FEDERAL SECTION W-2 Information No W-2 information to enter Exercise Number Five - Advanced Competencies (Page 2) 1099-R Retirement Information 1099-R Information Payer's Identification Number Payer's Name Payer's Address Gross Distribution Taxable Amount Federal Withholdings Box 7 Code 1099-R Information Payer's Identification Number Payer's Name Payer's Address Gross Distribution Taxable Amount Federal Withholdings Box 7 Code 58-5687215 Fidelity 178 Central Avenue, 30906 $ 54589 See 1099-R See 1099-R 58-9462879 Office of Personnel Management PO Box 45, 16017 $ 13987 $ 0 (Direct Rollover) $ 0 G SSA-1099 Information Social Security Benefits Received Federal Withholdings Medicare Premiums $ 12000 $1200 $ 1608