9898 VOID CORRECTED

PAYER'S name, street address, city or town, state or province, 1 Gross distribution OMB No. 1545-0119 Distributions From
country, ZIP or foreign postal code, and phone no. Pensions, Annuities,
Retirement or
DEFENSE FINANCE AND ACCOUNTING SVC $ 4,632 Profit-Sharing Plans,
2a Taxable amount 2018 IRAs, Insurance
P O BOX 99191 Contracts, etc.
CLEVELAND OH 44199-1126 $ 4,632 Form 1099-R
2b Taxable amount Total
not determined distribution Copy A
For
PAYER'S TIN RECIPIENT'S TIN 3 Capital gain (included 4 Federal income tax
in box 2a) withheld
Internal Revenue
Service Center

34-0727612 174-58-0831 $ $ 94 File with Form 1096.

RECIPIENT'S name 5 Employee contributions/ 6 Net unrealized
Designated Roth appreciation in For Privacy Act
contributions or employer's securities and Paperwork
RICHARD W FEENEY insurance premiums Reduction Act
$ $ Notice, see the
Street address (including apt. no.) 7 Distribution IRA/ 8 Other 2018 General
SEP/ Instructions for
code(s)
22309 SPRING LAKE RD SIMPLE
Certain
7 $ % Information
City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions Returns.
SHELL LAKE WI 54871 distribution % $
10 Amount allocable to IRR 11 1st year of FATCA filing 12 State tax withheld 13 State/Payer's state no. 14 State distribution
within 5 years desig. Roth contrib. requirement
$ 3585783 $
$ $ $
Account number (see instructions) Date of 15 Local tax withheld 16 Name of locality 17 Local distribution
payment
$ $
$ $
Form 1099-R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service
EEA Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page
9898
The information VOID
on the Form 1099R CORRECTED
was used to prepare the taxpayer's 2018 Federal tax return by SPOONER TAX PROFESSIONAL
PAYER'S name, street address, city or town, state or province, 1 Gross distribution OMB No. 1545-0119 Distributions From
country, ZIP or foreign postal code, and phone no. Pensions, Annuities,
Retirement or
$ Profit-Sharing Plans,
2a Taxable amount 2018 IRAs, Insurance
Contracts, etc.
$ Form 1099-R
2b Taxable amount Total
not determined distribution Copy A
For
PAYER'S TIN RECIPIENT'S TIN 3 Capital gain (included 4 Federal income tax
in box 2a) withheld
Internal Revenue
Service Center

$ $ File with Form 1096.

RECIPIENT'S name 5 Employee contributions/ 6 Net unrealized
Designated Roth appreciation in For Privacy Act
contributions or employer's securities and Paperwork
insurance premiums Reduction Act
$ $ Notice, see the
Street address (including apt. no.) 7 Distribution IRA/ 8 Other 2018 General
SEP/ Instructions for
code(s)
SIMPLE
Certain
$ % Information
City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions Returns.
distribution % $
10 Amount allocable to IRR 11 1st year of FATCA filing 12 State tax withheld 13 State/Payer's state no. 14 State distribution
within 5 years desig. Roth contrib. requirement
$ $
$ $ $
Account number (see instructions) Date of 15 Local tax withheld 16 Name of locality 17 Local distribution
payment
$ $
$ $
Form 1099-R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service
EEA
 a Employee's social security number Safe, accurate, Visit the IRS website at
FAST! Use IRS e-file www.irs.gov/efile
174-58-0831 OMB No. 1545-0008

b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld

41-0950527 3,776 312

c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld

PRAIRIE MANOR 3,776 234

5 Medicare wages and tips 6 Medicare tax withheld

220 3RD ST 3,776 55

Blooming Prairie MN 55917 7 Social security tips 8 Allocated tips

d Control number 9 Verification code 10 Dependent care benefits

12a See instructions for box 12

e Employee's first name and initial Last name Suff. 11 Nonqualified plans C
o
d
e
Statutory Retirement Third-party 12b
RICHARD W FEENEY 13 employee plan sick pay C
o
d
e
12c
22309 SPRING LAKE RD 14 Other C
o
SHELL LAKE WI 54871 d
e
12d
C
o
d
e

f Employee's address and ZIP code

15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

MN 7524510 3,776 137

W-2 Wage and Tax Department of the Treasury-Internal Revenue Service

Form Statement
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
2018
This information is being furnished to the Internal Revenue Service.
EEA
The information on the Form W-2 was used to prepare the taxpayer's 2018 Federal tax return by SPOONER TAX PROFESSIONALS
a Employee's social security number Safe, accurate, Visit the IRS website at
IRS e-file
174-58-0831 OMB No. 1545-0008 FAST! Use www.irs.gov/efile

b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
41-1273346 125,008 16,900
c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
MISSION FARMS NURSING HOME 125,008 7,750
5 Medicare wages and tips 6 Medicare tax withheld
3401 EAST MEDICINE 125,008 1,813
Minneapolis MN 55441 7 Social security tips 8 Allocated tips

d Control number 9 Verification code 10 Dependent care benefits

12a See instructions for box 12

e Employee's first name and initial Last name Suff. 11 Nonqualified plans C
o
d
e
Statutory Retirement Third-party
RICHARD W FEENEY 13 employee plan sick pay
12b
C
o
d
e

12448 COUNTY HWY 45 14 Other 12c

C
o
Blooming Prairie MN 55917 d
e
12d
C
o
d
e

f Employee's address and ZIP code

15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
MN 5289421 125,008 6,500

W-2 Wage and Tax Department of the Treasury-Internal Revenue Service

Form Statement
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
2018
This information is being furnished to the Internal Revenue Service.
EEA
The information on the Form W-2 was used to prepare the taxpayer's 2018 Federal tax return by SPOONER TAX PROFESSIONALS
 a Employee's social security number Safe, accurate, Visit the IRS website at
FAST! Use IRS e-file www.irs.gov/efile
387-92-2180 OMB No. 1545-0008

b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld

75-3175925 31,515 1,202

c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld

MRCI
5 Medicare wages and tips 6 Medicare tax withheld

15 MAP DR
Mankato MN 56002 7 Social security tips 8 Allocated tips

d Control number 9 Verification code 10 Dependent care benefits

12a See instructions for box 12

e Employee's first name and initial Last name Suff. 11 Nonqualified plans C
o
d
e
Statutory Retirement Third-party 12b
PATRICIA FEENEY 13 employee plan sick pay C
o
d
e
12c
12448 COUNTY HWY 45 14 Other C
o
Blooming Prairie MN 55917 d
e
12d
C
o
d
e

f Employee's address and ZIP code

15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

MN 5165734 31,515 790

W-2 Wage and Tax Department of the Treasury-Internal Revenue Service

Form Statement
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
2018
This information is being furnished to the Internal Revenue Service.
EEA
The information on the Form W-2 was used to prepare the taxpayer's 2018 Federal tax return by SPOONER TAX PROFESSIONALS
a Employee's social security number Safe, accurate, Visit the IRS website at
OMB No. 1545-0008 FAST! Use IRS e-file 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

d Control number 9 Verification code 10 Dependent care benefits

12a See instructions for box 12

e Employee's first name and initial Last name Suff. 11 Nonqualified plans C
o
d
e
Statutory Retirement Third-party 12b
13 employee plan sick pay C
o
d
e
12c
14 Other C
o
d
e
12d
C
o
d
e

f Employee's address and ZIP code

15 State Employer's state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

W-2 Wage and Tax Department of the Treasury-Internal Revenue Service

Form Statement
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
2018
This information is being furnished to the Internal Revenue Service.
EEA