Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2005 Page 4
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8and does not include any amount
return (for example, if you reported the
However, if a contribution was made to
received as deferred compensation.
contributions as excess contributions on
an Archer MSA in 2005 (by you or your
your original return, include an amended
employer), do not include on line 9
Line 7
Form 5329 reflecting that the withdrawn
withdrawals from an Archer MSA if the
If you (or your employer) contributed
contributions are no longer treated as
individual for whom the expenses were
more to your Archer MSA than is
having been contributed).
incurred was not covered by an HDHP or
was covered by a plan that was not an
allowable, you may have to pay an
additional tax on the excess contributions.
Part III—Archer MSA
HDHP (other than the exceptions listed
Figure the excess contributions using the
on page 1) at the time the expenses were
Distributions
instructions below. See Form 5329,
incurred.
Additional Taxes on Qualified Plans
Example. In 2005, you were covered
Line 8a
(Including IRAs) and Other Tax-Favored
by an HDHP with self-only coverage and
Accounts, to figure the additional tax.
Enter the total distributions you and your
your spouse was covered by a health
spouse received in 2005 from all Archer
plan that was not an HDHP. You made
Excess Contributions You Make
MSAs. These amounts should be shown
contributions to an Archer MSA for 2005.
To figure your excess contributions,
in box 1 of Form 1099-SA.
You cannot include on line 9 withdrawals
subtract your deductible contributions
made from the Archer MSA to pay your
Line 8b
(line 7) from your actual contributions (line
spouse’s medical expenses incurred in
4). However, you can withdraw some or
Include on line 8b any distributions you
2005 because your spouse was covered
all of your excess contributions for 2005
received in 2005 that were rolled over.
by a plan that was not an HDHP.
and they will be treated as if they had not
See Rollovers below. Also include any
You cannot take a deduction on
been contributed if:
excess contributions (and the earnings on
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Schedule A (Form 1040) for any
You make the withdrawal by the due
those excess contributions) included on
amount you include on line 9.
date, including extensions, of your 2005
CAUTION
line 8a that were withdrawn by the due
tax return (but see the Note below),
date, including extensions, of your return.
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Lines 11a and 11b
You do not claim a deduction for the
See the instructions for line 7 on this
amount of the withdrawn contributions,
page.
Additional 15% Tax
and
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Archer MSA distributions included in
You also withdraw any income earned
Rollovers
income (line 10) are subject to an
on the withdrawn contributions and
A rollover is a tax-free distribution
additional 15% tax unless one of the
include the earnings in “Other income” on
(withdrawal) of assets from one Archer
following exceptions apply.
your tax return for the year you withdraw
MSA that is reinvested in another Archer
the contributions and earnings.
MSA or a health savings account.
Exceptions to the Additional 15%
Generally, you must complete the rollover
Tax
Excess Employer Contributions
within 60 days following the distribution.
The additional 15% tax does not apply to
Excess employer contributions are the
You can make only one rollover
distributions made on or after the date
excess, if any, of your employer’s
contribution to an Archer MSA during a
that the account holder —
contributions over the smaller of (a) your
1-year period. See Pub. 590, Individual
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Dies,
limitation on line 5, or (b) your
Retirement Arrangements (IRAs), for
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Becomes disabled (see page 1), or
compensation from the employer(s) who
more details and additional requirements
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Turns age 65.
maintained your HDHP (line 6). If the
regarding rollovers.
If any of the exceptions apply to any of
excess was not included in income on
the distributions included on line 10,
Form W-2, you must report it as “Other
Note. If you instruct the trustee of your
check the box on line 11a. Enter on line
income” on your tax return. However, you
Archer MSA to transfer funds directly to
11b only 15% (.15) of any amount
the trustee of another Archer MSA, the
can withdraw some or all of the excess
included on line 10 that does not meet
employer contributions for 2005 and they
transfer is not considered a rollover.
any of the exceptions.
will be treated as if they had not been
There is no limit on the number of these
contributed if:
transfers. Do not include the amount
Example 1. You turned age 66 in
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transferred in income, deduct it as a
You make the withdrawal by the due
2005 and had no Archer MSA during
contribution, or include it as a distribution
date, including extensions, of your 2005
2005. Your spouse turned age 63 in 2005
tax return (but see the Note below),
on line 8a.
and received a distribution from an Archer
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You do not claim an exclusion from
MSA that is included in income. Do not
Line 9
income for the amount of the withdrawn
check the box on line 11a because your
In general, include on line 9 distributions
contributions, and
spouse (the account holder) did not meet
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from all Archer MSAs in 2005 that were
You also withdraw any income earned
the age exception for the distribution.
used for the qualified medical expenses
on the withdrawn contributions and
Enter 15% of the amount from line 10 on
(see page 1) of:
include the earnings in “Other income” on
line 11b.
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your tax return for the year you withdraw
Yourself and your spouse.
Example 2. Both you and your
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the contributions and earnings.
All dependents you claim on your tax
spouse received distributions from your
return.
Note. If you timely filed your return
Archer MSAs in 2005 that are included in
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Any person you could have claimed as
without withdrawing the excess
income. You were age 65 at the time you
a dependent on your return except that
contributions, you can still make the
received the distributions and your
person received $3,200 or more of gross
withdrawal no later than 6 months after
spouse was age 63 when he or she
income or filed a joint return.
the due date of your tax return, excluding
received the distributions. Check the box
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extensions. If you do, file an amended
Any person you could have claimed as
on line 11a because the additional 15%
return with “Filed pursuant to section
a dependent except that you, or your
tax does not apply to the distributions you
301.9100-2” written at the top. Include an
spouse if filing jointly, were claimed as a
received (because you met the age
explanation of the withdrawal. Make all
dependent on someone else’s 2005
exception). However, the additional 15%
necessary changes on the amended
return.
tax does apply to your spouse’s
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