Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2002 Page 3
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8Line 5 Limitation Chart and Worksheet
on this page for each month of 2002.
Enter the result on the worksheet next to
Go through this chart for each month of 2002.
the corresponding month.
See the instructions for line 5 beginning on page 2.
(Keep for your records)
If eligibility and coverage of both
you and your spouse did not
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change from one month to the
next, enter the same number you entered
Were you eligible for Medicare
Yes
for the previous month. If eligibility and
benefits for the month?
coverage did not change during the entire
year, figure the number for January only,
No
and enter this amount on line 5 of Form
8853.
More than one HDHP. If you (and your
Enter -0- on the line
Were you an eligible individual (see
spouse, if filing jointly) had more than one
No
below for the month.
page 1 of the instructions) on the
HDHP on the first of the month and one of
first day of the month?
the plans provides family coverage, use
the Family coverage rules on the chart
and disregard any plans with self-only
Yes
coverage.
Married filing separately. If you have an
HDHP with family coverage and are
What type of coverage did your HDHP provide on the first day of the
married filing separately, enter only
month? If you had more than one HDHP, see instructions on this page.
37.5% (.375) (one-half of 75%) of the
annual deductible on the worksheet; or, if
you and your spouse agree to divide the
Self-only coverage
Family coverage
75% of the annual deductible in a
Enter annual deductible
Enter annual deductible
different manner, enter your share.
(must be at least $1,650
(must be at least $3,300
but not more than $2,500)
but not more than $4,950)
Line 6
$
$
Compensation
Compensation includes wages, salaries,
Enter 65% (.65) of the annual
Enter 75% (.75) of the annual
professional fees, and other pay you
deductible on the line below for the
deductible on the line below for the
receive for services you perform. It also
month.
month. If married filing separately,
includes sales commissions,
see instructions on this page.
commissions on insurance premiums, pay
based on a percentage of profits, tips,
and bonuses. Generally, these amounts
are included on the Form(s) W-2 you
Amount from
receive from your employer(s).
Month in 2002
chart above
Compensation also includes net earnings
from self-employment, but only for a trade
or business in which your personal
January
services are a material income-producing
February
factor. Generally, this amount is shown on
the Schedule SE (Form 1040) you
March
complete for your business or farm.
Compensation does not include any
April
amounts received as a pension or annuity
May
and does not include any amount
received as deferred compensation.
June
Line 7
July
If you (or your employer) contributed
more to your Archer MSA than is
August
allowable, you may have to pay a tax on
September
the excess contributions. Figure the
excess contributions using the
October
instructions below. See Form 5329,
Additional Taxes on Qualified Plans
November
(Including IRAs) and Other Tax-Favored
December
Accounts, to figure the additional tax.
Excess Contributions You Make
Total for all months
To figure your excess contributions,
Limitation. Divide the total by 12. Enter here and on line 5
subtract your deductible contributions
(line 7) from your actual contributions (line
4). However, you may withdraw some or
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