Form 8959 Department of the Treasury Internal Revenue Service | Additional Medicare Tax If any line does not apply to you, leave it blank. See separate instructions. Attach to Form 1040, 1040NR, 1040-PR, or 1040-SS. Go to www.irs.gov/form8959 for instructions and the latest information. | OMB No. 1545-0074 | 2017 Attachment Sequence No. 71 | Name(s) shown on Form 1040 Eang and Meng Ung | Your social security number | Part I | Additional Medicare Tax on Medicare Wages | 1 | Medicare wages and tips from Form W-2, box 5. If you have more than one Form W-2, enter the total of the amounts from box 5 . . . . . | 1 | | | | | | 2 | Unreported tips from Form 4137, line 6 . . . . . . . . . . . . . . . . . . | 2 | | | | | | 3 | Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . . . . | 3 | | | | | | 4 | Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 4 | | | | | | 5 | Enter the following amount for your filing status: Married filing jointly . . . . . . . . . . . . . . . . . . . . . . . . | $250,000 | Married filing separately . . . . . . . . . . . . . . . . . . . . . | $125,000 | Single, Head of household, or Qualifying widow(er) . . . | $200,000 | | 5 | | | | | | 6 | Subtract line 5 from line 4. If the result is zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . | 6 | | | 7 | Additional Medicare Tax on Medicare wages. Multiply line 6 by 0.9% (0.009). Enter here and go to Part II | 7 | | | Part II | Additional Medicare Tax on Self-Employment Income | 8 | Self-employment income from Schedule SE (Form 1040), Section A, line 4, or Section B, line 6. If you had a loss, enter -0- (Form 1040-PR and Form 1040-SS filers, see instructions.) . . . . . . . . . . . . . . . . | 8 | | | | | | 9 | Enter the following amount for your filing status: Married filing jointly . . . . . . . . . . . . . . . . . . . . . . . . . . | $250,000 | Married filing separately . . . . . . . . . . . . . . . . . . . . . . . | $125,000 | Single, Head of household, or Qualifying widow(er) . . . | $200,000 | | 9 | | | | | | 10 | Enter the amount from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 10 | | | | | | 11 | Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . . | 11 | | | | | | 12 | Subtract line 11 from line 8. If the result is zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . | 12 | | | 13 | Additional Medicare Tax on self-employment income. Multiply line 12 by 0.9% (0.009). Enter here and go to Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 13 | | | Part III | Additional Medicare Tax on Railroad Retirement Tax Act (RRTA) Compensation | 14 | Railroad retirement (RRTA) compensation and tips from Form(s) W-2, box 14 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 14 | | | | | | 15 | Enter the following amount for your filing status: Married filing jointly . . . . . . . . . . . . . . . . . . . . . . . . . . | $250,000 | Married filing separately . . . . . . . . . . . . . . . . . . . . . . . | $125,000 | Single, Head of household, or Qualifying widow(er) . . . | $200,000 | | 15 | | | | | | 16 | Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 16 | | | 17 | Additional Medicare Tax on railroad retirement (RRTA) compensation. Multiply line 16 by 0.9% (0.009). Enter here and go to Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 17 | | | Part IV | Total Additional Medicare Tax | 18 | Add lines 7, 13, and 17. Also include this amount on Form 1040, line 62, (Form 1040NR, 1040-PR, and 1040-SS filers, see instructions) and go to Part V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 18 | | | Part V | Withholding Reconciliation | 19 | Medicare tax withheld from Form W-2, box 6. If you have more than one Form W-2, enter the total of the amounts from box 6 . . . . . . . | 19 | | | | | | 20 | Enter the amount from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 20 | | | | | | 21 | Multiply line 20 by 1.45% (0.0145). This is your regular Medicare tax withholding on Medicare wages . . . . . . . . . . . . . . . . . . . . . . . . . . | 21 | | | | | | 22 | Subtract line 21 from line 19. This is your Additional Medicare Tax withholding on Medicare wages . . . | 22 | | | 23 | Additional Medicare Tax withholding on railroad retirement (RRTA) compensation from Form W-2, box 14 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 23 | | | 24 | Total Additional Medicare Tax withholding. Add lines 22 and 23. Also include this amount with federal income tax withholding on Form 1040, line 64 (Form 1040NR, 1040-PR, and 1040-SS filers, see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 24 | | | For Paperwork Reduction Act Notice, see your tax return instructions. | Cat. No. 59475X | Form 8959 (2017) | |