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.

Transcription

1 Guide To Your USAA nvestment Management Company Forms 1099-R (mutual fund RAs), 1099-Q (mutual fund Coverdell ESAs), USAA 529 College Savings Plan accounts and 1099-SA For Tax Year 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 n 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 RS treats distributions from your investments descriptions and explanations of tax forms related to your investments f 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 f 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 usaacom From the usaacom home page, scroll down to ocuments and Forms and sign up to receive your tax forms electronically in the future n addition to the information in this guide, on usaacom/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 on 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 RS publications and forms TurboTax is a registered trademark, and TurboTax On is a service mark of ntuit nc 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

2 Form 1099-R The Form 1099-R you receive from USAA MCO provides information to you and the RS regarding distributions from your: Form 1099-R What is it? RAs (Traditional, Roth, SEP and SMPLE) 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 SMPLE RA that is rolled over to a Roth RA Recharacterization refers to the treatment of a contribution to one type of RA as having been made to a different type of RA, or to the treatment of a conversion to a Roth RA as though it had not occurred Where is it reported? You will use information from Form 1099-R when completing RS form 1040 or 1040A, and you may also need to report it on one or more of these RS forms: Form 8606 (Nondeductible RAs) Form 4972 (Tax on Lump-Sum istributions) Form 5329 (Additional Taxes on Qualified Plans [ncluding RAs] and Other Tax-Favored Accounts) 2

3 Form 1099-R ] 1040 Home address (number and street) f you have a PO box, see instructions Apt no Make sure the SSN(s) above and on 6c are correct City, town or post office, state, and ZP code f you have a foreign address, also complete spaces below (see instructions) Presidential Election Campaign Check here if you, or your spouse if filing ,jointly, want$3to go to this fund Checking Foreign country name Foreign province/state/county refund You Spouse 1 Filing Status Single 4 Head of household (with qualifying person) (See instructions) f 2 Married filing jointly (even if only one had income) the qualifying person is a child but not your dependent, enter this 3 Married filing separately Enter spouse's SSN above child's name here box and full name here 5 Qualifying widow(er) with dependent child 6a Exemptions Yourself f someone can claim you as a dependent, do not check box 6a Boxes checked on 6a and 6b epartment b of the Spouse Treasury-nternal Revenue Service (99) } No of children ] 1040 US ndividual ncome Tax Return 1 0M B No RS Use Only-o not write or staple in this C ependents: (2) ependent's (3) ependent's (4)! if child under age 17 on 6cwho: qualifying for child tax credit lived with you For the year Jan 1-ec (1) 31,, First name or other tax year beginning Last name social security number,, relationship ending to you (see instructions), 20 See separate did not live instructions with Your first name and initial Last name Your you social due security to divorce number or separation f more than four (see i instructions)! : : dependents, see f a joint return, spouse's first name and initial Last name Spouse's ependents social security on 6c number instructions and not entered above 1! check here : : Add numbers on Home address (number and d street) Total f number you have of a PO exemptions box, see instructions claimed Apt no Make s sure above the SSN(s) above 7 Wages, salaries, tips, etc Attach Form(s) W-2 7 and on 6c are correct ncome City, town or post office, state, Ba and Taxable ZP code interest f you have Attach a foreign Schedule address, also B complete if required spaces below (see instructions) Ba Presidential Election Campaign b Tax-exempt interest o not include on 8a Check here if you, or your spouse if filing ab -----,jointly, Attach want$3to go to this fund Checking Foreign Form(s) country name 9a Ordinary dividends Attach Schedule Foreign B if required province/state/county 9a W-2 here Also refund attach Forms b Qualified dividends 9b You Spouse W-2G and 101 Filing Status Taxable Single refunds, credits, or offsets of state and local income 4 taxes Head of household (with qualifying 10 person) (See instructions) f 1099-R if tax 112 Alimony Married received filing jointly (even if only one had income) the qualifying person is a child 11 but not your dependent, enter this was withheld Check only one 12 3 Business Married income filing separately or (loss) Attach Enter spouse's Schedule SSN C or above C-EZ child's name here 12 box 13 Capital and full gain name or (loss) here Attach Schedule if required f not required, 5 Qualifying check here widow(er) with dependent 13 child f you did not 146a Other Exemptions Yourself gains or f (losses) someone Attach can claim Form you 4797 as a dependent, do not check box 6a 14 Boxes checked get a W-2, on 6a and 6b see instructions 15a b RA Spouse distributions b Taxable amount 15b } No of children 16a C ependents: Pensions and annuities :: (2) ependent's (3) ependent's (4)! if child under age 17 on 6cwho: b Taxable amount 16b qualifying for child tax credit lived with you (1) 17 First name Rental real estate, Last name royalties, partnerships, social security S number corporations, relationship trusts, to etc you Attach (see Schedule instructions) E 17 did not live with 18 Farm income or (loss) Attach Schedule F 18 you due to divorce or separation f more than four 19 Unemployment compensation (see instructions) 19 dependents, see ependents on 6c instructions and 20a Social security benefits i 2oa b Taxable amount 20b not entered above check here 21 Other income List type and amount Add numbers on 22 d Total Combine number the amounts of exemptions in the far claimed right column for s 7 through 21 This is your total income 22 s above Form Check only 1040 one Adjusted ncome Gross ncome Attach Form(s) W-2 here Also attach Forms W-2G and 1099-R if tax was withheld f you did not get a W-2, see instructions Adjusted Gross ncome epartment of the Treasury-nternal Revenue Service (99) US ndividual ncome Tax Return 237 Wages, Educator salaries, expenses tips, etc Attach Form(s) W Ba Certain Taxable business interest expenses Attach of Schedule reservists, B performing if required artists, and b Tax-exempt fee-basis government interest officials o not Attach include Form on 2106 or 8a 2106-EZ ab a Ordinary Health savings dividends account Attach deduction Schedule Attach B if required Form b Moving Qualified expenses dividends Attach Form b eductible Taxable refunds, part of self-employment credits, or offsets tax of Attach state Schedule and local SE income 27 taxes Self-employed Alimony received SEP, SMPLE, and qualified plans Self-employed Business income health or (loss) insurance Attach deduction Schedule C or C-EZ Penalty Capital gain on early or (loss) withdrawal Attach of Schedule savings if required f not required, 30 check here! 31a 14 Other Alimony gains paid or b (losses) Recipient's Attach SSN Form a distributions Taxable amount : : 31a 32 RA deduction 32 Account istributions :: b 33 16a Student Pensions loan and interest annuities deduction b 33 Taxable amount Tuition Rental real and estate, fees Attach royalties, Form partnerships, 8917 S corporations, trusts, 34 etc Attach Schedule E Foreign postal code a box below will not change your tax or Refer to the RS instruction book for RS Form 1040 for more information Ba The amount in box 1 of Form 1099-R should be reported on 15a of RS Form 1040 or 11a of RS 9a Form 1040A (Special reporting rules may apply for direct distributions to qualified charities made 10 by taxpayers age 70 1 /2 or over See 11 RS instructions for form or 1040A) omestic Farm income production or (loss) activities Attach deduction Schedule Attach F Form Lump-Sum Add Unemployment s istribution 23 through compensation a Social Subtract security 36 benefits from i 2oa 22 This is your adjusted gross income from Keogh Plan b Taxable amount 20b 37 For isclosure, Privacy 21 Act, Other and income Paperwork List Reduction type and amount Act Notice, see separate instructions Cat No 11320B 21 Form 1040 (2014) 22 Combine the amounts in the far right column for that s 7 through may 21 be This favorable is your total income to you, if 22 you are eligible 23 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 Moving expenses Attach Form eductible part of self-employment tax Attach Schedule SE M B No RS Use Only-o not write or staple in this For the year Jan 1-ec 31,, or other tax year beginning,, ending, 20 See separate instructions Your first name and initial Last name Your social security number i! : : f a joint return, spouse's first name and initial Last name Spouse's social security number 1! : : Foreign postal code a box below will not change your tax or b 16b 17 f the amount in box 1 of Form 1099-R is a lump-sum distribution from a Keogh plan, Total istribution should be checked in box 2b Use RS Form 4972 (Tax on Lump-Sum istribution) to choose the tax treatment 3

4 Form 8606 nformation about Form 8606 and its separate instructions is at wwwirsgov/form8606 epartment of the Treasury Attach to Form 1040, Form 1040A, or Form 1040NR nternal Revenue Service (99) Name f married, file a separate form for each spouse required to file Form 8606 See instructions Form 1099-R Fill in Your Address Only f You Are Filing This Form by tself and Not With Your Tax Return 2 Enter your total basis in traditional RAs (see instructions) 2 Nondeductible RAs OMB No Form Add s 1 and 2 3 n, did you take a nformation distribution about Form 8606 No and its separate Enter instructions the amount is at from wwwirsgov/form on 14 epartment of the Treasury from traditional, SEP, or SMPLE RAs, Attach to Form 1040, Form o 1040A, not complete or Form 1040NR the rest of Part nternal Revenue Service (99) Sequence No 48 or make a Roth RA conversion? Yes Name f married, file a separate form for each spouse required to file Form 8606 See Go to 4 instructions Your social security number 4 Enter those contributions included on 1 that were made from January 1, 2016, through April 18, Subtract 4 from 3 Home address (number and street, or PO box if mail is not delivered to your home) 5 Apt no Fill 6 in Your Enter Address the value Only of all your traditional, SEP, and SMPLE RAs as of f You Are ecember Filing This 31,, plus any City, outstanding town or post office, rollovers state, and (see ZP instructions) code f you have a foreign 6address, also complete the spaces below Form 7 by Enter tself your and distributions Not from traditional, SEP, and SMPLE RAs in With Your Tax o Return not include rollovers, Foreign a country one-time namedistribution to fund Foreign an HSA, province/state/county Foreign postal code conversions to a Roth RA, certain returned contributions, or Part recharacterizations Nondeductible of Contributions traditional RA contributions to Traditional (see RAs instructions) and istributions 7 From Traditional, SEP, and SMPLE RAs 8 Enter Complete the net amount this part you only converted if one or more from of traditional, the following SEP, apply and SMPLE RAs to You Roth made RAs nondeductible in o not contributions include amounts to a traditional converted RA that for you later recharacterized You took distributions (see instructions) from a traditional, Also enter SEP, this or amount SMPLE on RA in 16 and 8 you made nondeductible contributions to a 9 Add s traditional 6, 7, and RA 8 in or an earlier year For 9 this purpose, a distribution does not include a rollover, one-time 10 distribution to fund an HSA, conversion, recharacterization, or return of certain contributions ivide 5 by 9 Enter the result as a decimal rounded to at least 3 places You f converted the result is part, 1000 but or not more, all, of enter your 1000 traditional, SEP, and SMPLE RAs 10 to Roth RAs in (excluding any portion you recharacterized) and you made nondeductible contributions to a traditional RA in or an earlier year 11 Multiply 8 by 10 This is the nontaxable portion of the amount 1 you Enter converted your nondeductible to Roth RAs contributions Also enter to this traditional amount RAs on for 17, including 11 those made for 12 Multiply from January 1, , by through 10 This April 18, is the 2016 nontaxable (see instructions) portion of your 1 2 distributions Enter your total that basis you in did traditional not convert RAs to (see a Roth instructions) RA Add Add s s 1 11 and and 2 12 This is the nontaxable portion of all your distributions 3 13 n, did you take a distribution No Enter the amount from 3 on Subtract 13 from 3 This is your total basis in traditional RAs for and earlier years 14 from traditional, SEP, or SMPLE RAs, o not complete the rest of Part 15 Taxable or make a amount Roth RA conversion? Subtract 12 from 7 f more than zero, also include this amount on Form Yes Go to , 15b; Form 1040A, 11b; or Form f you 1040NR, made nondeductible 16b RA contributions for or in previous 4 Enter those contributions included on 1 that were made from January 1, 2016, through April 18, Note You may be subject to an additional years, 10% tax report on the amount on of these 15 if contributions you were under on RS Form Subtract 4 from 3 5 Nondeductible age 59½ at RA the time Contributions of the distribution (see instructions) (Nondeductible RAs) to determine the taxable portion of your distribution 6 Enter the value of all your traditional, SEP, and SMPLE RAs as of For Privacy Act and Paperwork Reduction Act Notice, ecember 31,, plus any outstanding rollovers Report see separate (see the instructions) distribution instructions amount 6 from box Cat No 1 of 63966F Form Form 1099-R on 7 or 8606 () 8 7 Enter your distributions from traditional, SEP, of Form and 8606 SMPLE RAs in o not include rollovers, a one-time distribution to fund an HSA, conversions to a Roth RA, certain returned contributions, or recharacterizations of traditional RA contributions (see instructions) 7 8 Enter the net amount you converted from traditional, SEP, and SMPLE RAs to Roth RAs in o not include amounts converted that you later recharacterized (see instructions) Also enter this amount on Add s 6, 7, and ivide 5 by 9 Enter the result as a decimal rounded to at least 3 places f the result is 1000 or more, enter Multiply 8 by 10 This is the nontaxable portion of the amount you converted to Roth RAs Also enter this amount on Home address (number and street, or PO box if mail is not delivered to your home) City, town or post office, state, and ZP code f you have a foreign address, also complete the spaces below Sequence No 48 Your social security number Apt no Foreign country name Foreign province/state/county Foreign postal code Part Nondeductible Contributions to Traditional RAs and istributions From Traditional, SEP, and SMPLE RAs Complete this part only if one or more of the following apply You made nondeductible contributions to a traditional RA for You took distributions from a traditional, SEP, or SMPLE RA in and you made nondeductible contributions to a traditional RA in or an earlier year For this purpose, a distribution does not include a rollover, one-time distribution to fund an HSA, conversion, recharacterization, or return of certain contributions You converted part, but not all, of your traditional, SEP, and SMPLE RAs to Roth RAs in (excluding any portion you recharacterized) and you made nondeductible contributions to a traditional RA in or an earlier year Form Enter your nondeductible contributions to traditional RAs for, including those made for from January 1, 2016, through April 18, 2016 (see instructions) 1

5 Form 1099-R Form 5329 Additional Taxes on Qualified Plans (ncluding RAs) and Other Tax-Favored Accounts Attach to Form 1040 or Form 1040NR epartment of the Treasury nternal Revenue Service (99) nformation about Form 5329 and its separate instructions is at wwwirsgov/form5329 Name of individual subject to additional tax f married filing jointly, see instructions OMB No Sequence No 29 Your social security number Home address (number and street), or PO box if mail is not delivered to your home Apt no Fill in Your Address Only City, town or post office, state, and ZP code f you have a foreign address, also complete f You Are Filing This the spaces below (see instructions) Form by tself and Not f this is an amended With Your Tax Return return, check here Foreign country name Foreign province/state/county Foreign postal code Additional Taxes on Qualified Plans OMB No Form 5329 (ncluding RAs) and Other Tax-Favored Accounts f you only owe the additional 10% tax on early distributions, you may be able to report this tax directly on Form 1040, 59, or Form 1040NR, 57, without filing Form 5329 See Attach the instructions to Form 1040 for or Form Form 1040, 1040NR 59, or for Form 1040NR, 57 epartment of the Treasury nternal Part Revenue Service Additional (99) Tax nformation on Early about istributions Form 5329 Complete and its separate this part instructions if you took a is taxable at wwwirsgov/form5329 distribution before you reached Sequence age 59½ No 29 Name of individual from subject a qualified to additional retirement tax f married plan (including filing jointly, an see RA) instructions or modified endowment contract (unless you are reporting Your this social tax security directly number on 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 RA distributions (see instructions) Home address (number and street), or PO box if mail is not delivered to your home 1 Early distributions included in income For Roth RA distributions, see instructions 1 Apt no Fill in 2 Your Early Address distributions Only included on 1 that are not subject to the additional tax (see instructions) City, town or post office, state, and ZP code f you have a foreign address, also complete f You Are Enter Filing the This appropriate exception the spaces number below (see from instructions) the instructions: 2 Form 3 by tself Amount and subject Not to additional tax Subtract 2 from 1 3 f this is an amended With Your Tax Return return, check here 4 Additional tax Enter 10% (10) of 3 nclude this amount on Form 1040, 59, or Form 1040NR, 57 4 Foreign country name Foreign province/state/county Caution: f any part of the amount on 3 was a distribution from a SMPLE RA, you may have Foreign postal code to include 25% of that amount Box on 7 of Form 4 instead 1099-R of 10% identifies (see instructions) the distribution type See nstructions for Recipient, f you Part only owe Additional the additional Tax on 10% Certain Box tax 7, of istributions your early distributions, Form From 1099-R Education you for may an be explanation Accounts able to report and of the this ABLE code(s) tax Accounts directly appearing on Complete Form here 1040, this part 59, if or Form 1040NR, you included 57, without an amount filing Form in income, 5329 on See Form the 1040 instructions or Form 1040NR, for Form 1040, 21, from 59, a Coverdell or for Form education 1040NR, savings 57 account Part Additional (ESA), a qualified Tax on tuition Early program istributions (QTP), or an Complete ABLE account For example, code 1 indicates this distributions part if you took made a taxable before distribution you reached before you age reached 59 1 /2 age 59½ 5 istributions from a qualified included retirement in income plan from (including a Coverdell an RA) ESA, or modified a QTP, or endowment an ABLE account contract (unless you are reporting 5 this tax directly on 6 istributions Form 1040 or included Form 1040NR see on and 5 that above) are are, not in subject general, You may to also the subject additional to have to complete tax a 10% (see this instructions) additional tax part to indicate However, that you 6 as explained istribution Type qualify for an exception to 7 Amount the additional subject tax to additional early in distributions the tax Form Subtract 1040 or for certain 6 instructions, from Roth 5 RA certain distributions exceptions (see instructions) to the additional 7 tax apply 1 8 Early Additional distributions tax Enter included 10% (10) in of income 7 nclude For Roth this amount RA distributions, on Form 1040, see instructions 59, or Form 1040NR, 57 8 with respect to qualified withdrawals for first-time homebuyers expenses, 1 higher 2 Part Early distributions Additional Tax included on Excess Contributions 1 that are not subject to Traditional to the additional RAs Complete tax (see instructions) this part if you contributed more to your traditional RAs for education than is allowable expenses, or you medical had an amount insurance on premiums 17 of your 2014 and Form deductible 5329 medical expenses Enter the appropriate exception number from the instructions: 2 9 Enter your excess contributions For from further 16 clarification of your 2014 Form of 5329 exceptions, (see instructions) see RS f zero, Publication go to B 9 ndividual 3 Amount subject to additional tax Subtract 2 from f your traditional RA contributions 4 Additional tax Enter 10% (10) Retirement for of 3 nclude Arrangements are less this amount on Form discussed than your 1040, in 59, Chapter or Form 1040NR, 1 under Early 57 istributions 4 maximum allowable contribution, see instructions Otherwise, enter Caution: f any part of the amount on 3 was a distribution from a SMPLE RA, you may have 11 traditional RA distributions included in income (see instructions) 11 to include 25% of that amount on 4 instead of 10% (see instructions) 12 distributions of prior year excess contributions (see instructions) 12 Part 13 Add Additional s 10, 11, Tax and on 12 Certain f your istributions Form 1099-R From has a Education distribution Accounts code 1 in and box ABLE 7 and Accounts you 13 qualify Complete for an this part if 14 Prior you year included excess an contributions amount in income, on Form 1040 or Form 1040NR, 21, from a Coverdell education savings account exception Subtract to the 13 additional from 9 tax, f zero you or may less, enter be required -0- to file Form (Additional 15 Excess (ESA), contributions a qualified tuition for program (see instructions) (QTP), or an ABLE account istributions Total excess included contributions in income Taxes Add from s on Qualified a 14 Coverdell and 15 Plans ESA, a [ncluding QTP, or an RAs] ABLE account and Other Tax-Favored 16 5 Accounts) 617 istributions Additional tax included Enter 6% on (06) Report of 5 the that smaller the are of not amount subject 16 or the in to box value the additional of 1 of your your traditional tax Form (see RAs 1099-R instructions) ecember Form 31, 5329, Amount (including subject contributions to additional made tax in 2016) Subtract nclude this 6 amount from on Form , 59, or Form 1040NR, Part Additional V Additional tax Enter Tax 10% on (10) Excess of 7 Contributions nclude this amount to Roth on Form RAs 1040, Complete 59, or this Form part 1040NR, if you contributed 57 more 8 to your Roth Part Additional RAs for Tax than on is Excess allowable Contributions or you had an amount to Traditional 25 of RAs your 2014 Complete Form this 5329 part if you contributed more to your 18 Enter traditional your excess RAs contributions for than from is allowable 24 of your or 2014 you Form had an 5329 amount (see instructions) 17 f of zero, your go 2014 to Form Enter f your Roth excess RA contributions from for 16 of are your less 2014 than Form your 5329 maximum (see instructions) f zero, go to f allowable your traditional contribution, RA see contributions instructions for Otherwise, are enter less -0- than your maximum distributions allowable from contribution, your Roth see RAs instructions (see instructions) Otherwise, enter Add traditional s 19 and RA 20 distributions included in income (see instructions) Prior year excess contributions Subtract 21 from 18 f zero or less, enter Form 5329 istribution Code 1 5

6 Form 1099-R State ncome Tax Any state income tax withheld from retirement account distributions will be shown in box 12 For more information, see RS Publication 590-B (ndividual Retirement Arrangements) 6

7 Form 1099-Q Form 1099-Q What is it? Who receives it? The Form 1099-Q you receive from USAA MCO provides information to you and the RS regarding distributions or trustee-to-trustee transfers from your: Coverdell Education Savings Account (ESA) 529 College Savings Plan Account, a qualified tuition program (QTP) defined under nternal Revenue Code section 529 n 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 RS form 1040 or 1040A, and you may also need to report it on RS Form 5329 (Additional Taxes on Qualified Plans [including RAs] and Other Tax-Favored Accounts) 7

8 Form 1099-Q Taxable istributions RS 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 n 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, 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 istributions that meet certain criteria are not taxable and need not be reported on Form 1040 These distributions may include: Non-Taxable istributions 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

9 instructions and not entered above check here Add numbers on d Total number of exemptions claimed s above 7 Wages, salaries, tips, etc Attach Form(s) W-2 7 Ba Taxable interest Attach Schedule B if required Ba b Tax-exempt interest o not include on 8a ] 1040 ab Attach Form(s) epartment 9a Ordinary of the Treasury-nternal dividends Attach Revenue Schedule Service B if (99) required 9a W-2 here Also attach Forms b Qualified dividends US ndividual ncome Tax Return 9b 1 0M B No RS Use Only-o not write or staple in this W-2G For the and 10 Taxable refunds, credits, or offsets of state and local income taxes 10 year Jan 1-ec 31,, or other tax year beginning,, ending, 20 See separate instructions 1099-R if tax Additional Taxes on Qualified Plans OMB No Your first name and initial 11 Alimony received Last name 11 Your social security number Form was 5329 withheld 12 Business (ncluding income or (loss) RAs) Attach and Schedule Other C or C-EZ Tax-Favored Accounts 12 i! : : f a joint return, spouse's 13 first name Capital and gain initial or (loss) Attach Last name Schedule if required f not required, check here 13 Spouse's social security number f you did not Attach to Form 1040 or Form 1040NR epartment of the Treasury 14 Other gains or (losses) Attach 1! nternal get a Revenue W-2, Form Service (99) : : nformation about Form 5329 and its separate instructions is at wwwirsgov/form5329 Sequence No 29 see Home instructions address (number 15a and street) RA distributions f you have a PO box, see instructions Taxable amount Apt no 15b Name of individual subject to additional tax f married filing jointly, see instructions Your social Make security sure the number SSN(s) above 16a Pensions and annuities b Taxable amount 16b and on 6c are correct City, town or post office, state, 17 and Rental ZP code real f you estate, have a royalties, foreign address, partnerships, also complete S corporations, spaces below (see trusts, instructions) etc Attach Schedule E 17 Presidential Election Campaign Home address (number and street), or PO box if mail is not delivered to your home Apt no 18 Farm income or (loss) Attach Schedule F 18 Check here if you, or your spouse if filing ,jointly, want$3to go to this fund Checking Fill Foreign in Your country Address name 19 Unemployment compensation Only Foreign province/state/county 19 City, town or post office, state, and ZP code f you have a foreign address, also complete 20a Social security benefits f You Are Filing This the spaces below (see i 2oa instructions) b Taxable amount 20b refund You Spouse Form by tself and Not 21 Other income List type and amount f this is an amended 1 With Filing Your Status Single Head of household (with qualifying Tax Return return, person) check (See here instructions) f 22 Combine the amounts in the far right column for s 7 through 21 This is your total income 22 2 Married Foreign filing country jointly name (even if only one had income) Foreign province/state/county the qualifying person is a child Foreign but not postal your code dependent, enter this 23 Educator expenses 23 Married filing separately Enter spouse's SSN above child's name here ncome Form 1040 :: b Foreign postal code a box below will not change your tax or Check only one Adjusted 3 box 24 Certain and full business name expenses here of reservists, performing artists, and 5 Qualifying widow(er) with dependent child f Gross you only owe the additional fee-basis 10% government tax on officials early distributions, Attach Form 2106 you or 2106-EZ may be able 24 to report this tax directly on Form 1040, 59, or 6a Form Exemptions Yourself f someone can claim you as a dependent, do not check box 6a Boxes checked ncome 1040NR, 57, 25 without Health filing savings Form account 5329 deduction See the instructions Attach Form for 8889 Form 1040, 25 59, or for Form 1040NR, on 6a 57 and 6b b Form Part 5329 Spouse } Additional 26 Tax Moving on Early expenses istributions Attach Form 3903 Complete this part if you took 26 No of children a taxable distribution before you reached age 59½ C ependents: (2) ependent's (3) ependent's (4)! if child under age 17 on 6cwho: from a qualified 27 retirement eductible part plan of (including self-employment an RA) or modified endowment contract (unless qualifying for you child are tax reporting credit this lived tax with directly you (1) First name Last name social tax Attach security number Schedule SE relationship 27 to you on (see instructions) did not live with Form or Form Self-employed 1040NR see SEP, above) SMPLE, You and may qualified also have plans to complete 28 this part to indicate that you qualify you for due an to exception divorce to Additional Taxes on Qualified Plans OMB No or separation Form f more 5329 than the four additional 29 tax Self-employed on early distributions health insurance or for certain deduction Roth RA distributions 29 (see instructions) (see instructions) 1 Early distributions included (ncluding in income RAs) For Roth and RA distributions, Other Tax-Favored see instructions Accounts dependents, see 30 Penalty on early withdrawal of savings 30 1 ependents instructions 2 Early and on 6c distributions included on 1 that are not subject to the! additional tax (see instructions) not entered above 31a Alimony paid b Recipient's SSN Attach to Form : 1040 : or Form 1040NR 31a epartment check here of the Treasury Enter the appropriate exception number from the instructions: 2 Add numbers on nternal Revenue Service (99) 32 RA d Total nformation deduction number about of exemptions Form 5329 claimed and its separate instructions 32 is at wwwirsgov/form5329 s Sequence above No 29 Name 3 of individual Amount subject subject 33 to additional to additional Student tax loan f married tax interest Subtract filing deduction jointly, see 2 instructions from 1 33 Your 3 social security number 7 Wages, salaries, tips, etc Attach Form(s) W-2 7 ncome 4 Additional tax 34 Enter Tuition 10% (10) and of fees 3 Attach nclude Form this 8917 amount on Form 1040, 59, 34 or Form 1040NR, 57 4 Ba Taxable interest Attach Schedule B if required Ba Caution: f any 35 part omestic of the Home amount production address on activities (number 3 deduction and was street), a distribution Attach or PO Form box if from 8903 mail is a not SMPLE 35 delivered RA, to your you home may have Apt no b Tax-exempt interest o not include on 8a to include 25% of that amount on 4 instead of 10% (see instructions) ab Attach Form(s) 36 Add s 23 through a Ordinary dividends Attach Schedule B if required 9a Fill Part W-2 in here Your Also Additional Address 37 Only Tax Subtract on Certain City, town 36 from or istributions post office, 22 This state, is From and your ZP adjusted code Education f you gross have Accounts a income foreign and ABLE Accounts Complete this part if attach Forms b Qualified dividends you included an amount in income, on Form 1040 or Form 1040NR, 9b address, also complete 37 f You Are Filing This the spaces below (see instructions) 21, from a Coverdell education savings account Form W-2G by and tself (ESA), and a qualified Not 10 Taxable refunds, credits, or offsets of state and local income taxes f this 10 is an amended tuition program (QTP), or an ABLE account With 1099-R Your if tax Tax Return 11 Alimony received return, 11 check here was 5 withheld istributions included in income Foreign country from a name Coverdell ESA, a QTP, or Foreign an ABLE province/state/county account Foreign 5 postal code 12 Business income or (loss) Attach Schedule C or C-EZ 12 6 istributions included on 5 that are not subject to the additional tax (see instructions) 6 13 Capital gain or (loss) Attach Schedule if required f not required, check here 7 Amount subject to additional tax Subtract 6 from f f you you 8 only did not Additional owe the 14 tax additional Other Enter 10% 10% gains (10) of tax or (losses) on 7 nclude early Attach distributions, Form 4797 this amount on you Form may 1040, be able 59, to or report Form 1040NR, this tax directly 57 on get a W-2, :: 14 Form 1040, 59, or 8 Form 1040NR, 57, Part see instructions 15a without RA distributions filing Form 5329 See the instructions for Form 1040, b Taxable amount 59, or for Form 1040NR, 15b 57 Part Additional Tax on Excess Contributions to Traditional RAs Complete this part if you contributed more to your Additional 16a traditional RAs Tax Pensions for Early and annuities than istributions is allowable or Complete you had an this amount part if you b on took Taxable 17 a taxable amount of your distribution 2014 Form before 16b 5329 you reached age 59½ from a qualified 17 retirement Rental real plan estate, (including royalties, an partnerships, RA) or modified S corporations, endowment trusts, contract etc Attach (unless Schedule you are E reporting 17 this tax directly on 9 Enter your excess contributions from 16 of your 2014 Form 5329 (see instructions) f zero, go to 15 9 Form or Form Farm 1040NR see income or (loss) above) Attach 10 f your traditional RA contributions for An You additional Schedule may also F have are less 10% to than tax complete your may apply this part to to part indicate or all that of you the qualify 18 amount for an included exception in to the additional 19 tax Unemployment on early distributions compensation or for certain Roth RA distributions (see instructions) 19 maximum allowable contribution, see instructions income from Otherwise, an ESA enter or College 10 Savings Plan Account (Publication 1 Early distributions 20a included Social security in income benefits For i 2oa Roth 11 traditional Additional RA distributions Taxes included 970 in income RA distributions, outs (see in instructions) see instructions b Taxable amount 20b 1 detail the exceptions 11 2 Early distributions to this tax) 21 included Other income on List 1 type that and are amount not subject to the additional tax (see instructions) 12 distributions of prior year excess contributions (see instructions) 12 Enter the appropriate 22 Combine exception the amounts number in the from far right the column instructions: for s 7 through 21 This is your total income Add s 10, 11, and 12 Generally, the amount of the taxable distribution is to 13 3 Amount subject 23 to additional Educator expenses tax Subtract 2 from be reported on 14 Adjusted Prior year excess contributions Subtract 13 from 9 f zero or less, enter Additional tax 24 Enter 10% Certain (10) business of expenses 3 nclude of Form reservists, this amount 5329 performing on Form artists, 1040, and 59, or Form 1040NR, Gross Excess contributions for (see instructions) 15 Caution: f any part fee-basis of the government amount on officials 3 Attach was Form a distribution 2106 or 2106-EZ from a SMPLE 24 RA, you may have 16 ncome to Total include excess 25% contributions Add s 14 and of that Health amount savings on account 4 instead deduction of 10% Attach (see Form instructions) Part Additional tax Enter 6% (06) of the smaller of 16 or the value of your traditional RAs on ecember 31, Additional 26 Tax Moving on Certain expenses istributions Attach Form 3903 From Education Accounts 26 and ABLE Accounts Complete this part if (including contributions made in 2016) nclude this amount on Form 1040, 59, or Form 1040NR, you included 27 an eductible amount in part income, of self-employment on Form 1040 tax Attach or Form Schedule 1040NR, SE 27 21, from a Coverdell education savings account Part V (ESA), Additional a qualified Tax on Excess Contributions to Roth RAs Complete this part if you contributed more to your Roth 28 Self-employed tuition program SEP, (QTP), SMPLE, or and ABLE qualified account plans 28 RAs for than is allowable or you had an amount on 25 of your 2014 Form istributions included 29 Self-employed in income from health a insurance Coverdell deduction ESA, a QTP, or an ABLE 29 account 5 18 Enter your excess contributions from 24 of your 2014 Form 5329 (see instructions) f zero, go to istributions included 30 Penalty on on early 5 that withdrawal are not subject of savings to the additional tax (see 30 instructions) Amount f your Roth subject RA contributions for are less than your! maximum 31a to additional Alimony paid tax b Subtract Recipient's SSN 6 from : 5 : 31a 7 8 Additional allowable tax contribution, see instructions Otherwise, enter Enter 10% RA deduction (10) of 7 nclude this amount on Form 1040, 59, 32 or Form 1040NR, distributions from your Roth RAs (see instructions) 20 Part Additional 33 Tax Student on Excess loan interest Contributions deduction to Traditional RAs 33Complete this part if you contributed more to your 21 Add s 19 and traditional 34 RAs for Tuition and than fees is Attach allowable Form or 8917 you had an amount on 3417 of your 2014 Form Prior year excess contributions Subtract 21 from 18 f zero or less, enter Enter your excess 35 contributions omestic production from activities 16 of your deduction 2014 Form Attach 5329 Form (see 8903 instructions) 35 f zero, go to Excess contributions for (see instructions) f your traditional 36 Add RA s contributions 23 through 35 for are less than your Total excess contributions Add s 22 and maximum allowable 37 Subtract contribution, 36 see from instructions 22 This is Otherwise, your adjusted enter gross -0-income Additional tax Enter 6% (06) of the smaller of 24 or the value of your Roth RAs on ecember 31, 11 traditional RA distributions included in income (see instructions) 11 (including contributions made in 2016) nclude this amount on Form 1040, 59, or Form 1040NR, distributions of prior year excess contributions (see instructions) 12 For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions Cat No 13329Q Form 5329 () 13 Add s 10, 11, and Prior year excess contributions Subtract 13 from 9 f zero or less, enter For isclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions Cat No 11320B Form 1040 (2014) For isclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions Cat No 11320B Form 1040 (2014) 9

10 Form 1099-SA Form 8853 epartment of the Treasury nternal Revenue Service (99) Name(s) shown on return Archer MSAs and Long-Term Care nsurance Contracts nformation about Form 8853 and its separate instructions is available at wwwirsgov/form8853 Attach to Form 1040 or Form 1040NR Social security number of MSA account holder f both spouses have MSAs, see instructions OMB No Sequence No 39 Section A Archer MSAs f you have only a Medicare Advantage MSA, skip Section A and complete Section B Part Archer MSA Contributions and eductions See instructions before completing this part f you are filing jointly and both you and your spouse have high deductible health plans with self-only coverage, complete a separate Part for each spouse 1 Total employer contributions to your Archer MSA(s) for 1 2 Archer MSA contributions you made for, including those made from January 1,, through April 15, 2016, that were for o not include rollovers (see instructions) 2 Form Limitation from the Line 3 Limitation Chart and Worksheet in the instructions 3 4 Compensation (see instructions) from the employer maintaining the high deductible health plan (f self-employed, enter your earned income from the trade or business under which the high deductible health plan was established) Archer MSAs and OMB No Form Archer MSA deduction Enter the Long-Term smallest of Care 2, 3, or nsurance 4 here Also include Contracts this amount on epartment Form of the 1040, Treasury nformation about Form 8853 and its separate instructions is available at wwwirsgov/form , or Form 1040NR, 35 On the dotted next to Form 1040, 36, or nternal Revenue Service (99) Attach to Form 1040 or Form 1040NR Sequence No 39 Form 1040NR, 35, enter MSA and the amount 5 Name(s) shown on return Social security number of MSA Caution: f 2 is more than 5, you may have to pay an account additional holder tax f both (see spouses instructions) have MSAs, see instructions Part Archer MSA istributions Section A Archer MSAs f you have only a Medicare Advantage MSA, skip Section A and complete Section B 6a Total distributions you and your spouse received in from all Archer MSAs (see instructions) 6a Part Archer MSA Contributions and eductions See instructions before completing this part f you are filing b istributions included on 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 for each spouse included on 6a that were withdrawn by the due date of your return (see instructions) 6b 1 Total employer contributions to your Archer MSA(s) for 1 c Subtract 6b from 6a 6c 2 Archer MSA contributions you made for, including those made from January 1,, 7 Unreimbursed qualified medical expenses (see instructions) 7 through April 15, 2016, that were for o Form not 8 Taxable Archer MSA distributions Subtract SA include rollovers from shows (see 6c f zero shareholder instructions) or less, enter distributions -0- Also from 2Archer Medical 3 Form Limitation include 1099-SA from the this amount What Line 3 Limitation in the total is it? Chart and on Form 1040, Savings Worksheet 21, Accounts in the or Form 1040NR, (MSAs) instructions You 21 will On receive the dotted one if you 3 had distributions 4 Compensation next to Who (see 21, receives enter instructions) MSA it? and from the the amount employer during maintaining the year (Archer the high MSAs deductible are no health longer plan offered (f 8by USAA MCO self-employed, enter your earned income from 9a f any of the distributions included on 8 meet for the new trade any of accounts) or business under which the high the Exceptions to the Additional deductible health plan was established) 20% Tax (see instructions), check here 4 5 Archer MSA deduction Enter the smallest b Additional 20% tax (see instructions) Enter You of 20% must 2, 3, (20) of file or 4 the RS here distributions Form Also 8853 include included (Archer this amount on MSAs on 8 that and Long-Term Care Form 1040, 36, or Form 1040NR, 35 On the dotted next to Form 1040, 36, or are subject to the additional 20% tax Also include nsurance this amount Contracts) in the with total your on Form RS 1040, Form , to report a distribution Form 1040NR, 35, enter MSA and the amount or Form 1040NR, 60 On the dotted from next to an Form MSA 1040, and calculate 62, or Form the taxable 1040NR, portion 60, (The 5 payer USAA is Caution: f 2 is more than 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 9b of any Part Archer MSA istributions Section B Medicare Advantage MSA istributions MSA distribution) f you are filing jointly and both you and your spouse received 6a Total Where distributions distributions it you reported? and your spouse received in from all Archer MSAs (see instructions) 6a in 2014 from a Medicare Advantage MSA, complete a separate Section B for each spouse (see b istributions instructions) included on 6a that you rolled An over MSA to distribution, another Archer shown MSA in or box a health 1, generally savings is not taxable if you used account Also include any excess contributions (and the earnings on those excess contributions) 10 Total distributions you received in 2014 from it all to Medicare pay qualified Advantage medical MSAs expenses (see instructions) for yourself or your 10 family, or if you included on 6a that were withdrawn by the due date of your return (see instructions) 6b 11 Unreimbursed qualified medical expenses (see rolled instructions) it over to another MSA or health savings account 11 (HSA) Otherwise, c Subtract 6b from 6a 6c 12 Taxable Medicare Advantage MSA distributions you must Subtract include the 11 from distribution 10 f in zero your or income less, on RS Form 8853, and 7 Unreimbursed qualified medical expenses (see instructions) 7 enter -0- Also include this amount in the total you on may Form owe 1040, a 20% 21, penalty or Form For 1040NR, more information, 21 see RS Publication 8 On Taxable the dotted Archer MSA next distributions to 21, enter Subtract Med 969 MSA 7 (Health and from the Savings amount 6c f zero Accounts or less, and enter Other -0- Also Tax-Favored 12 Health Plans) include this amount in the total on Form 1040, 21, or Form 1040NR, 21 On the dotted 13a f any of the distributions included on 12 meet any of the Exceptions to the Additional next to 21, enter MSA and the amount 50% Tax (see instructions), check here 8 For 9a more f any information of the distributions regarding included your USAA on Tax 8 meet ocuments, any of the please Exceptions visit to usaacom/taxes the Additional or contact one of our Member b Additional 20% Tax (see 50% instructions), tax (see instructions) check here Enter 50% (50) of the distributions included on 12 that Service are Representatives subject to the additional at % tax Also Questions include this regarding amount your in the specific total on Form tax situation 1040, should 62, be directed to your tax and b or Additional legal Form advisers 1040NR, 20% tax (see 60 On instructions) the dotted Enter next 20% to (20) Form of 1040, the distributions 62, or Form included 1040NR, on 8 that 60, enter are subject Med MSA to the and additional the amount 20% tax Also include this amount in the total on Form 1040, 62, 13b USAA means or United Form 1040NR, Services Automobile 60 On Association the dotted and its insurance, next to Form banking, 1040, investment 62, and or other Form companies 1040NR, Banks 60, Member FC nvestments provided by For USAA Paperwork nvestment Reduction Act Notice, see your tax return instructions Cat No 24091H Form 8853 () enter MSA Management and the Company amount and USAA Financial Advisors nc, both registered broker dealers 9b The Section contents of B this Medicare document is Advantage not intended to be, MSA and istributions not, legal or tax advice f you The are applicable filing tax jointly law is and complex, both the you penalties and for your non-compliance spouse received are severe, 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 instructions) retirement plans, Coverdell ESAs, 529 plans and MSAs is very complex, the penalties for noncompliance are severe, and the 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 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 11 from 10 f zero or less, enter -0- Also include this amount in the total on Form 1040, 21, or Form 1040NR, 21 On the dotted next to 21, enter Med MSA and the amount