on line 4 instead of 10% (see instructions).
12
2015 distributions of prior year excess contributions (see instructions) .
12
Part
Additional
Tax
on12Certain
and
Complete
13 II Add
lines 10, 11,
and
.If your
. . Distributions
.Form
. . 1099-R
. . . From
. . aEducation
.distribution
. . . .Accounts
. code
. . 1 .in
.box
.ABLE
. Accounts.
. you
13qualify
has
7. and
for anthis part if
you year
included
ancontributions.
amount in income,
online
Form
1040
or Form
1040NR,
line
21,-0from. a .Coverdell
education
savings account
14
Prior
excess
Subtract
13
from
line
9.
If
zero
or
less,
enter
.
.
.
14
exception
to the additional
tax, you may be required to file Form 5329 (Additional
(ESA), contributions
a qualified tuition
program
(QTP), or an .ABLE
15
Excess
for 2015
(see instructions)
. . account.
. . . . . . . . . . . . . .
15
Distribution
Code
1
Taxes
on
Qualified
Plans
[Including
and
5 16 Distributions
included
in income
ABLE
.. .. .. . 16 5Accounts).
Total excess
contributions.
Add from
lines a
14Coverdell
and 15 .ESA,
. .a QTP,
. . or
. an
. IRAs]
. . .account
. Other
. . . . Tax-Favored
6 17 Distributions
included
line
are of
not
the additional
tax
(see
instructions)
.5329,
.
6
Report
the
amount
intobox
1 of
Form
on Form
line
1.
Additional tax.
Enter 6%on
(.06)
of 5
thethat
smaller
linesubject
16 or the
value
of
youryour
traditional
IRAs1099-R
on December
31, .2015
7
Amount
subject
to additional
tax.
Subtract
line
from line
5 .1040,
. line
. 59,
. or
. Form
. .1040NR,
. . line
. 57
. .. . 17 7
(including
2015 contributions
made
in 2016).
Include
this6amount
on Form
tax. EnterTax
10%on
(.10)
of line 7.
Include this amount
on Form
1040,
line 59, orthis
Form
line 57
8PartAdditional
IV Additional
8
Excess
Contributions
to Roth
IRAs.
Complete
part1040NR,
if you contributed
more
to your Roth
IRAs for 2015
than
is
allowable
or
you
had
an
amount
on
line
25
of
your
2014
Form
5329.
Part III Additional
Tax on Excess Contributions to Traditional IRAs. Complete this part if you contributed more to your
Enter
your excess
fromisline
24 of your
5329
(see instructions).
go2014
to lineForm
23 5329.
18
18
traditional
IRAscontributions
for 2015 than
allowable
or2014
you Form
had an
amount
on line 17Ifofzero,
your
If your
IRA
contributions
than
your
maximum
9 19 Enter
your Roth
excess
contributions
fromfor
line2015
16 ofare
yourless
2014
Form
5329
(see instructions). If zero, go to line 15
9
contribution,
instructions. for
Otherwise,
enterless
-0- .than
. . your
.
19
10
If allowable
your traditional
IRA see
contributions
2015 are
20 maximum
2015 distributions
your Rothsee
IRAs
(see instructions)
. . enter
. . -0.
2010
allowable from
contribution,
instructions.
Otherwise,
21
Add
lines
19
and
20
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.11 . . . . . . .
21
11
2015 traditional IRA distributions included in income (see instructions) .
22
Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter -0- . . . . .
22
5
Form 1099-R
�
State Income Tax
Any state income tax withheld from retirement account distributions will
be shown in box 12. For more information, see IRS Publication 590-B
(Individual Retirement Arrangements).
6
Form 1099-Q
�
The Form 1099-Q you receive from USAA IMCO provides information to
you and the IRS regarding distributions or trustee-to-trustee transfers
from your:
Form 1099-Q What is it?
Who receives it?
• Coverdell Education Savings Account (ESA).
• 529 College Savings Plan Account, a qualified tuition program
(QTP) defined under Internal Revenue Code section 529.
In the event you took distributions from both a USAA Coverdell ESA and
a USAA 529 College Savings Plan Account, you will receive a separate
Form 1099-Q for each account.
Where is it reported?
You may need to use information from Form 1099-Q when completing
IRS form 1040 or 1040A, and you may also need to report it on IRS Form
5329 (Additional Taxes on Qualified Plans [including IRAs] and Other
Tax-Favored Accounts).
7
Form 1099-Q
�
Taxable Distributions
IRS Publication 970 (Tax Benefits for Education) provides information to
recipients for figuring and reporting the taxable portion of a withdrawal,
if any, reported on Form 1099-Q. We also recommend that you consult a
tax advisor regarding:
• the benefits and taxable events of ESAs and qualified tuition programs. • the restrictions that apply to designating a beneficiary.
• the calculation of taxable amounts.
In general, part or all of the amount shown in box 1 is taxable to the
beneficiary, who should report the taxable amount on Form 1040, line
21 (“Other income”). (The payer—USAA—is not required to and does not
compute the taxable amount of any ESA or 529 College Savings Plan
Account distribution.) See Form 1040 on the next page.
Distributions that meet certain criteria are not taxable and need not be
reported on Form 1040. These distributions may include:
Non-Taxable Distributions
• One transfer or rollover per beneficiary in a 12-month period
to another education program, completed within 60 days of
the distribution.
• Qualified education expenses (limited to higher education
expenses for a 529 College Savings Plan Account) totaling
at least as much as the amount withdrawn.
8
instructions and
check here D
Income
Form 1040
�
d
7
not entered above
D
D
Total number of exemptions claimed
Wages, salaries, tips, etc. Attach Form(s) W-2
Taxable interest. Attach Schedule B if required
b Tax-exempt interest. Do not include on line 8a
9a Ordinary
dividends. Attach
B if(99)
required
Department
of the Treasury-Internal
Revenue Schedule
Service
7
Add numbers on
lines above
D
I ab I
I
Attach Form(s)
9a
W-2 here. Also
IRS Use Only-Do not write or staple in this
9b I1 0M B No. 1545-00741
b Qualified dividends
I
I
attach Forms
U.S. Individual Income Tax Return
10
Taxable refunds, credits, or offsets of state and local income taxes
10
W-2G
See separate instructions.
For theand
year Jan. 1-Dec. 31, 2015, or other tax year beginning
, 2015, ending
, 20
OMB No. 1545-0074
1099-R if tax
11Your social
11
Alimony
received
Your first name and initial
Last name
security number
was withheld.
Form
12
12
Business income or (loss). Attach Schedule C or C-EZ
!
i
:
:
13
13
Capital
gain
or
(loss).
Attach
Schedule
D
if
required.
If
not
required,
check
here
Spouse's social security number
If a joint return, spouse's first name and initial
Last name
a Attach to Form 1040 or Form 1040NR.
If you did not
14
Other gains or (losses). Attach
Form 4797 .
Department of the Treasury 14
!
Attachment
1
get
a
W-2,
:
:
Internal Revenue Service (99)15a aIRA
Sequence
No. 29
Information about Form 5329 and its separate instructions
is at www.irs.gov/form5329.
b Taxable
amount
Home
address (number and street). distributions
If you have a P.O. box, see instructions.
Apt. no. 15b Make sure the SSN(s) above
see
instructions.
Name of individual subject to additional tax. If married filing jointly, see instructions.
Your social security number
16a Pensions and annuities
b Taxable amount I
16b and on line 6c are correct.
17 Presidential Election Campaign
17 andRental
real
estate,
partnerships,
S corporations,
trusts,
etc. Attach Schedule E
City, town or post office, state,
ZIP code.
If you
have aroyalties,
foreign address,
also complete
spaces below (see
instructions).
Ba
] 1040
5329
Ba
I 2015
Additional Taxes on Qualified Plans
(Including IRAs) and Other Tax-Favored Accounts
D
I :: I
I I
2015
18
Farm income or (loss). Attach Schedule F
18
Check here if you, or your spouse if filing
- -------------- - - - --,jointly,
-----------------------19 want$3to go to this fund. Checking
19
Unemployment
compensation
postal
Foreig
code
Foreign
province/state/county
Foreign
country
name
n
a box below will not change your tax or
Fill in Your Address Only
City, town or post office, state, and ZIP code. If you have a foreign address, also complete
20a Social security
benefits i 2oa I
20b
I
refund.
I b Taxable amount
I
I
You
Spouse
the spaces below (see
instructions).
If You Are Filing This
21
Other income. List type and amount ------------------------------ If this
21 is an amended
Form by Itself and Not
1
Single
4
Head of household (with qualifying
person).
(See
instructions.)
If
return,
Filing
Status
22
Combine the amounts in the far right column for lines 7 through 21. This is your total income
22 check here a
With
Your
Tax Return
the qualifying person is a child
but not
your code
dependent, enter this
2
Married
filingcountry
jointly name
(even if only one had income)
Foreign
Foreign province/state/county
Foreign
postal
23
Educator expenses
23
child's name here. Check only one
3
Married filing separately. Enter spouse's SSN above
Adjusted
24
Certain
business
expenses
of
reser
v
ists,
performing
artists,
and
box.
and full name here. 5
Qualifying widow(er) with dependent child
fee-basis
government
Attach Form 2106
or 2106-EZ
24to report this tax directly on Form
If Gross
you only owe the additional
10%
tax on officials.
early distributions,
you
may be able
1040,
line 59, or
Boxes
checked
6a
Yourself. If someone can claim you as a dependent, do not check box 6a
.
Income
Exemptions
Form
1040NR, line 57,
filing
Form
5329.deduction.
See the instructions
Form 1040,
57.
on 6a
and 6b
25 without
Health
savings
account
Attach Form for
8889
25 line 59, or for Form 1040NR, line
b
Spouse
· } No. of children
Part
I Additional
Form
5329
26 Tax
Moving
expenses.
Attach Form 3903
26 a taxable
Complete
this part if you
took
distribution
before
on Early
Distributions.
(4) .!
if child under age
17 youonreached
6cwho: age 59½
(2) Dependent's
(3) Dependent's
C Dependents:
qualifying for
childare
tax reporting
credit
• lived
with
you on
27
Deductible part
of (including
self-employment
tax. or
Attach
Schedule
SErelationship
27contract
from a qualified
retirement
plan
an
IRA)
modified
endowment
(unless
you
this
tax
directly
social
security
number
to
you
(1) First name
Last name
(see instructions)
• did not live with
Form 104028
or Form
1040NR—see
You
also have
fordue
an
Self-employed
SEP,above).
SIMPLE,
andmay
qualified
plansto complete
28this part to indicate that you qualify
you
toexception
divorce
OMB
No.
1545-0074 to
or separation
the
additional
on early distributions
or for certain
Roth IRA distributions
29 taxSelf-employed
health insurance
deduction
29 (see instructions).
Form
If more than
four
(see instructions)
1
Early distributions
income.
For Roth
IRA distributions,
see instructions
. . . . . .
1
dependents,
see
30 included
30
Penalty oninearly
withdrawal
of savings
.
Dependents on 6c
not entered above
! additional tax (see instructions).
instructions
2
Early and
distributions
on line
1 that a
are
not
subject
to
the
31a included
Alimony paid
b Recipient's
SSN
31a
:
:
Attach to Form 1040 or Form 1040NR.
Department
of the Treasury
check here
Attachment
numbers on
Enter
the appropriate
exception
number
from
the
instructions:
. is. at.www.irs.gov/form5329.
. . . . . .
2 Add
32
deductionabout
Internal Revenue
Service
(99)32d aIRA
Sequence
Information
Form
5329
and
its separate instructions
Total
number of exemptions
claimed
lines
above No. 29
3
Amount
subject
to
additional
tax.
Subtract
line
2
from
line
1
.
.
.
.
.
.
.
.
.
.
.
.
.
3
Student
interest
33
Name of individual subject 33
to additional
tax. loan
If married
filingdeduction
jointly, see .instructions.
Your social security number
7
7
Wages, salaries, tips, etc. Attach Form(s) W-2
4
Additional tax.34
Enter Tuition
10% (.10)
line 3.
Include
this8917
amount
on Form 1040, line 59,
4
Income
34 or Form 1040NR, line 57 .
andoffees.
Attach
Form
.
Ba
Taxable interest. Attach Schedule B if required
Ba
Caution: If any
of theHome
amount
on
line
3
was
a
distribution
from
a
SIMPLE
IRA,
you
may
have
35 partDomestic
production
activities
deduction.
Attach
Form
8903
35
address (number and street), or P.O. box if mail is not delivered to your home
Apt. no.
b Tax-exempt interest. Do not include on line 8a
I ab I
I
to include 25%
on line 435instead of 10% (see instructions).
36of that
Addamount
lines 23 through
36
Attach Form(s)
9a Ordinary dividends. Attach Schedule B if required
9a
Part
II Also
Subtract
linetown
36 from
line
22. This
your
gross
W-2
Fill
in here.
Your
Address 37
Only
37
Additional
Tax
on Certain
Distributions
From
Education
andalso
ABLE
Accounts.
Complete this part if
City,
or
post
office,
state,is
and
ZIPadjusted
code.
If you
haveAccounts
aincome
foreign address,
complete
b Qualified
dividends
I 9b I
I
Forms
the
spaces
below
(see
instructions).
If attach
You
Are
Filing
This
1040 (2014)
Formaccount
you included
an amount
in income,
on Form
1040
or Form
1040NR,
line 21, from a Coverdell
savings
For Disclosure,
Privacy Act,
and Paperwork
Reduction
Act
Notice,
see separate
instructions.
Cat. No. education
11320B
If this
10
Taxable refunds, credits, or offsets of state and local income taxes
10 is an amended
W-2Gby
and
Form
Itself
and
Not
(ESA),
a
qualified
tuition
program
(QTP),
or
an
ABLE
account.
a
return,
1099-R
if tax
11 check here
11
Alimony received
With
Your
Tax Return
5 postal code
5 withheld.
Distributions included in income
from aname
Coverdell ESA, a QTP, or
an ABLE
account . . . . . Foreign
was
Foreign country
Foreign
province/state/county
12
12
Business income or (loss). Attach Schedule C or C-EZ
6
Distributions included on line 5 that are not subject to the additional tax (see instructions) . . .
6
13
13
Capital gain or (loss). Attach Schedule D if required. If not required, check here 7
Amount
subject
to
additional
tax.
Subtract
line
6
from
line
5
.
.
.
.
.
.
.
.
.
.
.
.
.
7
you only
did not
If Ifyou
owe the
additional
on
early
distributions,
may
beline
able
this taxline
directly
on
14 Form 1040, line 59, or
gains tax
(losses).
Attach
4797 you
8 a W-2,
Additional
tax.14
Enter Other
10% 10%
(.10)
oforline
7. Include
thisForm
amount
on. Form
1040,
59,to
or report
Form 1040NR,
57
8
get
Form 1040NR, line 57,
without
filing Form 5329. See the instructions for Form 1040,
line amount
59, or for Form 1040NR,
15b line 57.
15a
IRA distributions
b Taxable
see instructions.
Home address (number and street), or P.O. box if mail is not delivered to your home
F
D
D
D
D
D
D
D
D
D
5329
Apt. no.
Additional Taxes on Qualified Plans D
D
(Including IRAs) and Other Tax-Favored Accounts
D
D
D
2015
D
F
...
I :: I
I I
D
Part III Additional Tax on Excess Contributions to Traditional IRAs. Complete this part if you contributed more to your
Part I Additional
16b
16aTax
Pensions
and annuities
btook
Taxable
amount
on2015
Early
Distributions.
thisamount
part if you
a taxable
traditional IRAs
for
than
is allowable or Complete
you had an
on line
17
of your distribution
2014 Form before
5329. you reached age 59½
17 this tax directly on
17
Rental real plan
estate,
royalties,an
partnerships,
S corporations,
trusts,
etc. Attach
Schedule
from a qualified
retirement
(including
IRA) or modified
endowment
contract
(unless
you areE reporting
9
Enter your excess contributions from line 16 of your 2014 Form 5329 (see instructions). If zero, go to line 15
9
Form 104018
or Form
1040NR—see
above).
You
may
also
have
to
complete
this
part
to
indicate
that
you
qualify
for anincluded
exception in
to
18
Farm
income or (loss).
Attach
Schedule
F
An2015
additional
10%
tax your
may apply to part or all of the amount
10
If your
traditional
IRA
contributions
for
are
less
than
the additional
on early distributions
or for certain Roth IRA distributions (see instructions).
19
19 taxUnemployment
compensation
income
from
an ESA
or-0529 College
Savings Plan Account.
(Publication
maximum allowable contribution, see instructions.
Otherwise,
enter
10
1
Early distributions
in income.
. . . . . . 20b
1
20a included
Social security
benefitsFor
b Taxable amount
i 2Roth
oa I IRA distributions,
I seeI instructions
11
2015 traditional
IRA
distributions
included
in
income
(see
instructions)
.
11
970
outlines
in the
detail
the exceptions
to this tax.) 21
Additional
Taxes
�
2
Early distributions
on line
that and
are
not
subject
to
additional
tax (see instructions).
21 included
Other
income.
List1 type
amount
-----------------------------12
2015 distributions of prior year excess contributions (see
instructions) .
12
Enter the appropriate
exception
number
from
the column
instructions:
. . total
. income
. . . .
2
22
Combine
the amounts
in the
far right
for lines 7 through 21. .This. is your
22
13
Add lines 10, 11, and 12 . . . . . . Generally,
. . . . . amount
. . . . . . taxable
. . . . . . . . is to
13 be reported on
3
Amount subject
tax. Subtract line 2 from the
line 1 . . . of. the
. . . . distribution
. . . . .
3
23 to additional
Educator expenses
23
14
Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter -0- . . . . .
14
Adjusted
4
Additional tax. 24
Enter 10%
of lineexpenses
3. Include
this vamount
on Form
1040,and
line 59, or Form 1040NR, line 57 .
4
Form
5329.
Certain(.10)
business
of
reser
ists,
performing
artists,
15
Excess contributions for 2015 (see instructions) . . . . . . . . . . . . . . . . .
15
Gross
Caution: If any partfee-basis
of the government
amount on
line 3Attach
was Form
a distribution
from a SIMPLE
IRA, you may have
officials.
2106 or 2106-EZ
24
16
Total
excess
contributions.
Addonlines
and 15of .10%
. (see
. . instructions).
. . . . . . . . . . . . .
16
to
include
25%
amount
line 14
4 instead
Income
25of that
Health
savings
account
deduction. Attach
Form 8889
25
17
Additional
tax.
Enter
6%
(.06)
of
the
smaller
of
line
16
or
the
value
of
your
traditional
IRAs
on
December
31,
2015
Part II Additional
26 TaxMoving
expenses.
Attach Form 3903
26
on Certain
Distributions
From Education Accounts
and ABLE Accounts. Complete this part if
(including 2015 contributions made in 2016). Include this amount on Form 1040, line 59, or Form 1040NR, line 57 .
17
you included
amount in
income,
on Form 1040
or Form
1040NR,
line
27 anDeductible
part
of self-employment
tax. Attach
Schedule
SE
27 21, from a Coverdell education savings account
Part IV Additional Tax on Excess Contributions to Roth IRAs. Complete this part if you contributed more to your Roth
(ESA), a qualified
tuition program
or and
an ABLE
account.
28
Self-employed
SEP,(QTP),
SIMPLE,
qualified
plans
28
IRAs for 2015 than is allowable or you had an amount on line 25 of your 2014 Form 5329.
5
Distributions included
in income from
Coverdelldeduction
ESA, a QTP, or an ABLE
5
29
Self-employed
healthainsurance
29account . . . . .
Enter your excess contributions from line 24 of your 2014 Form 5329 (see instructions). If zero, go to line 23
18
18
6
Distributions included
on line
5 thatwithdrawal
are not subject
to the
additional tax (see
6
30
30 instructions) . . .
Penalty
on early
of savings
.
19
If your Roth
IRA contributions
for 2015 are
less
than
! maximum
7
Amount
subject
line
6 from
lineyour
. . . 31a
. . . . . . . . .
7
31ato additional
Alimony paidtax.
b Subtract
Recipient's
SSN
: 5 :.
allowable tax.
contribution,
see
Otherwise,
enter
-0- . 1040,
. .line. 59, 19
Additional
Enter 10%
(.10)instructions.
of line 7. Include
this amount
on Form
8
8
32
32 or Form 1040NR, line 57
IRA deduction
20
distributions from your Roth IRAs (see instructions) . . . . .
20
Part
III2015
Additional
Tax
on
Excess
Contributions
to
Traditional
IRAs.
Complete
this
part
if
you
contributed
more to your
33
Student loan interest deduction .
33
21
Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . .
21
traditional 34
IRAs for
2015
than
is
allowable
or
you
had
an
amount
on
line
17
of
your
2014
Form
5329.
34
Tuition and fees. Attach Form 8917 .
22
Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter -0- . . . . .
22
9
Enter your excess
from lineactivities
16 of your
2014 Form
5329
(see
instructions).
If zero, go to line 15
9
35 contributions
Domestic production
deduction.
Attach
Form
8903
35
23
Excess contributions for 2015 (see instructions) . . . . . . . . . . . . . . . . .
23
10
If your traditional
IRAlines
contributions
36
Add
23 through 35for 2015 are less than your
36
24
Total excess contributions. Add lines 22 and 23 . . . . . . . . . . . . . . . . .
24
maximum allowable
contribution,
enter
-0- income
10
37
Subtract
line 36 see
frominstructions.
line 22. This isOtherwise,
your adjusted
gross
37
Additional tax. Enter 6% (.06) of the smaller of line 24 or the value of your Roth IRAs on December 31, 2015
25
11
2015 traditional
included
in income
(see see
instructions)
.
11
Form 1040 (2014)
For Disclosure,
PrivacyIRA
Act,distributions
and Paperwork
Reduction
Act Notice,
separate instructions.
(including 2015
contributions
made in 2016).
Include this
amount on
Form
1040, line 59, or Form 1040NR,Cat.
lineNo.
5711320B25
12
2015 distributions of prior year excess contributions (see instructions) .
12
Form 5329 (2015)
For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions.
13
Add lines 10, 11, and 12 . . . . . . . . . . . . . . . . . . . . . Cat.
. No.
. 13329Q
. .
13
14
Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter -0- . . . . .
14
...
9
Form 1099-SA
�
Form
8853
Department of the Treasury
Internal Revenue Service (99)
Name(s) shown on return
Archer MSAs and
Long-Term Care Insurance Contracts
▶
OMB No. 1545-0074
Information about Form 8853 and its separate instructions is available at www.irs.gov/form8853.
▶ Attach to Form 1040 or Form 1040NR.
2015
Attachment
Sequence No. 39
Social security number of MSA
account holder. If both spouses
have MSAs, see instructions ▶
Section A. Archer MSAs. If you have only a Medicare Advantage MSA, skip Section A and complete Section B.
Part I
Archer MSA Contributions and Deductions. See instructions before completing this part. If you are filing
jointly and both you and your spouse have high deductible health plans with self-only coverage, complete a
separate Part I for each spouse.
1
2
Total employer contributions to your Archer MSA(s) for 2015 . . . .
1
Archer MSA contributions you made for 2015, including those made from January 1, 2015,
through April 15, 2016, that were for 2015. Do not include rollovers (see instructions) . . .
.
.
3 8853
Limitation from the Line 3 Limitation Chart and Worksheet in the instructions . . . . . . .
Form
4
Compensation (see instructions) from the employer maintaining the high deductible health plan. (If
self-employed, enter your earned income from the trade or business under which the high
deductible health plan was established.)
. .Archer
. . . MSAs
. . . . and
. . . . . . . . . .
Form
5
8853
Long-Term
Care
Contracts
Archer MSA deduction. Enter the
smallest of line
2, 3, orInsurance
4 here. Also include
this amount on
2
3
4
▶ Information about Form 8853 and its separate instructions is available at www.irs.gov/form8853.
Department
of the1040,
Treasuryline 36,
Form
or Form 1040NR, line 35. On the dotted line next to Form 1040, line 36, or
▶ Attach to Form 1040 or Form 1040NR.
Internal Revenue Service (99)
Form 1040NR, line 35, enter “MSA” and the amount . . . . . . . . . . . . . . . .
5
Social security number of MSA
Name(s) shown on return
Caution: If line 2 is more than line 5, you may have to pay an account
additional
taxIf both
(seespouses
instructions).
holder.
have MSAs, see instructions ▶
OMB No. 1545-0074
2015
Attachment
Sequence No. 39
Archer MSA Distributions
Part II
Section
A. Archer MSAs. If you have only a Medicare Advantage MSA, skip Section A and complete Section B.
6a Total distributions you and your spouse received in 2015 from all Archer MSAs (see instructions) .
6a
Part I
Archer MSA Contributions and Deductions. See instructions before completing this part. If you are filing
b Distributions included on line 6a that you rolled over to another Archer MSA or a health savings
jointly and both you and your spouse have high deductible health plans with self-only coverage, complete a
account. Also include any excess contributions (and the earnings on those excess contributions)
separate Part I for each spouse.
included on line 6a that were withdrawn by the due date of your return (see instructions) . . . .
6b
Total employer contributions to your Archer MSA(s) for 2015 . . . .
1
Subtract line 6b from line 6a
. . . . . . . . . . . . . . . . . . . . . . .
6c
Archer MSA contributions you made for 2015, including those made from January 1, 2015,
Unreimbursed qualified medical expenses (see instructions) . . . . . . . . . . . . .
7
through April 15, 2016, that were for 2015. Do
not include rollovers
(see
instructions)
. . . . .from2Archer Medical
Form
shareholder
distributions
Taxable Archer MSA distributions. Subtract
line 71099-SA
from lineshows
6c. If zero
or less, enter
-0-. Also
Limitation from theWhat
Line 3 Limitation
Chart and
Worksheet in the (MSAs).
instructions
. . receive
. . .one
. if
. you3 had distributions
Form
is it?
�
Savings
You
include1099-SA
this amount in the total
on Form 1040,
line 21,Accounts
or Form 1040NR, line
21.will
On the dotted
Compensation
(see
instructions)
from
the
employer
maintaining
the
high
deductible
health
plan.
(If
during
line next to line
21,receives
enter “MSA”
and the amount
. the
. . year.
. . (Archer
. . . MSAs
. . are
. . no. longer
. . .offered
.
Who
it?
�
8 by USAA IMCO
self-employed, enter your earned income from
trade
or business under which the high
forthe
new
accounts.)
9a If any of the distributions included on line 8 meet
any of
the Exceptions to the Additional
deductible health plan was established.)
. . . . . . . . . . . . . . . . . . .
4
20% Tax (see instructions), check here . . . . . . . . . . . . . . . . . . ▶
5
Archer MSA deduction. Enter the smallestYou
of line
2,
3,
or
4
here.
Also
include
this
amount
on
file
Form 8853
(Archer
MSAs
and Long-Term Care
b Additional 20% tax (see instructions). Enter 20%must
(.20) of
theIRS
distributions
included
on line
8 that
Form 1040, line 36, or Form 1040NR, line 35. On the dotted line next to Form 1040, line 36, or
Insurance
Contracts)
IRS1040,
Formline
1040
are subject to the additional 20% tax. Also include
this amount
in thewith
total your
on Form
62, to report a distribution
Form 1040NR, line 35, enter “MSA” and the amount . . . . . . . . . . . . . . . .
5
MSA
andline
calculate
the taxable
or Form 1040NR, line 60. On the dotted line from
next toan
Form
1040,
62, or Form
1040NR,portion.
line 60, (The payer—USAA—is
Caution: If line 2 is more than line 5, you may have to pay an additional tax (see instructions).
enter “MSA” and the amount . . . . .not
. required
. . . .to .and
. does
. . not
. . compute
. . . the
. . taxable
. .
amount
of any
9b
1
c
2
7
8
3
4
Archer MSA Distributions
Part II
Section B. Medicare Advantage MSA Distributions.
If you are filing jointly and both you and your spouse received
MSA distribution.)
6a Total Where
distributions
and your spouse received in 2015 from all Archer MSAs (see instructions) .
6a
is ityou
reported?
distributions
in 2014 from a Medicare Advantage MSA, complete a separate Section B for each spouse (see
b Distributions
included
on
line
6a
that
you
rolled
over
to
another
Archer
MSA
or
a
health
savings
instructions).
An MSA distribution, shown in box 1, generally is not taxable if you used
account. Also include any excess contributions (and the earnings on those excess contributions)
pay qualified
medical
expenses
for yourself
10
Total distributions you received in 2014 fromitalltoMedicare
Advantage
MSAs
(see instructions)
. . or your
10 family, or if you
included on line 6a that were withdrawn by the due date of your return (see instructions) . . . .
6b
rolled
it over to.another
11
Unreimbursed qualified medical expenses (see
instructions)
. . . MSA
. . or. health
. . savings
. . . .account
11 (HSA). Otherwise,
c Subtract line 6b from line 6a
. . . . . . . . . . . . . . . . . . . . . . .
you must
include
distribution
your
on6c
IRS Form 8853, and
12
Taxable Medicare Advantage MSA distributions.
Subtract
linethe
11 from
line 10. Ifinzero
or income
less,
7
Unreimbursed qualified medical expenses (see instructions) . . . . . . . . . . . . .
7
enter -0-. Also include this amount in the total
on may
Formowe
1040,
21,penalty.
or FormFor
1040NR,
21.
you
a line
20%
moreline
information,
see IRS Publication
8 On
Taxable
Archer
Subtract
line 7 and
from lineamount
6c. If zero
the dotted
lineMSA
nextdistributions.
to line 21, enter
“Med969
MSA”
. or. less,
. and
. enter
. Other
.-0-.
. Also
. . .
12 Health Plans).
(Healththe
Savings Accounts
Tax-Favored
include this amount in the total on Form 1040, line 21, or Form 1040NR, line 21. On the dotted
If any of the distributions included on line 12 meet any of the Exceptions to the Additional
line next to line 21, enter “MSA” and the amount . . . . . . . . . . . . . . . . .
8
50% Tax (see instructions), check here . . . . . . . . . . . . . . . . . . ▶
of the distributions
included
on lineTax
8 meet
any of the please
Exceptions
the Additional or contact one of our Member
For 9a
moreIf any
information
regarding
your USAA
Documents,
visit to
usaa.com/taxes
50%instructions),
tax (see instructions).
Enter
that
b Additional
20%
Tax (see
check here
. . 50%
. .(.50)
. of. the
. distributions
. . . specific
. .included
. tax
. situation
.on. line
. 12
. ▶
Service are
Representatives
at 800-531-6347.
Questions
regarding
be directed to your
subject to the additional
50% tax. Also
include this
amount your
in the total on Form
1040, lineshould
62,
b or
Additional
20% tax
instructions).
20%to(.20)
of 1040,
the distributions
included
on lineline
8 that
Form
1040NR,
line(see
60. On
the dottedEnter
line next
Form
line 62, or Form
1040NR,
60,
tax and
legal
advisers.
are subject
to the and
additional
20% tax.
enter
“Med MSA”
the amount
. . Also
. include
. . . this
. .amount
. . in. the
. total
. . on. Form
. . 1040,
. . line
. 62,
. . 13b
or United
Form 1040NR,
line 60. On
the dotted
next to Form
1040,
line 62,
orother
Form
1040NR,Banks
line 60,
USAA means
Services Automobile
Association
and line
its insurance,
banking,
investment
and
companies.
Member FDIC. Investments provided
Form 8853 (2015)
For
Paperwork
Reduction
Act
Notice,
see
your
tax
return
instructions.
Cat.
No.
24091H
by USAA Investment
Management
enter “MSA”
and theCompany
amountand.USAA
. .Financial
. . Advisors
. . . Inc.,
. both
. . registered
. . . broker
. . dealers.
. . . . . . .
9b
13a
The
contents of
document is Advantage
not intended to be,
and is
not, legal or tax advice.
Theare
applicable
law isand
complex,
theyou
penalties
non-compliance
are severe,
Section
B.thisMedicare
MSA
Distributions.
If you
filing tax
jointly
both
andforyour
spouse received
and the applicable tax law of your state may differ from federal tax law. Therefore, you should consult your tax and legal advisers regarding your specific situation.
distributions in 2014 from a Medicare Advantage MSA, complete a separate Section B for each spouse (see
The applicable law concerning
retirement plans, Coverdell ESAs, 529 plans and MSAs is very complex, the penalties for noncompliance are severe, and the
instructions).
applicable tax laws of your state may differ from the federal laws. Therefore, you should consult your tax and legal advisors regarding your specific situation.
10
11
12
Total distributions you received in 2014 from all Medicare Advantage MSAs (see instructions) . .
Unreimbursed qualified medical expenses (see instructions) . . . . . . . . . . . . .
Taxable Medicare Advantage MSA distributions. Subtract line 11 from line 10. If zero or less,
enter -0-. Also include this amount in the total on Form 1040, line 21, or Form 1040NR, line 21.
On the dotted line next to line 21, enter “Med MSA” and the amount . . . . . . . . . .
10
11
12
45370-011 6
10