Instructions For Form 8889 - Health Savings Accounts (Hsas) - 2004 Page 4
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Line 7
Line 9
Spouses that have separate HSAs
Additional Contribution Amount
Employer Contributions
and had family coverage under an
You can increase the amount of your
Employer contributions include any
HDHP at any time during 2004, use
amount an employer contributes to
contribution limit on the worksheet
the following rules to figure the
any HSA for you for 2004. These
amount on line 6.
below if all of the following apply.
•
contributions should be shown in box
•
If you were treated as having family
You were age 55 or older at the
12 of Form W-2 with code W. If your
coverage for each month you were an
end of 2004.
employer made excess contributions,
eligible individual, divide the amount
•
you may have to report the excess as
You were married at the end of
on line 5 equally between you and
income. See Excess Employer
2004.
your spouse, unless you both agree
Contributions on page 5 for details.
•
on a different allocation (such as
You or your spouse had family
allocating nothing to one spouse).
Line 11
coverage under an HDHP on the first
Enter your allocable share on line 6.
day of the month.
If you or someone on your behalf (or
•
If you were treated as having
•
your employer) contributed more to
You were not enrolled in Medicare
self-only coverage for any month you
your HSA than is allowable, you may
for the month.
were an eligible individual, use the
have to pay a tax on the excess
following steps to determine the
contributions. Figure the excess
amount to enter on line 6.
For each month that all of the
contributions using the instructions
above apply, enter $500 on the
that begin on this page. See Form
Step 1. Refigure the contribution
worksheet below.
5329, Additional Taxes on Qualified
limit that would have been entered on
Plans (Including IRAs) and Other
line 5 if you had entered on line 3 the
Tax-Favored Accounts, to figure the
Example. For 2004, you and your
total of the worksheet amounts only
additional tax.
spouse have family coverage under
for the months you were treated as
an HDHP for the entire months of
Excess Contributions You Make
having family coverage. When
July through December (6 months).
refiguring line 5, use the same
To figure your excess contributions
At the end 2004, you were age 55.
amount you previously entered on
(including those made on your
You would enter $500 on the
line 4.
behalf), subtract your deductible
worksheet for the months of July
contributions (line 11) from your
Step 2. Divide the refigured
through December. You can make an
actual contributions (line 2). However,
contribution limit from Step 1 equally
additional contribution of $250 ($500
you may withdraw some or all of your
between you and your spouse, unless
x 6/12).
excess contributions for 2004 and
you both agree on a different
allocation (such as allocating nothing
Line 7 Additional Contribution Amount Worksheet
to one spouse).
(Keep for your records)
Step 3. Subtract the part of the
contribution limit allocated to your
Before you begin:
spouse in Step 2 from the amount
•
you previously entered on line 5.
Complete the Line 3 Limitation Chart and Worksheet on page 3.
•
Enter the result on line 6.
See the instructions for line 7 on this page to see if you can use this worksheet.
Example. In 2004, you are an
Month in 2004
Additional contribution
eligible individual and have self-only
amount
coverage under an HDHP with a
January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$1,200 deductible. In March, you get
married and as of April 1, you have
February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
family coverage under an HDHP with
a $2,400 deductible. Neither you nor
March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
your spouse qualify for the additional
April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
contribution. Your spouse has a
separate HSA and is an eligible
May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
individual from April 1 to December
June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31, 2004. The contribution limit for the
9 months of family coverage is
July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$1,800 ($2,400 X 9/12). You and your
spouse can divide the $1,800 in any
August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
allocation you agree to. Your
September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
contribution limit for the 3 months of
self-only coverage is $300 ($1,200 x
October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3/12). This amount is not divided
between you and your spouse. If you
November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
and your spouse divide the
December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
contribution limit for the months of
family coverage equally, you will
Total for all months . . . . . . . . . . . . . . . . . . . . . . . . . .
show $1,200 on line 6 ($2,100 from
Additional contribution amount. Divide the total by
your original line 5 minus $900
allocated to your spouse). Your
12. Enter here and on line 7 . . . . . . . . . . . . . . . . . . . . .
spouse will show $900 on line 6.
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