Exhibit U
Internal Revenue Bulletin 2003-16 · 2026-10-03 edition · updated 2026-10-04 · United States
Copy A
For Internal Revenue
Service Center File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act Notice, see the
2003 General Instructions for Forms 1099, 1098,
5498, and W-2G.
| TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code | 1IRA contributions (other than amounts in boxes 2–4 and 8–10) $ |
OMB No. 1545-0747 2003 Form 5498 |
||
|---|---|---|---|---|
| TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
Rollover contributions 2 $ 1.40" |
Rollover contributions 2 $ 1.40" |
| TRUSTEE’S or ISSUER’S Federal identification no. | PARTICIPANT’S social security number | PARTICIPANT’S social security number | Roth IRA conversion amount 3 $ |
4 Recharacterized contributions $ |
| PARTICIPANT’S name | PARTICIPANT’S name | PARTICIPANT’S name | Fair market value of account 5 $ |
Life insurance cost included in box 1 6 $ |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | 7 IRA SEP SIMPLE Roth IRA |
7 IRA SEP SIMPLE Roth IRA |
| City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | 8 SEP contributions $ 1.40" |
9 SIMPLE contributions $ 1.40" |
| Account number (optional) | Account number (optional) | 10 Roth IRA contributions $ |
Form 5498 Cat. No. 50010C Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page
Copy A
For Internal Revenue
Service Center File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act Notice, see the
2003 General Instructions for Forms 1099, 1098,
5498, and W-2G.
| TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code | 1IRA contributions (other than amounts in boxes 2–4 and 8–10) $ |
OMB No. 1545-0747 2003 Form 5498 |
||
|---|---|---|---|---|
| TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
Rollover contributions 2 $ |
Rollover contributions 2 $ |
| TRUSTEE’S or ISSUER’S Federal identification no. | PARTICIPANT’S social security number | PARTICIPANT’S social security number | Roth IRA conversion amount 3 $ |
4 Recharacterized contributions $ |
| PARTICIPANT’S name | PARTICIPANT’S name | PARTICIPANT’S name | Fair market value of account 5 $ |
Life insurance cost included in box 1 6 $ |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | 7 IRA SEP SIMPLE Roth IRA |
7 IRA SEP SIMPLE Roth IRA |
| City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | 8 SEP contributions $ |
9 SIMPLE contributions $ |
| Account number (optional) | Account number (optional) | 10 Roth IRA contributions $ |
Form 5498 Cat. No. 50010C Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page
Copy A
For Internal Revenue
Service Center File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act Notice, see the
2003 General Instructions for Forms 1099, 1098,
5498, and W-2G.
| TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code | 1IRA contributions (other than amounts in boxes 2–4 and 8–10) $ |
OMB No. 1545-0747 2003 Form 5498 |
||
|---|---|---|---|---|
| TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code |
Rollover contributions 2 $ |
Rollover contributions 2 $ |
| TRUSTEE’S or ISSUER’S Federal identification no. | PARTICIPANT’S social security number | PARTICIPANT’S social security number | Roth IRA conversion amount 3 $ |
4 Recharacterized contributions $ |
| PARTICIPANT’S name | PARTICIPANT’S name | PARTICIPANT’S name | Fair market value of account 5 $ |
Life insurance cost included in box 1 6 $ |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | 7 IRA SEP SIMPLE Roth IRA |
7 IRA SEP SIMPLE Roth IRA |
| City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | 8 SEP contributions $ |
9 SIMPLE contributions $ |
| Account number (optional) | Account number (optional) | 10 Roth IRA contributions $ |
Form 5498 Cat. No. 50010C Department of the Treasury - Internal Revenue Service
2003–16 I.R.B. 798 April 21, 2003
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