Instructions For Form 8889 - Health Savings Accounts Hsas - 2007 Page 5

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distribution in a later month in that tax
You also withdraw any income
Additional Contribution Amount
year if you change to family HDHP
Worksheet
earned on the withdrawn contributions
coverage.
and include the earnings in “Other
1. $ 800 × number of months
income” on your tax return for the year
A qualified HSA funding distribution
eligible . . . . . . . . . . . . . . . . .
you withdraw the contributions and
made during your tax year reduces the
2. Divide line 1 by 12. Enter here
earnings.
amount that can be contributed from
and on line 7 . . . . . . . . . . . . .
other sources (including employer
contributions) to your HSA. See the
Excess Employer Contributions
Example. At the end of 2007, you
discussions under Line 13 for the
were age 55 and married. You had
Excess employer contributions are the
treatment of excess contributions.
family coverage under an HDHP from
excess, if any, of your employer’s
January 1 through June 30, 2007 (6
See Pub. 969 for more information.
contributions over your limitation on line
months). You were not enrolled in
8. If you made a qualified HSA funding
Testing period. You must remain
Medicare in 2007. You would enter an
distribution (line 10) during the tax year,
an eligible individual during the testing
additional contribution amount of $400
reduce your limitation (line 8) by that
on line 7 ($800 × 6 ÷ 12).
period. The testing period begins with
distribution before you determine
the month in which the qualified HSA
whether you have excess employer
Line 9
funding distribution is contributed to the
contributions. If the excess was not
HSA and ends on the last day of the
12th month following that month. For
included in income on Form W-2, you
Employer Contributions
example, if the distribution is
must report it as “Other income” on
Employer contributions (including
contributed on June 12, 2007, the
your tax return. However, you can
contributions through a cafeteria plan)
testing period ends on June 30, 2008. If
withdraw some or all of the excess
include any amount an employer
you fail to remain an eligible individual
employer contributions for 2007 and
contributes to any HSA for you for
during this period, other than because
they will be treated as if they had not
2007. These contributions should be
of death or becoming disabled, you will
shown in box 12 of Form W-2 with code
been contributed if:
have to include the qualified HSA
W. If either of the following apply,
You make the withdrawal by the due
funding distribution in income in the
complete the Employer Contribution
date, including extensions, of your 2007
year in which you fail to be an eligible
Worksheet below.
tax return (but see the Note below),
individual. This amount is also subject
Employer contributions for 2006 are
to a 10% additional tax. (See Part III.)
You do not claim an exclusion from
included in the amount reported in box
income for the amount of the withdrawn
12 of Form W-2 with code W.
Line 13
contributions, and
Employer contributions for 2007 are
If you or someone on your behalf (or
made in 2008.
You also withdraw any income
your employer) contributed more to
If your employer made excess
earned on the withdrawn contributions
your HSA than is allowable, you may
contributions, you may have to report
and include the earnings in “Other
have to pay an additional tax on the
the excess as income. See Excess
income” on your tax return for the year
excess contributions. Figure the excess
Employer Contributions on this page.
you withdraw the contributions and
contributions using the instructions
earnings.
below. See Form 5329, Additional
Line 10
Taxes on Qualified Plans (Including
Enter on line 10 any qualified HSA
IRAs) and Other Tax-Favored
Note. If you timely filed your return
funding distribution. This is a
Accounts, to figure the additional tax.
without withdrawing the excess
distribution from your IRA, other than a
contributions, you can still make the
SEP IRA or SIMPLE IRA, to your HSA
Excess Contributions You Make
withdrawal no later than 6 months after
in a direct trustee-to-trustee transfer.
To figure your excess contributions
the due date of your tax return,
This distribution is not included in your
(including those made on your behalf),
excluding extensions. If you do, file an
income, is not deductible, and reduces
subtract your deductible contributions
amended return with “Filed pursuant to
the amount that can be contributed to
(line 13) from your actual contributions
section 301.9100-2” written at the top.
your HSA.
(line 2). However, you can withdraw
Include an explanation of the
The maximum amount that can be
some or all of your excess contributions
withdrawal. Make all necessary
excluded from income is based on your
for 2007 and they will be treated as if
changes on the amended return (for
HDHP coverage (self-only or family).
they had not been contributed if:
example, if you reported the
You can make only one qualified HSA
You make the withdrawal by the due
contributions as excess contributions
funding distribution during your lifetime.
date, including extensions, of your 2007
on your original return, include an
However, if you make the distribution
tax return (but see the Note below),
amended Form 5329 reflecting that the
during a month when you have
You do not claim a deduction for the
withdrawn contributions are no longer
self-only HDHP coverage, you can
amount of the withdrawn contributions,
treated as having been contributed).
make another qualified HSA funding
and
Employer Contribution Worksheet
Keep for Your Records
1. Enter the employer contributions reported in box 12 of Form W-2, with code W . . . . . . . . . . . . . . . . . . . . . . .
1.
2. Enter employer contributions made in 2007 for tax year 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
3. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
4. Enter employer contributions made in 2008 for tax year 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.
5. Employer contributions for 2007. Add lines 3 and 4. Enter here and on Form 8889, line 9 . . . . . . . . . . . . . .
5.
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