Instructions For Forms 1099-Sa And 5498-Sa

Distribution in year of death. If you learn of the account

For HSAs and Archer MSAs, if you are reporting earnings on

holder's death and make a distribution to the beneficiary in the year

a distribution of excess contributions, use the method under

TIP

of death, issue a Form 1099-SA and enter in:

Regulations section 1.408-11 for calculating the net income

Box 1, the gross distribution;

attributable to IRA contributions that are distributed as a returned

Box 3, code 4 (see Box 3. Distribution Code, later); and

contribution. If the amount in box 2 includes earnings on excess

Box 4, the FMV of the account on the date of death.

contributions, enter distribution code 2 in box 3.

Distribution after year of death. If you learn of the death of the

account holder and make a distribution after the year of death, issue

Box 3. Distribution Code

a Form 1099-SA in the year you learned of the death of the account

Enter the appropriate distribution code from the following list that

holder. Enter in:

shows the type of distribution.

Box 1, the gross distribution;

Box 3, one of the following codes (see Box 3. Distribution Code,

later):

1—Normal distributions

Use this code for normal distributions to

the account holder and any direct

1—If the beneficiary is the spouse,

payments to a medical service

4—If the beneficiary is the estate, or

provider. Use this code if no other code

6—If the beneficiary is not the spouse or estate;

Box 4, the FMV of the account on the date of death, reduced by

applies. Also, see Distribution after

any payments from the HSA made for the decedent's qualified

year of death, earlier.

medical expenses, if paid within one year after death.

2—Excess contributions

Use this code for distributions of

HSAs. When the account holder dies, the following applies.

excess HSA or Archer MSA

If the designated beneficiary is the surviving spouse, the spouse

contributions to the account holder.

becomes the account holder of the HSA.

3—Disability

Use this code if you made distributions

If the designated beneficiary is not the surviving spouse, the

after the account holder was disabled

account ceases to be an HSA on the date of the account holder's

(see section 72(m)(7)).

death. The FMV of the account as of the date of death is required to

be reported in box 4. Follow the rules and coding above under

4—Death distribution other

Use this code for payments to a

Distribution in year of death and Distribution after year of death.

than code 6

decedent's estate in the year of death.

Also use this code for payments to an

Statements to Recipients

estate after the year of death. Do not

use with code 6. See Death of Account

If you are required to file Form 1099-SA, you must provide a

Holder, earlier.

statement to the recipient. For more information about the

requirement to furnish a Form 1099-SA or acceptable substitute

5—Prohibited transaction

See sections 220(e)(2) and 223(e)(2).

statement to recipients, see part M in the 2018 General Instructions

6—Death distribution after

Use this code for payments to a

for Certain Information Returns.

year of death to a

decedent's nonspouse beneficiary,

Truncating Recipient's TIN on Payee Statements

nonspouse beneficiary

other than an estate, after the year of

death. Do not use with code 4.

Pursuant to Treasury Regulations section 301.6109-4, all filers of

this form may truncate a recipient’s TIN (social security number

(SSN), individual taxpayer identification number (ITIN), adoption

taxpayer identification number (ATIN), or employer identification

Box 4. FMV on Date of Death

number (EIN)) on payee statements. Truncation is not allowed on

Enter the FMV of the account on the date of death. See Death of

any documents the filer files with the IRS. A trustee/payer's TIN may

Account Holder, earlier.

not be truncated on any form. See part J in the 2018 General

Instructions for Certain Information Returns.

Box 5. Checkbox

Account Number

Check the box to indicate if this distribution was from an HSA,

Archer MSA, or MA MSA.

The account number is required if you have multiple accounts for a

recipient for whom you are filing more than one Form 1099-SA.

Specific Instructions for Form

Additionally, the IRS encourages you to designate an account

number for all Forms 1099-SA that you file. See part L in the 2018

5498-SA

General Instructions for Certain Information Returns.

File Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA

Box 1. Gross Distribution

Information, with the IRS on or before June 3, 2019, for each person

Enter the total amount of the distribution. Include any earnings

for whom you maintained a health savings account (HSA), Archer

separately reported in box 2. You are not required to determine the

medical savings account (Archer MSA), or Medicare Advantage

taxable amount of a distribution. Do not report a negative amount in

MSA (MA MSA) during 2018. You are required to file if you are the

box 1. Do not report the withdrawal of excess employer contributions

trustee or custodian of an HSA, Archer MSA, or MA MSA. A

(and the earnings on them) returned to an employer as a distribution

separate form is required for each type of plan.

from an employee's HSA. Do not report excess MA MSA

contributions returned to the Secretary of Health and Human

For HSA or Archer MSA contributions made between January 1,

Services or his or her representative.

2019, and April 15, 2019, you should obtain the participant's

designation of the year for which the contributions are made.

Box 2. Earnings on Excess Contributions

For repayment of a mistaken distribution amount, see HSA

Enter the total earnings distributed with any excess HSA or Archer

mistaken distributions, earlier. Do not treat the repayment as a

MSA contributions returned by the due date of the account holder's

contribution on Form 5498-SA.

tax return. Include this amount in box 1. Report earnings on other

distributions only in box 1.

Rollovers

You must report the receipt of a rollover from one Archer MSA to

another Archer MSA, and receipt of a rollover from an Archer MSA

or an HSA to an HSA in box 4.

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Instructions for Forms 1099-SA and 5498-SA (2018)

Instructions For Forms 1099-Sa And 5498-Sa - 2018 Page 2

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