Instructions For Forms 1099-Sa And 5498-Sa

Statements to Participants

2014, for 2013. Report gross contributions, including any excess

contributions, even if the excess contributions were withdrawn. No

If you are required to file Form 5498-SA, you must provide a

HSA information is to be reported in box 1.

statement to the participant (generally Copy B) by June 2, 2014. You

may, but you are not required to, provide participants with a

Box 2. Total Contributions Made in 2013

statement of the December 31, 2013, FMV of the participant's

account by January 31, 2014. For more information about

Enter the total HSA or Archer MSA contributions made in 2013.

statements to participants, see part M in the 2013 General

Include any contribution made in 2013 for 2012. Also include

Instructions for Certain Information Returns.

qualified HSA funding distributions (trustee-to-trustee transfers from

an IRA to an HSA under section 408(d)(9)) received by you during

If you furnished a statement of the FMV of the account to the

2013. Any excess employer contributions (and the earnings on

participant by January 31, 2014, and no reportable contributions,

them) withdrawn by the employer pursuant to Notice 2008-59, Q/A

including rollovers, were made for 2013, you need not furnish

24, available at , should not

another statement (or Form 5498-SA) to the participant to report

be reported as a contribution. You may, but you are not required to,

zero contributions. However, you must file Form 5498-SA with the

report the total MA MSA contributions the Secretary of Health and

IRS by June 2, 2014, to report the December 31, 2013, FMV of the

Human Services or his or her representative made in 2013. Do not

account.

include amounts reported in box 4.

If you do not furnish another statement to the participant

Box 3. Total HSA or Archer MSA Contributions

because no reportable contributions were made for the

year, the statement of the FMV of the account must contain

Made in 2014 for 2013

CAUTION

a legend designating which information is being furnished to the

Enter the total HSA or Archer MSA contributions made in 2014 for

Internal Revenue Service.

2013.

Account Number

Box 4. Rollover Contributions

The account number is required if you have multiple accounts for a

Enter rollover contributions to the HSA or Archer MSA received by

recipient for whom you are filing more than one Form 5498-SA.

you during 2013. These amounts are not to be included in box 2.

Additionally, the IRS encourages you to designate an account

number for all Forms 5498-SA that you file. See part L in the 2013

Box 5. Fair Market Value of HSA, Archer MSA, or

General Instructions for Certain Information Returns.

MA MSA

Enter the FMV of the account on December 31, 2013.

Box 1. Employee or Self-Employed Person's

Archer MSA Contributions Made in 2013 and 2014

Box 6. Checkbox

for 2013

Check the box to indicate if this account is an HSA, Archer MSA, or

Enter the employee's or self-employed person's regular

MA MSA.

contributions to the Archer MSA made in 2013 and through April 15,

Instructions for Forms 1099-SA and 5498-SA (2013)

-3-

Instructions For Forms 1099-Sa And 5498-Sa - 2013 Page 3

Related Articles

Related forms

Related Categories