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Form 1099-R
Distributions From Pension, Annuities,
Retirement or Profit-Sharing Plans
 Payer's name: Print or type your company name and street address exactly as on the Form 1096.
Recipient's name: Print or type the name and address of the employee who received the distribution (address information is recorded in your 401k software's Employee Information).
Box 1: The amount listed for the employee on the Year-to-Date Activity Summary by Employee report you printed from your 401k plan administration software.
Box 2a: If the amount in Box 1 was a lump-sum distribution, enter the same amount in Box 2a. If the amount in Box 1 was a rollover to a qualified plan or IRA, enter 0.
Boxes 2b: Leave "Taxable amount not determined" unchecked. Check "Total distribution" if all funds were distributed from the account as of year's end (i.e., no balance remains in the account).
Payer's Federal identification number: Type in your employer ID number (see your plan's Adoption Agreement, page 1, item A4).
Recipient ’s identification number: The employee's social security number.
Box 3: Leave blank.
Box 4: Type in the tax withheld, if any; 20 percent of the distribution for lump-sum distributions.
Boxes 5 and 6: Leave blank.
Box 7: See IRS instructions pages R9-10 for a list of codes. Your distributions will most likely be one of the following, as defined in the aforementioned list of codes: 1, G, H, 7, 8 or L.
Boxes 8, 9a and 9b: Leave blank.
Boxes 10-15: Complete as needed. Not applicable in most states. |
