Instructions For Form 8889 - Health Savings Accounts Hsas

Part I—HSA

Contributions and

Line 3 Limitation Chart and Worksheet

Deductions

Go through this chart for each month of 2007.

See the instructions for line 3 on page 4.

Use Part I to figure:

•

(Keep for your records)

Your HSA deduction,

•

Any excess contributions you made

Start Here

(or those made on your behalf), and

•

Were you enrolled in Medicare for the

Any excess contributions made by an

Yes

month?

employer (see Excess Employer

Contributions beginning on page 5).

Figuring Your HSA

Were you an eligible individual (see

Deduction

page 1 of the instructions) on the first

Enter -0- on the line

The maximum amount that can be

day of the month (see the line 3

below for the month.

contributed to your HSA depends on

instructions on page 4)?

the type of HDHP coverage you have. If

you have self-only coverage, your

Yes

maximum contribution is $2,850. If you

have family coverage, your maximum

contribution is $5,650.

What type of coverage did your HDHP provide on the first

day of the month?

Note. If you are age 55 or older at the

end of 2007, you can make an

additional contribution of $800.

Self-only coverage

Family coverage

Your maximum contribution is

Enter $5,650 on the line below for the

Enter $2,850 on the line below for the

reduced by any employer contributions

month. If you were age 55 or older at the

month. If, at the end of 2007, you were

to your HSA, any contributions made to

unmarried and age 55 or older, increase

end of 2007, increase this amount by

your Archer MSA, and any qualified

$800.

this amount by $800.

HSA funding distributions.

You can make deductible

contributions to your HSA even if your

Amount from

employer made contributions. However,

chart above

Month in 2007

if you (or someone on your behalf)

made contributions in addition to any

January

employer contributions and qualified

HSA funding distributions, you may

February

have to pay an additional tax. See

Excess Contributions You Make on

March

page 5.

April

You cannot deduct any contributions

for any month in which you were

May

enrolled in Medicare. Also, you cannot

June

deduct contributions if you can be

claimed as a dependent on someone

July

else’s 2007 tax return.

August

How To Complete Part I

September

Complete lines 1 through 13 as

instructed on the form. However, if you,

October

and your spouse if filing jointly, are both

November

eligible individuals and either of you

have an HDHP with family coverage,

December

you both are treated as having only the

family coverage plan. Disregard any

Total for all months

plans with self-only coverage.

Limitation. Divide the total by 12. Enter here and on line 3

Complete a separate Form 8889 for

each spouse. Combine the amounts on

line 13 of both Forms 8889 and enter

this amount on Form 1040, line 25; or

Form 1040NR, line 25. Be sure to

attach both Forms 8889 to your tax

return.

-3-

Instructions For Form 8889 - Health Savings Accounts Hsas - 2007 Page 3

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