I am sole owner of an S-Corp which earned more than $500k, so I need to fill out form 1125-E.

My gross salary was $55,500.

The company also paid for health insurance for me, which cost $8516.

My W2 shows that I paid $11920 in Fed taxes, $3441 in Social Security, and $805 in Medicare, so my take-home pay was $39334.

The company also paid an additional $3441 in Social Security, and $805 in Medicare.

What do I put in box (f) on form 1125-E?

What (if anything) do I put in box 3?