Instructions For Form 8889 - Health Savings Accounts

your 2006 tax return (but see the

expenses (see page 1) you incurred

not check the box on line 15a

Note below),

after the HSA was established. Do

because you (the account

•

You do not claim an exclusion from

not include the distribution of an

beneficiary) did not meet the age

income for the amount of the

excess contribution taken out after

exception for the distribution. Enter

withdrawn contributions, and

the due date, including extensions, of

10% of the amount from line 14 on

•

You also withdraw any income

your return even if used for qualified

line 15b.

earned on the withdrawn

medical expenses.

Example 2. You turned age 65 in

contributions and include the

In general, include on line 13

2006. You received distributions that

earnings in “Other income” on your

distributions from all HSAs in 2006

are included in income both before

tax return for the year you withdraw

that were used for the qualified

and after you turned age 65. Check

the contributions and earnings.

medical expenses (see page 1) of:

the box on line 15a because the

Note. If you timely filed your return

additional 10% tax does not apply to

1. Yourself and your spouse.

without withdrawing the excess

the distributions made after the date

2. All dependents you claim on

contributions, you can still make the

you turned age 65. However, the

your tax return.

withdrawal no later than 6 months

additional 10% tax does apply to the

3. Any person you could have

after the due date of your tax return,

distributions made on or before the

claimed as a dependent on your

excluding extensions. If you do, file

date you turned age 65. Enter on line

return except that:

an amended return with “Filed

15b, 10% of the amount of these

a. The person filed a joint return.

pursuant to section 301.9100-2”

distributions included in line 14.

b. The person had gross income

written at the top. Include an

of $3,300 or more.

Paperwork Reduction Act Notice.

explanation of the withdrawal. Make

c. You, or your spouse if filing

We ask for the information on this

all necessary changes on the

jointly, could be claimed as a

form to carry out the Internal

amended return (for example, if you

dependent on someone else’s return.

Revenue laws of the United States.

reported the contributions as excess

You are required to give us the

contributions on your original return,

You cannot take a deduction

information. We need it to ensure that

include an amended Form 5329

on Schedule A (Form 1040)

you are complying with these laws

reflecting that the withdrawn

for any amount you include on

CAUTION

and to allow us to figure and collect

contributions are no longer treated as

line 13.

the right amount of tax.

having been contributed).

You are not required to provide the

Lines 15a and 15b

Part II—HSA

information requested on a form that

is subject to the Paperwork Reduction

Additional 10% Tax

Distributions

Act unless the form displays a valid

HSA distributions included in income

OMB control number. Books or

(line 14) are subject to an additional

Line 12a

records relating to a form or its

10% tax unless one of the following

Enter the total distributions you

instructions must be retained as long

exceptions apply.

received in 2006 from all HSAs.

as their contents may become

Exceptions to the Additional

material in the administration of any

These amounts should be shown in

10% Tax

Internal Revenue law. Generally, tax

box 1 of Form 1099-SA.

returns and return information are

The additional 10% tax does not

Line 12b

confidential, as required by section

apply to distributions made after the

Include on line 12b any distributions

6103.

account beneficiary —

•

you received in 2006 that qualified as

Dies,

The average time and expenses

•

a rollover contribution to another

Becomes disabled (see page 2), or

required to complete and file this form

•

HSA. See Rollovers on page 2. Also

Turns age 65.

will vary depending on individual

include any excess contributions (and

circumstances. For the estimated

If any of the exceptions apply to

the earnings on those excess

averages, see the instructions for

any of the distributions included on

contributions) included on line 12a

your income tax return.

line 14, check the box on line 15a.

that were withdrawn by the due date,

Enter on line 15b only 10% (.10) of

If you have suggestions for making

including extensions, of your return.

any amount included on line 14 that

this form simpler, we would be happy

See the instructions for line 11

does not meet any of the exceptions.

to hear from you. See the instructions

beginning on page 4.

for your income tax return.

Example 1. You turned age 63 in

Line 13

2006 and received a distribution from

an HSA that is included in income. Do

Only include on line 13

distributions from your HSA

that were used to pay or

CAUTION

reimburse you for qualified medical

-5-

Instructions For Form 8889 - Health Savings Accounts - 2006 Page 5

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