Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2003 Page 4
ADVERTISEMENT
1
2
3
4
5
6
7
8Part III—Archer MSA
(Including IRAs) and Other Tax-Favored
Lines 11a and 11b
Accounts, to figure the additional tax.
Distributions
Additional 15% Tax
Archer MSA distributions included in
Excess Contributions You Make
Line 8a
income (line 10) are subject to an
To figure your excess contributions,
Enter the total distributions you and your
additional 15% tax unless an exception
subtract your deductible contributions
spouse received in 2003 from all Archer
applies. If any of the following exceptions
(line 7) from your actual contributions (line
MSAs. These amounts should be shown
apply to any of the distributions included
4). However, you may withdraw some or
in box 1 of Form 1099-MSA.
on line 10, check the box on line 11a.
all of your excess contributions for 2003
Enter on line 11b only 15% (.15) of any
Line 8b
and they will be treated as if they had not
amount included on line 10 that does not
been contributed if:
Include on line 8b any distributions you
meet any of the exceptions.
•
received in 2003 that were rolled over.
You make the withdrawal by the due
Exceptions to the Additional 15%
See Rollovers below. Also include any
date, including extensions, of your 2003
Tax
excess contributions (and the earnings on
tax return,
those excess contributions) included on
•
The additional 15% tax does not apply to
You do not claim a deduction for the
line 8a that were withdrawn by the due
distributions made on or after the date
amount of the withdrawn contributions,
date, including extensions, of your return.
that the account holder —
and
•
See the instructions for line 7 beginning
Dies,
•
You also withdraw any income earned
•
on page 3.
Becomes disabled (see page 1), or
on the withdrawn contributions and
•
Turns age 65.
Rollovers
include the earnings in “other income” on
Example 1. You turned age 66 during
your tax return for the year you withdraw
A rollover is a tax-free distribution
the year and had no Archer MSA during
(withdrawal) of assets from one Archer
the contributions and earnings.
the year. Your spouse turned age 63
MSA that is reinvested in another.
during the year and received a distribution
Generally, you must complete the rollover
Excess Employer Contributions
from an Archer MSA that is included in
within 60 days following the distribution.
income. You do not check the box on line
Excess employer contributions are the
See Pub. 590, Individual Retirement
11a because your spouse (the account
excess, if any, of your employer’s
Arrangements (IRAs), for more details
holder) did not meet the age exception for
contributions over the smaller of (a) your
and additional requirements regarding
the distribution. You enter 15% of the
limitation on line 5 or (b) your
rollovers.
amount from line 10 on line 11b.
compensation from the employer(s) who
Note: If you instruct the trustee of your
Example 2. Both you and your spouse
maintained your HDHP (line 6). If the
Archer MSA to transfer funds directly to
received distributions from your Archer
excess was not included in income on
another Archer MSA, the transfer is not
MSAs in 2003 that are included in
Form W-2, you must report it as “other
considered a rollover. Do not include the
income. You were age 65 at the time you
income” on your tax return. However, you
amount transferred in income, deduct it
received the distributions and your
may withdraw some or all of the excess
as a contribution, or include it as a
spouse was age 63 when he or she
employer contributions for 2003 and they
distribution on line 8a.
received the distributions. You check the
will be treated as if they had not been
box on line 11a because the additional
Line 9
contributed if:
15% tax does not apply to the
•
In general, include on line 9 distributions
You make the withdrawal by the due
distributions you received (because you
from all Archer MSAs in 2003 that were
date, including extensions, of your 2003
met the age exception). However, the
used for the qualified medical expenses
tax return,
additional 15% tax does apply to your
•
(see page 1) of the account holder and
You do not claim an exclusion from
spouse’s distributions. You enter on line
his or her spouse or dependents.
income for the amount of the withdrawn
11b only 15% of the amount of your
However, if a contribution was made to an
contributions, and
spouse’s distributions included in line 10.
Archer MSA in 2003 (by you or your
•
You also withdraw any income earned
Example 3. You turned age 65 during
employer), do not include on line 9
on the withdrawn contributions and
the year. You received distributions that
withdrawals from an Archer MSA if the
include the earnings in “other income” on
are included in income both before and
individual for whom the expenses were
your tax return for the year you withdraw
after you turned age 65. You check the
incurred was not covered by an HDHP or
the contributions and earnings.
box on line 11a because the additional
was covered by a plan that was not an
15% tax does not apply to the
HDHP (other than the exceptions listed
distributions you received after you turned
Note: If you timely filed your return
on page 1) at the time the expenses were
age 65. However, the additional 15% tax
without withdrawing the excess
incurred.
does apply to the distributions you
contributions, you may still make the
Example. In 2003, you were covered
received before you turned age 65. You
withdrawal no later than 6 months after
by an HDHP with self-only coverage and
enter on line 11b, 15% of the amount of
the due date of your tax return, excluding
your spouse was covered by a health
these distributions included in line 10.
extensions. If you do, file an amended
plan that was not an HDHP. You made
return with “Filed pursuant to section
contributions to an Archer MSA for 2003.
Section B—
301.9100-2” written at the top. Include an
You may not include on line 9 withdrawals
explanation of the withdrawal. Make all
Medicare+Choice MSA
made from the Archer MSA to pay your
necessary changes on the amended
spouse’s medical expenses incurred in
Distributions
return (for example, if you reported the
2003 because your spouse was covered
contributions as excess contributions on
Complete Section B if you (or your
by a plan that was not an HDHP.
your original return, include an amended
spouse, if filing jointly) received
You may not take a deduction on
Form 5329 reflecting that the withdrawn
distributions from a Medicare+Choice
!
Schedule A (Form 1040) for any
contributions are no longer treated as
MSA in 2003. If both you and your spouse
having been contributed).
amount you include on line 9.
CAUTION
received distributions, complete a
-4-
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial