Instructions For Form 8889 - Health Savings Accounts

•

You make the withdrawal by the due

extensions, of your return. See the

check the box on line 17a. Enter on line

date, including extensions, of your 2010

instructions for line 13 on page 5.

17b only 10% (.10) of any amount

tax return (but see the Note below),

included on line 16 that does not meet

Line 15

•

You do not claim an exclusion from

any of the exceptions.

income for the amount of the withdrawn

Example 1. You turned age 63 in

Only include on line 15

contributions, and

2010 and received a distribution from

•

distributions from your HSA that

You also withdraw any income

an HSA that is included in income. Do

were used to pay you for

earned on the withdrawn contributions

CAUTION

not check the box on line 17a because

qualified medical expenses (see page

and include the earnings in “Other

you (the account beneficiary) did not

1) not reimbursed by insurance or other

income” on your tax return for the year

meet the age exception for the

coverage and that you incurred after

you withdraw the contributions and

distribution. Enter 10% of the amount

the HSA was established. Do not

earnings.

from line 16 on line 17b.

include the distribution of an excess

Note. If you timely filed your return

Example 2. You turned age 65 in

contribution taken out after the due

without withdrawing the excess

2010. You received distributions that

date, including extensions, of your

contributions, you can still make the

are included in income both before and

return even if used for qualified medical

withdrawal no later than 6 months after

after you turned age 65. Check the box

expenses.

the due date of your tax return,

on line 17a because the additional 10%

In general, include on line 15

excluding extensions. If you do, file an

tax does not apply to the distributions

distributions from all HSAs in 2010 that

amended return with “Filed pursuant to

made after the date you turned age 65.

were used for the qualified medical

section 301.9100-2” written at the top.

However, the additional 10% tax does

expenses (see page 1) of:

Include an explanation of the

apply to the distributions made on or

withdrawal. Make all necessary

1. Yourself and your spouse.

before the date you turned age 65.

changes on the amended return (for

2. All dependents you claim on your

Enter on line 17b, 10% of the amount of

example, if you reported the

tax return.

these distributions included in line 16.

contributions as excess contributions

3. Any person you could have

Part III—Income and

on your original return, include an

claimed as a dependent on your return

amended Form 5329 reflecting that the

except that:

Additional Tax for

withdrawn contributions are no longer

a. The person filed a joint return.

treated as having been contributed).

b. The person had gross income of

Failure to Maintain HDHP

$3,650 or more.

Deducting an Excess

Coverage

c. You, or your spouse if filing

Contribution in a Later Year

jointly, could be claimed as a

Use Part III to figure any income and

dependent on someone else’s return.

You may be able to deduct excess

additional tax that must be reported on

contributions for previous years that are

Form 1040 or Form 1040NR for failure

For this purpose, a child of

still in your HSA. The excess

to be an eligible individual during the

contributions you can deduct in the

parents that are divorced,

TIP

testing period for:

current year is the lesser of the

separated, or living apart for the

•

A qualified HSA distribution (see

following two amounts.

last 6 months of the calendar year is

page 2),

•

Your maximum HSA contribution limit

treated as the dependent of both

•

Last-month rule (see page 1), and

for the year minus any amounts

parents whether or not the custodial

•

A qualified HSA funding distribution

parent releases the claim to the child’s

contributed to your HSA for the year.

(see page 5).

•

exemption.

The total excess contributions in your

See the discussions on the pages

HSA at the beginning of the year.

You cannot take a deduction on

indicated to determine the testing

Any excess contribution remaining at

Schedule A (Form 1040) for any

period for each of these items. Include

the end of the tax year is subject to the

amount you include on line 15.

the amount in income in the year in

CAUTION

additional tax. See Form 5329.

which you fail to be an eligible

Lines 17a and 17b

individual.

Part II—HSA

Line 18

Additional 10% Tax

Distributions

HSA distributions included in income

Enter the total of any qualified HSA

(line 16) are subject to an additional

distribution.

Line 14a

10% tax unless one of the following

Line 19

Enter the total distributions you

exceptions applies.

received in 2010 from all HSAs. Your

You can use the Line 3 Limitation Chart

Note. For distributions included in

total distributions include amounts paid

and Worksheet in the Instructions for

income in tax years beginning after

with a debit card that restricts payments

Form 8889 for the year the contribution

December 31, 2010, the additional tax

to health care and amounts withdrawn

was made to determine the contribution

increases to 20%.

by other individuals that you have

you could have made if the last-month

Exceptions to the Additional

designated. These amounts should be

rule did not apply. Enter on line 19 the

10% Tax

shown in box 1 of Form 1099-SA.

excess of the amount contributed over

the redetermined amount. Examples of

The additional 10% tax does not apply

Line 14b

this computation are in Pub. 969.

to distributions made after the account

Include on line 14b any distributions

beneficiary —

Line 20

you received in 2010 that qualified as a

•

Dies,

rollover contribution to another HSA.

•

Enter the total of any qualified HSA

Becomes disabled (see page 2), or

See Rollovers on page 2. Also include

•

funding distribution.

Turns age 65.

any excess contributions (and the

If any of the exceptions apply to any

earnings on those excess contributions)

of the distributions included on line 16,

included on line 14a that were

withdrawn by the due date, including

-6-

Form 8889 (2010)

Instructions For Form 8889 - Health Savings Accounts - 2010 Page 6

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