Instructions For Form 8889 - Health Savings Accounts - 2005 Page 4


you previously entered on line 5.
an amended return with “Filed
Line 11
Enter the result on line 6.
pursuant to section 301.9100-2”
If you or someone on your behalf (or
written at the top. Include an
Example. In 2005, you are an
your employer) contributed more to
explanation of the withdrawal. Make
eligible individual and have self-only
your HSA than is allowable, you may
all necessary changes on the
coverage under an HDHP with a
have to pay an additional tax on the
amended return (for example, if you
$1,200 deductible. In March, you get
excess contributions. Figure the
reported the contributions as excess
married and as of April 1, you have
excess contributions using the
contributions on your original return,
family coverage under an HDHP with
instructions below. See Form 5329,
include an amended Form 5329
a $2,400 deductible. Neither you nor
Additional Taxes on Qualified Plans
reflecting that the withdrawn
your spouse were age 55 or older at
(Including IRAs) and Other
contributions are no longer treated as
the end of 2005 so you do not qualify
Tax-Favored Accounts, to figure the
having been contributed).
for the additional contribution amount.
additional tax.
Your spouse has a separate HSA and
is an eligible individual from April 1
Excess Contributions You Make
through December 31, 2005. The
To figure your excess contributions
contribution limit for the 9 months of
(including those made on your
family coverage is $1,800 ($2,400 ×
behalf), subtract your deductible
Line 12a
9/12). You and your spouse can
contributions (line 11) from your
Enter the total distributions you
divide the $1,800 in any allocation
actual contributions (line 2). However,
received in 2005 from all HSAs.
you agree to. Your contribution limit
you can withdraw some or all of your
These amounts should be shown in
for the 3 months of self-only coverage
excess contributions for 2005 and
is $300 ($1,200 × 3/12). This amount
box 1 of Form 1099-SA.
they will be treated as if they had not
is not divided between you and your
been contributed if:
spouse. If you and your spouse divide
Line 12b
You make the withdrawal by the
the contribution limit for the months of
Include on line 12b any distributions
due date, including extensions, of
family coverage equally, you will
you received in 2005 that qualified as
your 2005 tax return (but see the
show $1,200 on line 6 ($2,100 from
a rollover contribution to another
Note below),
your original line 5 minus $900
HSA. See Rollovers on page 2. Also
You do not claim a deduction for
allocated to your spouse). Your
include any excess contributions (and
the amount of the withdrawn
spouse will show $900 on line 6.
the earnings on those excess
contributions, and
contributions) included on line 12a
Line 7
You also withdraw any income
that were withdrawn by the due date,
earned on the withdrawn
including extensions, of your return.
Additional Contribution Amount
contributions and include the
See the instructions for line 11 on this
earnings in “Other income” on your
If, at the end of 2005, you were age
tax return for the year you withdraw
55 or older and married, multiply $50
the contributions and earnings.
by the number of months during 2005
Line 13
that both of the following apply.
Excess Employer Contributions
1. You or your spouse had family
Only include on line 13
Excess employer contributions are
coverage under an HDHP on the first
distributions from your HSA
the excess, if any, of your employer’s
day of the month.
that were used to pay or
contributions over your limitation on
2. You were not enrolled in
reimburse qualified medical expenses
line 8. If the excess was not included
Medicare for the month.
(see page 1) you incurred on or after
in income on Form W-2, you must
the first day of the first month you
Enter the result on line 7.
report it as “Other income” on your
became an eligible individual (see
tax return. However, you can
If items (1) and (2) apply to all
page 1).
withdraw some or all of the excess
months during 2005, enter
employer contributions for 2005 and
In general, include on line 13
$600 on line 7.
they will be treated as if they had not
distributions from all HSAs in 2005
been contributed if:
Example. At the end of 2005, you
that were used for the qualified
You make the withdrawal by the
were age 55 and married. You had
medical expenses (see page 1) of:
due date, including extensions, of
family coverage under an HDHP from
Yourself and your spouse.
your 2005 tax return (but see the
July 1 through December 31, 2005 (6
All dependents you claim on your
Note below),
months). You were not enrolled in
tax return.
Medicare in 2005. You would enter
You do not claim an exclusion from
Any person you could have
an additional contribution amount of
income for the amount of the
$300 on line 7 ($50 × 6 months).
claimed as a dependent on your
withdrawn contributions, and
return except that person received
You also withdraw any income
Line 9
$3,200 or more of gross income or
earned on the withdrawn
filed a joint return.
contributions and include the
Employer Contributions
Any person you could have
earnings in “Other income” on your
claimed as a dependent except that
Employer contributions include any
tax return for the year you withdraw
you, or your spouse if filing jointly,
amount an employer contributes to
the contributions and earnings.
were claimed as a dependent on
any HSA for you for 2005. These
someone else’s 2005 return.
contributions should be shown in box
Note. If you timely filed your return
without withdrawing the excess
12 of Form W-2 with code W. If your
You cannot take a deduction
employer made excess contributions,
contributions, you can still make the
you may have to report the excess as
withdrawal no later than 6 months
on Schedule A (Form 1040)
for any amount you include on
income. See Excess Employer
after the due date of your tax return,
line 13.
Contributions on this page for details.
excluding extensions. If you do, file


00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Page of 5