Understanding IRS Form 1099-R
By now you should have received your 1099-R form from the Pension System. This form
reports distributions from the Pension System, and is used in filing your income taxes.
The example below shows the IRS Form 1099-R and illustrates parts of the form on which
Page 5 of 12 of Form 1099-R
Pensioners often have questions. 6
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
If you have any questions about your IRS Form 1099-R, please contact a Benefits Counselor
at 214.638.3863 or 800.638-3861.
CORRECTED (if checked)
PAYER’S name, street address, city, state, and ZIP code 1 Gross distribution OMB No. 1545-0119 Distributions From
Box 1 - Total gross Pensions, Annuities,
amounts paid to you $
2a Taxable amount 09 Profit-Sharing
$ Form 1099-R
2b Taxable amount Total Copy B
not determined distribution
Box 2a - Amount PAYER’S federal identification RECIPIENT’S identification 3 Capital gain (included 4 Federal income tax
income on your
subject to Federal number number in box 2a) withheld federal tax
return. If this
income tax $ $
RECIPIENT’S name 5 Employee contributions 6 Net unrealized tax withheld in
/Designated Roth appreciation in
contributions or employer’s securities box 4, attach
insurance premiums this copy to
Box 4 - Amount of $ $ your return.
Federal income tax Street address (including apt. no.) 7 Distribution 8 Other
code(s) SEP/ This information is
withheld and paid $ %
being furnished to
to the IRS for you City, state, and ZIP code 9a Your percentage of total
9b Total employee contributions
1st year of desig. Roth contrib. 10 State tax withheld 11 State/Payer’s state no. 12 State distribution
Account number (see instructions) 13 Local tax withheld 14 Name of locality 15 Local distribution
Form 1099-R Department of the Treasury - Internal Revenue Service
Box 5 - Amount not subject to income Box 7 - Identifies the distribution you
tax (the proration of your after tax received. For more information on these
contributions over your life expectancy). distributions, see the instructions on your
— Box 1 minus Box 2a = Box 5 tax return. Also, certain distributions
This does not include your health insurance may be subject to an additional 10% tax.