Your Employee Stock Purchase Plan (for qualified plans)
STEP
STEP 11
STEP 2
STEP
STEP33
STEP
4 4
STEP
STEP
5 5
STEP
FAQ
FAQ
Determining your 2016
stock plan tax requirements
— a step-by-step guide
INSIDE
How to use the
Supplemental Form
to avoid
overpaying taxes
Only when you sell shares acquired from a qualified
ESPP does a taxable event occur. Upon selling shares,
you may have taxable ordinary income to report, in
addition to any capital gains or losses. To determine
your tax-reporting requirements, follow the steps
outlined in this document.
1
Your Employee Stock Purchase Plan (for qualified plans)
STEP 11
STEP
STEP 2
STEP33
STEP
STEP
STEP
4 4
STEP
STEP
5 5
FAQ
FAQ
Please read
carefully before
you proceed.
Qualified ESPP
What is a qualified Employee Stock Purchase Plan (ESPP)?
A Section 423 ESPP is qualified under the U.S. tax code and allows employees under U.S. tax law to
purchase stock at a discount from fair market value without any taxes owed on the discount at the time
of purchase. To receive favorable long-term capital gains tax treatment on a portion of your gains when
the shares are sold, you must hold the shares for the time period required by Section 423 of the tax code
(see the FAQs in the back of the guide for more details). A Section 423 plan is the most common form of
ESPP offered by most companies.
How do I find out what type of ESPP I am enrolled in?
Your specific plan documents will address whether your ESPP offering is Section 423 qualified
or nonqualified.
What action do I need to take?
If you are enrolled in a qualified ESPP, the Tax Guide is provided below.
Nonqualified ESPP
What is a nonqualified ESPP?
A nonqualified ESPP may be structured like a qualified 423 plan, or it may offer different benefits from a
Section 423 plan, but without the preferred tax treatment for employees.
How do I find out what type of ESPP I am enrolled in?
Your specific plan documents will address whether your ESPP offering is qualified or nonqualified.
What action do I need to take?
If you are enrolled in a nonqualified ESPP, please click here to review the related separate nonqualified
ESPP Tax Guide.
2
Your Employee Stock Purchase Plan (for qualified plans)
STEP33
STEP
STEP 2
STEP 11
STEP
STEP
STEP
4 4
FAQ
FAQ
STEP
STEP
5 5
Gather the following documents.
1
FORM/DATA
WHERE TO FIND IT
WHO TO CALL
Form W-2
This form will be provided by your
employer/company.
Your company’s payroll
department
IRS Form 1040 (the full
1040, not the 1040EZ or the
1040A), including Schedule D
Capital Gains and Losses
Forms are available online at www.irs.gov,§
by calling 800.TAX.FORM (800.829.3676),
or by visiting your local IRS office.
Your local IRS office or
your tax advisor
IRS Form 8949
This form is available online at www.irs.gov,§
by calling 800.TAX.FORM (800.829.3676),
or by visiting your local IRS office.
Your local IRS office or
your tax advisor
Form 1099-B
You can access the form online at
Fidelity.com/taxforms at the end of January.
In addition, a form will be mailed no later than
mid-February, if applicable.
A Fidelity Stock Plan
Services Representative
at the number provided
on the statement
2016 Supplemental
Information (Fidelity is providing
you with additional information to
supplement your 1099-B due to
cost basis regulations that no
longer permit brokers to include
ordinary income.)
You can access the form online at
Fidelity.com/taxforms at the end of January.
In addition, a form will be mailed no later than
mid-February, if applicable.
A Fidelity Stock Plan
Services Representative
at the number provided
on the statement
Participant uses these
Fidelity forms…
Form 8949
Form
2016 TAX REPORTING STATEMENT
2016 Proceeds from Broker and Barter Exchange Transactions
(IRS Form 1099-B box numbers are shown below in bold type)
Action
Quantity 1b Date
Acquired
1c Date Sold
or Disposed
1d Proceeds
03/11/16
96,119.35
1e Cost or
Other Basis (b)
1f Accrued
Market
Discount
1g Wash Sale
Loss
Disallowed
Gain/Loss (-)
4 Federal
Income Tax
Withheld
14 State
16 State Tax
Withheld
THETA INC, TTT, 123456789
2,000.000
03/11/16
87,760.00 (e)
8,359.35
2016 SUPPLEMENTAL INFORMATION
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
96,119.35
Box A Short-Term Realized Gain
Box A Short-Term Realized Loss
87,760.00
0.00
0.00
0.00
8,359.35
NAME
Account No.
X30-000000 Customer Service:
800-000-0000
Recipient ID No. ***-**-0000 Payer's Fed ID Number: 04-0000000
0.00
Note: This information is not reported to the IRS. It may assist you in tax return preparation.
* This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you
0
if this income is taxable and the IRS determines that it has not been reported.
Detail Information
Information about Form 8949 and its separate instructions is at www.irs.gov/form8949.
File with your Schedule D to list your transactions for lines 1b, 2, 3, 8b, 9, and 10 of Schedule D.
Schedule D
Supplemental Stock Plan Lot Detail
Based on the disposal method you have selected, the lots that appear on your 1099 Supplemental may differ from the lots on the 1099-B.
Short-Term Transactions
Description of Property, Stock or Other Symbol, Cusip
For any transaction listed on Form 1099-B in a section indicating that "basis is reported to the IRS", we are reporting to the IRS: 1a Description of Property, 2 type of gain or loss (i.e. short-term or
Grant
Quantity
Date
DatetoSold
Ordinary
Income
long-term), 3 basis reported to IRS, 6 Gross or Net Proceeds, and
columns 1b, 1c, 1d, 1e, 1f, 1g,
4, 7, 14, 15 and 16.
Weof
are not reporting
the IRS: the Action, the Proceeds
Gain/Loss, and all
subtotals
and
Type (w)
Acquisition (x)
or Disposed
Reported (y)
totals.
Adjusted Cost or
Other Basis (z)
Wash Sale Loss
Disallowed
96,256.40
0.00
THETA
INC, TTT,
For any section 1256 option contracts we are reporting to the IRS:
1a Description
of 123456789
Property and totals for boxes 8, 9, 10 and 11.
QSOP
2,000.000
03/11/16
03/11/16
96,119.35
8,496.40
For any transaction listed on Form 1099-B in a section indicating that "basis is not reported to the IRS", we are reporting to the IRS: 1a Description of Property, 5 Noncovered security, 6 Gross or Net
Totals
96,119.35
Proceeds, and columns 1c, 1d, 4, 14, 15 and 16. We are not reporting to the IRS: 2 type of gain or loss (i.e. short-term
or long-term), the Action, the Gain/Loss, columns
1b, 1e, 1f, 1g, 2, 3 and 7 and all
subtotals and totals.
Short-Term Adjusted Realized Gain
Short-Term Adjusted Realized Loss
Wash Sale Loss Disallowed
Although Fidelity makes every effort to provide accurate information, please bear in mind that you, the taxpayer, are ultimately responsible for the accuracy of your tax returns.
2016
Attachment
Sequence No. 12A
96,256.40
Social security number or taxpayer identification number
to
complete…
You must check Box A, B, or C below. Check only one box. If more than one box applies for your short-term transactions,
complete a separate Form 8949, page 1, for each applicable box. If you have more short-term transactions than will fit on this page
for one or more of the boxes, complete as many forms with the same box checked as you need.
(A) Short-term transactions reported on Form(s) 1099-B showing basis was reported to the IRS (see Note above)
(B) Short-term transactions reported on Form(s) 1099-B showing basis wasn't reported to the IRS
(C) Short-term transactions not reported to you on Form 1099-B
1
(a)
Description of property
(Example: 100 sh. XYZ Co.)
(b)
Date acquired
(Mo., day, yr.)
(c)
Date sold or
disposed of
(Mo., day, yr.)
(d)
Proceeds
(sales price)
(see instructions)
Adjustment, if any, to gain or loss.
If you enter an amount in column (g),
(e)
(h)
enter a code in column (f).
Cost or other basis.
Gain or (loss).
See the Note below See the separate instructions.
Subtract column (e)
and see Column (e)
from column (d) and
(f)
(g)
in the separate
combine the result
Code(s) from
instructions
with column (g)
Amount of
instructions
adjustment
Adjusted Gain/Loss
-137.05
0.00
-137.05
0.00
Cost or other basis provided may include adjustments including, but not limited to, dividend reinvestment, return of capital/principal, wash sale loss disallowed, amortization, accretion, acquisition
premium, bond premium, market discount, market premium, and option premium.
xxxxxx
through
your employers
stockType
plan. Cost basis associated
with these
shares
may not have been adjusted for any compensation income
(e) Your 1099-B reflects shares disposed of that were acquiredGrant
Type
Equity Award
Acquisition
date
represents:
that was associated with those shares in the year of acquisition or disposal. Please consult a tax advisor for the rules specific to your grant and plan. Refer to the Supplemental Stock Plan Service
DO
Deposit Only Shares
Deposit Date
Lot Detail section of this form for additional detail.
NQSOP
Non Qualified Stock Option Shares Exercise Date
Amortization, accretion, and similar adjustments to cost basis are not provided for short-term instruments, unit investment trusts, or securities of foreign issuers.
NQSP
Non Qualified ESPP Shares
Purchase Date
11/18/2016 9002485943
Pages 3 of 6
NSR
Non-Incentive SAR (NSR)
Exercise Date
Qualified Stock Option Shares
QSP
Qualified ESPP Shares
Purchase Date
Restricted Awards
Vesting Date
2 Totals. Add the amounts in columns (d), (e), (g), and (h) (subtract
negative amounts). Enter each total here and include on your
Schedule D, line 1b (if Box A above is checked), line 2 (if Box B
above is checked), or line 3 (if Box C above is checked) ▶
Exercise Date
Form 1099-Supplemental
RSA
RSU
Restricted Units
Distribution Date
RSU
Performance Units
Distribution Date
RSU
Total Shareholder Return Units
Distribution Date
SAR
Stock Appreciation Rights
Exercise Date
Department of the Treasury
Internal Revenue Service (99)
Part I
Short-Term. Transactions involving capital assets you held 1 year or less are short term. For long-term
transactions, see page 2.
Note: You may aggregate all short-term transactions reported on Form(s) 1099-B showing basis was
reported to the IRS and for which no adjustments or codes are required. Enter the totals directly on
Schedule D, line 1a; you aren't required to report these transactions on Form 8949 (see instructions).
(b)
QSOP
SCHEDULE D
(Form 1040)
OMB No. 1545-0074
Note: If you checked Box A above but the basis reported to the IRS was incorrect, enter in column (e) the basis as reported to the IRS, and enter an
adjustment in column (g) to correct the basis. See Column (g) in the separate instructions for how to figure the amount of the adjustment.
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 37768Z
Form 8949 (2016)
2016
▶ Attach to Form 1040 or Form 1040NR.
Information about Schedule D and its separate instructions is at www.irs.gov/scheduled.
▶ Use Form 8949 to list your transactions for lines 1b, 2, 3, 8b, 9, and 10.
Attachment
Sequence No. 12
Your social security number
(d)
Proceeds
(sales price)
(e)
Cost
(or other basis)
(g)
Adjustments
to gain or loss from
Form(s) 8949, Part I,
line 2, column (g)
4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 .
5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover
Worksheet in the instructions
. . . . . . . . . . . . . . . . . . . . . . .
7 Net short-term capital gain or (loss). Combine lines 1a through 6 in column (h). If you have any longterm capital gains or losses, go to Part II below. Otherwise, go to Part III on the back . . . . .
4
5
6
(
)
7
Long-Term Capital Gains and Losses—Assets Held More Than One Year
(e)
Cost
(or other basis)
(g)
(h) Gain or (loss)
Adjustments
Subtract column (e)
to gain or loss from
from column (d) and
Form(s) 8949, Part II, combine the result with
line 2, column (g)
column (g)
8a Totals for all long-term transactions reported on Form
1099-B for which basis was reported to the IRS and for
which you have no adjustments (see instructions).
However, if you choose to report all these transactions
on Form 8949, leave this line blank and go to line 8b .
8b Totals for all transactions reported on Form(s) 8949 with
Box D checked . . . . . . . . . . . . .
9 Totals for all transactions reported on Form(s) 8949 with
Box E checked . . . . . . . . . . . . .
10 Totals for all transactions reported on Form(s) 8949 with
Box F checked . . . . . . . . . . . . . .
11 Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss)
from Forms 4684, 6781, and 8824 . . . . . . . . . . . . . . . . . . . . . .
11
12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1
12
13 Capital gain distributions. See the instructions . . . . . . . . . . . . . . . . . .
14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover
Worksheet in the instructions
. . . . . . . . . . . . . . . . . . . . . . .
15 Net long-term capital gain or (loss). Combine lines 8a through 14 in column (h). Then go to Part III on
the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see your tax return instructions.
Last name
Last name
Filing Status
(d)
Proceeds
(sales price)
U.S. Individual Income Tax Return
OMB No. 1545-0074
, 2016, ending
Foreign country name
1b Totals for all transactions reported on Form(s) 8949 with
Box A checked . . . . . . . . . . . . .
2 Totals for all transactions reported on Form(s) 8949 with
Box B checked . . . . . . . . . . . . .
3 Totals for all transactions reported on Form(s) 8949 with
Box C checked . . . . . . . . . . . . .
See instructions for how to figure the amounts to enter on the
lines below.
This form may be easier to complete if you round off cents to
whole dollars.
2016
(99)
Department of the Treasury—Internal Revenue Service
If a joint return, spouse’s first name and initial
Cat. No. 11338H
Rolls
up
into
13
14 (
IRS Use Only—Do not write or staple in this space.
See separate instructions.
, 20
Your social security number
Spouse’s social security number
Apt. no.
▲
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
(h) Gain or (loss)
Subtract column (e)
from column (d) and
combine the result with
column (g)
1a Totals for all short-term transactions reported on Form
1099-B for which basis was reported to the IRS and for
which you have no adjustments (see instructions).
However, if you choose to report all these transactions
on Form 8949, leave this line blank and go to line 1b .
Part II
1040
For the year Jan. 1–Dec. 31, 2016, or other tax year beginning
Your first name and initial
Home address (number and street). If you have a P.O. box, see instructions.
Short-Term Capital Gains and Losses—Assets Held One Year or Less
See instructions for how to figure the amounts to enter on the
lines below.
This form may be easier to complete if you round off cents to
whole dollars.
Rolls
up
into
Form 1040
OMB No. 1545-0074
Capital Gains and Losses
▶
Name(s) shown on return
Part I
1a Description of property, Stock or Other Symbol, CUSIP
Sale
▶
▶
Before you check Box A, B, or C below, see whether you received any Form(s) 1099-B or substitute statement(s) from your broker. A substitute
statement will have the same information as Form 1099-B. Either will show whether your basis (usually your cost) was reported to the IRS by your
broker and may even tell you which box to check.
Copy B for Recipient OMB No. 1545-0715
Short-term transactions for which basis is reported to the IRS --report on Form 8949 with Box A checked and/or Schedule D, Part I
Proceeds are reported as gross proceeds unless otherwise indicated (a).(This Label is a Substitute for Boxes 2, 3, 5 & 6)
TOTALS
Sales and Other Dispositions of Capital Assets
Name(s) shown on return
0 00
FORM 1099-B*
8949
Department of the Treasury
Internal Revenue Service
Account No.
X30-000000 Customer Service:
800-000-0000
Recipient ID No. ***-**-0000 Payer's Fed ID Number: 04-0000000
MASKED NAME
Form
Form 1099-B
)
15
Check only one
box.
Exemptions
Single
Married filing jointly (even if only one had income)
2
3
c
Head of household (with qualifying person). (See instructions.) If
5
Qualifying widow(er) with dependent child
the qualifying person is a child but not your dependent, enter this
child’s name here. ▶
Married filing separately. Enter spouse’s SSN above
and full name here. ▶
6a
b
4
Yourself. If someone can claim you as a dependent, do not check box 6a .
Spouse
.
Dependents:
(1) First name
.
.
.
.
.
.
.
.
.
.
.
(2) Dependent’s
social security number
Last name
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
}
(4) ✓ if child under age 17
qualifying for child tax credit
(see instructions)
(3) Dependent’s
relationship to you
Dependents on 6c
not entered above
d
Attach Form(s)
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.
Adjusted
Gross
Income
Boxes checked
on 6a and 6b
No. of children
on 6c who:
• lived with you
• did not live with
you due to divorce
or separation
(see instructions)
If more than four
dependents, see
instructions and
check here ▶
Income
Make sure the SSN(s) above
and on line 6c are correct.
Presidential Election Campaign
Check here if you, or your spouse if filing
jointly, want $3 to go to this fund. Checking
a box below will not change your tax or
refund.
You
Spouse
Foreign postal code
Foreign province/state/county
1
.
.
.
.
.
.
.
.
.
.
.
.
7
Wages, salaries, tips, etc. Attach Form(s) W-2
.
.
.
.
.
.
.
.
.
.
.
.
8a
b
9a
Taxable interest. Attach Schedule B if required .
Tax-exempt interest. Do not include on line 8a .
Ordinary dividends. Attach Schedule B if required
.
.
.
.
.
.
.
.
8b
.
.
.
.
.
.
.
.
8a
.
.
.
.
.
.
.
.
9a
10
11
Qualified dividends . . . . . . . . . . .
9b
Taxable refunds, credits, or offsets of state and local income taxes
Alimony received . . . . . . . . . . . . . . .
.
.
.
.
.
.
.
.
.
.
.
.
10
11
12
13
14
Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . .
Capital gain or (loss). Attach Schedule D if required. If not required, check here ▶
Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . .
.
.
12
13
14
15a
16a
17
IRA distributions .
15a
b Taxable amount
. . .
Pensions and annuities 16a
b Taxable amount
. . .
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
15b
16b
17
18
19
20a
Farm income or (loss). Attach Schedule F .
Unemployment compensation . . . .
Social security benefits 20a
18
19
20b
b
Total number of exemptions claimed
.
.
.
.
.
.
.
.
.
.
.
. . . . . .
. . . . . .
b Taxable amount
.
.
.
.
.
.
21
22
Other income. List type and amount
Combine the amounts in the far right column for lines 7 through 21. This is your total income
23
Educator expenses
.
.
.
.
.
.
.
.
.
.
.
24
Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
25
Health savings account deduction. Attach Form 8889
.
Add numbers on
lines above ▶
7
21
22
24
25
26
27
28
Moving expenses. Attach Form 3903 . . . . . .
Deductible part of self-employment tax. Attach Schedule SE .
Self-employed SEP, SIMPLE, and qualified plans
. .
26
27
28
Self-employed health insurance deduction
Penalty on early withdrawal of savings . .
.
.
.
.
.
.
.
.
32
33
34
Alimony paid b Recipient’s SSN ▶
IRA deduction . . . . . . .
Student loan interest deduction . .
Tuition and fees. Attach Form 8917 .
29
30
31a
.
.
.
.
.
.
.
.
.
.
.
.
32
33
34
35
36
37
Domestic production activities deduction. Attach Form 8903
35
Add lines 23 through 35 . . . . . . . . . . . . .
Subtract line 36 from line 22. This is your adjusted gross income
.
.
.
.
23
29
30
31a
.
.
.
.
.
.
▶
.
.
.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
.
.
.
.
.
.
.
.
.
▶
36
37
Cat. No. 11320B
Form
1040
(2016)
Schedule D (Form 1040) 2016
(w)xxxxxx
Grant Type describes the equity award source of the lot you sold this tax year. Please see the Grant Type table for additional description.
xxxxxx
(x)
Date of Acquisition is the date that shares were acquired from your Equity Plan and deposited into your brokerage account.
(y)
Fidelity-calculated ordinary income that was reported on the W2 from the year you acquired the shares. Fidelity-calculated ordinary income does not include any adjustments that your company
has made. Fidelity is not responsible for any adjustments that your company may have made to this number.
Adjusted cost or other basis provided may include the following adjustments: ordinary income reported, dividend reinvestment, return of capital/principal and wash sale loss disallowed.
(z)
Important Tax Return Document Enclosed.
§
idelity is not involved in the preparation of the content supplied at the third-party unaffiliated website and does not guarantee or
F
assume any responsibility for its content.
11/18/2016 9002485943
Pages 6 of 6
3
Your Employee Stock Purchase Plan (for qualified plans)
STEP 11
STEP
STEP33
STEP
STEP 2
STEP
STEP
4 4
STEP
STEP
5 5
FAQ
FAQ
Report your ordinary income.
2
Your company may report your ESPP income after you sell your stock on your W-2 as wages in
Box 1 if you are an employee. Even if your company does not report the income from an ESPP as
compensation on your W-2, you are still responsible for properly reporting and paying tax on the
amount of ordinary income. In addition, you may owe tax on any capital gains resulting from the
sale of your stock, which is explained in later steps.
Example: IRS W-2 for ESPP & 1040
a Employee’s social security number
OMB No. 1545-0008
Safe, accurate,
FAST! Use
Visit the IRS website at
www.irs.gov/efile§
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
c Employer’s name, address, and ZIP code
3 Social security wages
4 Social security tax withheld
5 Medicare wages and tips
6 Medicare tax withheld
7 Social security tips
8 Allocated tips
9
d Control number
e Employee’s first name and initial
10 Dependent care benefits
Suff. 11 Nonqualified plans
Last name
13
Statutory
employee
Retirement
plan
12a See instructions for box 12
C
o
d
e
Third-party
sick pay
12b
C
o
d
e
Your employer may also
use Box 14 to report
additional compensation.
12c
14 Other
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Form
Employer’s state ID number
W-2
Wage and Tax
Statement
16 State wages, tips, etc.
17 State income tax
2014
2016
2015
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury—Internal Revenue Service
Copy B—To Be Filed With Employee’s FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
For illustrative purposes only.
ESPP income will usually be
included with your other
compensation in box 1.
ESPP income could be included
in boxes 16 and 18 if state and
local tax applies.
idelity is not involved in the preparation of the content
F
supplied at the third-party unaffiliated website and does
not guarantee or assume any responsibility for its content.
§
W-2 income is
reported on Line 7 of
Form 1040.
For illustrative purposes only.
4
Your Employee Stock Purchase Plan (for qualified plans)
STEP 11
STEP
STEP33
STEP
STEP 2
STEP
STEP
4 4
FAQ
FAQ
STEP
STEP
5 5
Assemble information on the
purchase and sale of your stock.
3
2016 TAX REPORTING STATEMENT
MASKED NAME
Account No.
X30-000000 Customer Service:
You will need to refer to two documents this
year. Your Fidelity Brokerage
1099-B Tax-Reporting
Recipient ID No. ***-**-0000 Payer's Fed ID Number: 04-0000000
0
0
0
Statement and your 2016 Supplemental Information Form. The Supplemental Form may contain
Copy B for Recipient OMB No. 1545-0715
FORM 1099-B*
Proceedson
from
Broker
and Barter
Transactions
information
that is not2016
reported
your
1099-B
dueExchange
to cost basis
regulations. If the amounts on these
Short-term transactions for which basis is reported to the IRS --report on Form 8949 with Box A checked and/or Schedule D, Part I
two
forms differ, you’ll need to use information from both of these to complete your tax forms to
Proceeds are reported as gross proceeds unless otherwise indicated (a).(This Label is a Substitute for Boxes 2, 3, 5 & 6)
ensure you don’t overpay taxes. (IRS Form 1099-B box numbers are shown below in bold type)
1a Description of property, Stock or Other Symbol, CUSIP
Action
Quantity 1b Date
1c Date Sold
1d Proceeds
1e Cost or
1f Accrued
Example:
Fidelity
Brokerage
1099-B Tax-Reporting
Statement
Acquired
or Disposed
Other Basis
(b)
Market
1g Wash Sale
Loss
Disallowed
THETA INC, TTT, 123456789
Sale
1
160.452
2
3
09/30/15
09/01/16
MASKED NAME
3,900.51
3,445.54(e)
Sale
146.177
12/31/15
09/01/16
3,553.50
3,445.54(e)
Sale
162.000
03/31/16
09/01/16
3,938.14
3,054.51(e)
127.502
06/30/16
09/01/16
FORM
1099-B*
Sale
Subtotals
4
5
0 00
Gain/Loss (-)
4 Federal
Income Tax
Withheld
14 State
16 State Tax
Withheld
2016 TAX REPORTING STATEMENT
Discount
6
7
Account No.
X30-000000 Customer Service:
454.97
Recipient ID No. ***-**-0000 Payer's Fed ID Number: 04-0000000
107.96
3,099.52
2,292.74(e)
2016 Proceeds from Broker
and Barter
Exchange Transactions
14,491.67
12,238.33
0.00
883.63
Copy B for Recipient OMB No. 1545-0715
806.78
0.00
Short-term
transactions for which basis is reported to the14,491.67
IRS --report on12,238.33
Form 8949 with Box 0.00
A checked and/or
0.00 Schedule D, Part I
TOTALS
Proceeds are reported as gross
unless
otherwise
Boxproceeds
A Short-Term
Realized
Gain indicated (a).(This Label is a Substitute for Boxes 2, 3, 5 & 6)
2,253.34
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Box A Short-Term Realized
Loss
(IRS
Form 1099-B box numbers are shown below in bold type)
0.00
0.00
1a Description of property, Stock or Other Symbol, CUSIP
Quantity 1b Date
Acquired
Action
1c Date Sold
or Disposed
1d Proceeds
1e Cost or
Other Basis (b)
1f Accrued
Market
Discount
1g Wash Sale
Loss
Disallowed
Gain/Loss (-)
4 Federal
Income Tax
Withheld
14 State
16 State Tax
Withheld
THETA INC, TTT, 123456789
Sale
160.452
09/30/15
09/01/16
3,900.51
3,445.54(e)
454.97
Sale
146.177
12/31/15
09/01/16
3,553.50
3,445.54(e)
107.96
Sale
162.000
03/31/16
09/01/16
3,938.14
3,054.51(e)
883.63
Sale
127.502
06/30/16
09/01/16
3,099.52
2,292.74(e)
806.78
Subtotals
14,491.67
12,238.33
0.00
0.00
TOTALS
14,491.67
Box A Short-Term Realized Gain
Box A Short-Term Realized Loss
12,238.33
0.00
0.00
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2,253.34
0.00
0.00
* This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you
if this income is taxable and the IRS determines that it has not been reported.
Pages 3 of 10
10/14/2016 9001000000
1
— CUSIP (your company’s ticker/trading
symbol)
For illustrative purposes only.
5
— Proceeds (gross proceeds from stock sale)
6 — Cost or Other Basis (this is provided to
the IRS as directed, and may need to be
—
Quantity
(number
of
shares
sold)
2
* This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you
if this income is taxable and the IRS determines that it has not been reported.
adjusted — see Supplemental Form)
—
D
ate
Acquired
(date
shares
3
10/14/2016 9001000000
Pages 3 of 10
7 — Gain/Loss (from the proceeds of the
purchased)
sale and may also need to be
adjusted — see Supplemental Form)
4 — Date Sold or Disposed
5
Continues
Your Employee Stock Purchase Plan (for qualified plans)
STEP
STEP 11
STEP 2
STEP
STEP33
STEP
4 4
STEP
STEP
5 5
STEP
FAQ
FAQ
Assemble information on the
purchase and sale of your stock.
3
Example: 2016 Supplemental Form
2016 SUPPLEMENTAL INFORMATION
Account No.
X30-000000 Customer Service:
Recipient ID No. ***-**-0000 Payer's Fed ID Number: 04-0000000
NAME
Note: This information is not reported to the IRS. It may assist you in tax return preparation.
8
Detail Information
9
0
10
Supplemental Stock Plan Lot Detail
Based on the disposal method you have selected, the lots that appear on your 1099 Supplemental may differ from the lots on the 1099-B.
Short-Term Transactions
Description of Property, Stock or Other Symbol, Cusip
Grant
Type (w)
Quantity
THETA INC, TTT, 123456789
QSP
160.452
QSP
146.177
QSP
162.000
QSP
127.502
Date of
Acquisition (x)
Date Sold
or Disposed
09/30/15
12/31/15
03/31/16
06/30/16
09/01/16
09/01/16
09/01/16
09/01/16
Totals
Detail Information
Proceeds
Ordinary Income
Reported (y)
Adjusted Cost or
Other Basis (z)
Wash Sale Loss
Disallowed
Adjusted Gain/Loss
3,900.51
3,553.50
3,938.14
3,099.52
382.84
382.84
339.39
254.75
3,828.38
3,828.38
3,393.90
2,547.49
0.00
0.00
0.00
0.00
72.13
-274.88
544.24
552.03
14,491.67
13,598.15
Short-Term Adjusted Realized Gain
Short-Term Adjusted Realized Loss
Wash Sale Loss Disallowed
1,168.40
-274.88
0.00
Supplemental Stock Plan Lot Detail
Based on the disposal method you have selected, the lots that appear on your 1099 Supplemental may differ from the lots on the 1099-B.
Long-Term Transactions
For illustrative purposes only.
Description of Property, Stock or Other Symbol, Cusip
Grant
Type (w)
Quantity
Date of
Acquisition (x)
Date Sold
or Disposed
Proceeds
Ordinary Income
Reported (y)
Adjusted Cost or
Other Basis (z)
Wash Sale Loss
Disallowed
Adjusted Gain/Loss
CITIZENS FINL GROUP INC COM, CFG, 174610105
55.868
12/31/14
QSP
77.845
03/31/15
QSP
120.156
06/30/15
8QSP
09/01/16(cross reference
1,358.13
138.89 your company
1,388.89
— Ordinary Income Reported
this with
W-2 0.00
and input -30.76
in column (g)
09/01/16
1,892.36
187.84
1,878.39
0.00
13.97
of the 8949)
09/01/16
2,920.94
328.15
3,281.47
0.00
-360.53
Totals
9
10
6,171.43
6,548.75
Long-Term Adjusted Realized Gain
— Adjusted Cost Basis (this amount
is used
recalculate
your gain/loss and is -391.29
equal to the
Long-Term
Adjusted to
Realized
Loss
0.00
Wash Sale Loss Disallowed
ordinary income plus the cost basis on your 1099-B)
13.97
— Adjusted Gain/Loss (recalculated per your new basis; proceeds minus your adjusted cost
basis — this amount goes on column (h) of the 8949)
10/14/2016 9001000000
Pages 7 of 10
6
Your Employee Stock Purchase Plan (for qualified plans)
STEP 11
STEP
4
STEP 2
STEP33
STEP
STEP
STEP
4 4
STEP
STEP
5 5
FAQ
FAQ
Use the forms to calculate your capital
gains and/or losses on IRS Form 8949
and Schedule D.
Even though the ordinary income may be reported on your W-2, you still need to report the sale of the
stock on Form 8949 and carry over the amounts to Schedule D.* You will need both your 1099-B and
Supplemental Form to help you complete your tax forms.
In preparation for completing these forms, consider the following:
1. How long did you hold the shares before you sold them? This determines which section of Form 8949
to complete.
Form 8949 is divided into two parts. Determine which section you will need to complete:
• P
art I is for short-term capital gains or losses. Short term is defined as selling the stock less than
one year from the date you acquired it.
art II is for long-term capital gains and losses. Long term is defined as holding the stock for more
• P
than one year from the date you acquired it.
2. Does the cost basis on your 1099-B match the amount on your Supplemental Form? If it doesn’t, you
may need to make an adjustment on Form 8949. This is because you may have already paid tax on
your ordinary income (as reported on your W-2) and you don’t want to pay taxes twice.
*State and local taxes may also apply and the rules governing such taxes may vary from federal income tax rules. Please consult your tax advisor.
7
Your Employee Stock Purchase Plan (for qualified plans)
STEP 11
STEP
4
STEP 2
STEP33
STEP
STEP
STEP
4 4
STEP
STEP
5 5
FAQ
FAQ
Use the forms to calculate your capital
gains and/or losses on IRS Form 8949.
Example: ESPP Purchase and Sell after Holding Short Term (held less than 1 year)
To complete Form 8949
and Schedule D, you
need to know:
• N
umber of shares
you sold
• The date of sale
• W
hen you acquired/
purchased those shares
• T
he gross proceeds
from the sale
• Your Cost Basis
• A
mount of ordinary
income (from
Supplemental Form)
For illustrative purposes only.
8
Continues
Your Employee Stock Purchase Plan (for qualified plans)
STEP 11
STEP
4
STEP 2
STEP33
STEP
STEP
STEP
4 4
STEP
STEP
5 5
FAQ
FAQ
Use the forms to calculate your capital
gains and/or losses on IRS Form 8949.
Example: ESPP Purchase and Sell after Holding Long Term (held longer than 1 year)
Note: Qualified Dispositions will always be considered long-term holdings.
To complete Form 8949
and Schedule D, you
need to know:
• N
umber of shares
you sold
• The date of sale
• W
hen you acquired/
purchased those shares
• T
he gross proceeds
from the sale
• Your Cost Basis
• A
mount of ordinary
income (from
Supplemental Form)
For illustrative purposes only.
9
Your Employee Stock Purchase Plan (for qualified plans)
STEP 11
STEP
5
STEP 2
STEP33
STEP
STEP
STEP
4 4
STEP
STEP
5 5
FAQ
FAQ
Use IRS Form 8949 to calculate your capital gains
and/or losses on Schedule D.
Gain or loss from the sale of the stock should be reflected on Form 8949 and Schedule D. How this is reflected is
dependent on whether the sale is short term (less than one year from the date the stock was acquired to the date
it was sold) or long term (more than one year from the date acquired to the date of sale).
Example: Short-Term Gains or Losses
For illustrative purposes only.
Example: Long-Term Gains or Losses
For illustrative purposes only.
10
Your Employee Stock Purchase Plan (for qualified plans)
STEP 11
STEP
STEP33
STEP
STEP 2
STEP
STEP
4 4
STEP
STEP
5 5
FAQ
FAQ
Frequently Asked Questions
Q:I have a “qualified” ESPP. What do “qualified dispositions” and “disqualified
dispositions” mean?
A:A qualified ESPP is provided under Section 423 of the Internal Revenue Code and is
“qualified” for special capital gains treatment if you hold your shares for a certain
period of time. See the example below:
What is the date shares were purchased and when did you sell those shares?
Grant Date/
Beginning of
Offering Period
1/1/2014
Disqualified Disposition
Year 1
Qualified Disposition
Year 2
Purchase Date
Sold
2/3/2015
1/2/2016
For Example:
Grant date/Beginning of offering period: 1/1/2014
Date shares purchased for you: 2/3/2015
Date you sold these shares: 1/2/2016
{
Year 3
You have a disqualified disposition because even
though you sold two years after the grant date, it
was not yet a year after the purchase.
Q:Will I owe other taxes beyond federal tax when I sell my stock?
A:State and local taxes may also apply, and the rules governing such taxes may vary
from federal income tax rules. Please consult your tax advisor for more information.
Go back to the Fidelity SPS Resource Center
If you have questions, a Fidelity Stock Plan Services Representative can help. Call 800.544.9354.
Tax laws are complex and subject to change. State and local taxes may also apply, and the rules governing such taxes may vary from federal
income tax rules. Your actual income tax consequences depend on your individual circumstances. Therefore, you should always consult a qualified
tax advisor regarding your own particular tax situation.
Fidelity Brokerage Services LLC, Member NYSE, SIPC
Fidelity Stock Plan Services, LLC
© 2017 FMR LLC. All rights reserved.
710946.4.0
03/29767 SPS-QUAL-ESPP-TAX-PDF-0117