2013 Tax Analysis Calculation

Complete and submit the following information to perform an analysis of the potential tax savings related to participation in Flexible Spending Accounts and other tax favored benefits:


*Required fields are marked with an asterisk ()**

1. Enter YOUR Expected Annual Income: *


2. Enter YOUR Spouse's Expected Annual Income, If Applicable:


3. Choose your tax filing status:


4. Enter The Number of Your Dependents That Qualify For Exemption Status On Your Federal Tax Return : Do not include yourself in this number. Also, do not include your spouse in this number if you select a filing status of "Married Filing Jointly" above.


5. Enter Your Birthdate (MM/DD/YYYY): * This information will be used in projecting the number of years to retirement, based on your normal or full retirement age (the retirement age at which your Social Security benefits will not be reduced).	/ /


6. Enter The State Where You Reside: This information will be used to determine your minimum state income tax rate, if applicable.


7. Enter The Number Of Paychecks You Receive Per Plan Year: *


8. Enter Your ANNUAL Contribution To A Medical Flexible Spending Account:


9. Enter Your ANNUAL Contribution To A Dependent Care Flexible Spending Account:


10. Enter The Per Payroll Contribution To Your 401(k) Account:


11. Enter The Per Payroll Total Of Any Other Deductions That Are Taken Pre-Tax From Your Paycheck: Some examples to include in this amount would be the per payroll pre-tax deductions you have for Medical, Dental or Vision Care premiums.

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