Instructions For Form 8853 - Archer Msas And Long-Term Care Insurance Contracts - 2002 Page 4
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8all of your excess contributions for 2002
Line 8b
apply to any of the distributions included
and they will be treated as if they had not
on line 10, check the box on line 11a.
Include on line 8b any distributions you
been contributed if:
Enter on line 11b only 15% (.15) of any
received in 2002 that were rolled over.
•
amount included on line 10 that does not
You make the withdrawal by the due
See Rollovers below.
meet any of the exceptions.
date, including extensions, of your 2002
Also include any excess contributions
tax return,
Exceptions to the Additional 15%
(and the earnings on those excess
•
You do not claim a deduction for the
contributions) included on line 8a that
Tax
amount of the withdrawn contributions,
were withdrawn by the due date, including
The additional 15% tax does not apply to
and
extensions, of your return. See the
•
distributions made on or after the date
You also withdraw any income earned
instructions for line 7 beginning on page
that the account holder —
on the withdrawn contributions and
•
3.
Dies,
include the earnings in “other income” on
•
Becomes disabled (see page 1), or
Rollovers
your tax return for the year you withdraw
•
Turns age 65.
the contributions and earnings.
A rollover is a tax-free distribution
Example 1. You turned age 66 during
(withdrawal) of assets from one Archer
the year and had no Archer MSA during
Excess Employer Contributions
MSA that is reinvested in another.
the year. Your spouse turned age 63
Generally, you must complete the rollover
Excess employer contributions are the
during the year and received a distribution
within 60 days following the distribution.
excess, if any, of your employer’s
from an Archer MSA that is included in
See Pub. 590, Individual Retirement
contributions over the smaller of (a) your
income. You do not check the box on line
Arrangements (IRAs), for more details
limitation on line 5 or (b) your
11a because your spouse (the account
and additional requirements regarding
compensation from the employer(s) who
holder) did not meet the age exception for
rollovers.
maintained your HDHP (line 6). If the
the distribution. You enter 15% of the
Note: If you instruct the trustee of your
excess was not included in income on
amount from line 10 on line 11b.
Archer MSA to transfer funds directly to
Form W-2, you must report it as “other
Example 2. Both you and your spouse
another Archer MSA, the transfer is not
income” on your tax return. However, you
received distributions from your Archer
considered a rollover. Do not include the
may withdraw some or all of the excess
MSAs in 2002 that are included in
amount transferred in income, deduct it
employer contributions for 2002 and they
income. You were age 65 at the time you
as a contribution, or include it as a
will be treated as if they had not been
received the distributions and your
distribution on line 8a.
contributed if:
spouse was age 63 when he or she
•
You make the withdrawal by the due
Line 9
received the distributions. You check the
date, including extensions, of your 2002
box on line 11a because the additional
In general, include on line 9 distributions
tax return,
15% tax does not apply to the
•
from all Archer MSAs in 2002 that were
You do not claim an exclusion from
distributions you received (because you
used for the qualified medical expenses
income for the amount of the withdrawn
met the age exception). However, the
(see page 1) of the account holder and
contributions, and
additional 15% tax does apply to your
his or her spouse or dependents.
•
You also withdraw any income earned
spouse’s distributions. You enter on line
However, if a contribution was made to an
on the withdrawn contributions and
11b only 15% of the amount of your
Archer MSA in 2002 (by you or your
include the earnings in “other income” on
spouse’s distributions included in line 10.
employer), do not include on line 9
your tax return for the year you withdraw
withdrawals from an Archer MSA if the
Example 3. You turned age 65 during
the contributions and earnings.
individual for whom the expenses were
the year. You received distributions that
incurred was not covered by an HDHP or
are included in income both before and
Note: If you timely filed your return
was covered by a plan that was not an
after you turned age 65. You check the
without withdrawing the excess
HDHP (other than the exceptions listed
box on line 11a because the additional
contributions, you may still make the
on page 1) at the time the expenses were
15% tax does not apply to the
withdrawal no later than 6 months after
incurred.
distributions you received after you turned
the due date of your tax return, excluding
age 65. However, the additional 15% tax
Example. In 2002, you were covered
extensions. If you do, file an amended
does apply to the distributions you
by an HDHP with self-only coverage and
return with “Filed pursuant to section
received before you turned age 65. You
your spouse was covered by a health
301.9100-2” written at the top. Include an
enter on line 11b, 15% of the amount of
plan that was not an HDHP. You made
explanation of the withdrawal. Make all
these distributions included in line 10.
contributions to an Archer MSA for 2002.
necessary changes on the amended
You may not include on line 9 withdrawals
return (for example, if you reported the
Section B—
made from the Archer MSA to pay your
contributions as excess contributions on
spouse’s medical expenses incurred in
your original return, include an amended
Medicare+Choice MSA
2002 because your spouse was covered
Form 5329 reflecting that the withdrawn
by a plan that was not an HDHP.
contributions are no longer treated as
Distributions
having been contributed).
You may not take a deduction on
Complete Section B if you (or your
!
Schedule A (Form 1040) for any
spouse, if filing jointly) received
Part III—Archer MSA
amount you include on line 9.
distributions from a Medicare+Choice
CAUTION
MSA in 2002. If both you and your spouse
Distributions
Lines 11a and 11b
received distributions, complete a
separate Form 8853, Section B, for each
Line 8a
Additional 15% Tax
spouse. Write “statement” across the top
Enter the total distributions you and your
Archer MSA distributions included in
of each Form 8853, fill in the name and
spouse received in 2002 from all Archer
income (line 10) are subject to an
SSN, and complete Section B. Next, add
MSAs. These amounts should be shown
additional 15% tax unless an exception
lines 12, 13, 14, and 15b from the two
in box 1 of Form 1099-MSA.
applies. If any of the following exceptions
statement Forms 8853 and enter those
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