Instructions For Forms 1099sa And 5498sa - 2017 printable pdf download

2017

Department of the Treasury

Internal Revenue Service

Instructions for Forms

1099-SA and 5498-SA

Distributions From an HSA, Archer MSA, or Medicare Advantage MSA, and HSA,

Archer MSA, or Medicare Advantage MSA Information

Section references are to the Internal Revenue Code unless

mistake. For example, the account beneficiary reasonably, but

otherwise noted.

mistakenly, believed that an expense was a qualified medical

expense and was reimbursed for that expense from the HSA. The

Future Developments

account beneficiary then repays the mistaken distribution to the

HSA.

For the latest information about developments related to Forms

1099-SA and 5498-SA and their instructions, such as legislation

Under these circumstances, the mistaken distribution is not

enacted after they were published, go to

included in gross income, is not subject to the additional 20% tax,

and

and the repayment is not subject to the excise tax on excess

contributions. Do not treat the repayment as a contribution on Form

Reminders

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

Information.

General instructions. In addition to these specific instructions, you

should also use the 2017 General Instructions for Certain

As the trustee or custodian, you do not have to allow

Information Returns. Those general instructions include information

beneficiaries to return a mistaken distribution to the HSA.

TIP

about the following topics.

However, if you do allow the return of the mistaken

distribution, you may rely on the account beneficiary's statement that

Who must file (nominee/middleman).

the distribution was in fact a mistake. See Notice 2004-50, 2004-33

When and where to file.

I.R.B. 196, Q/A-76, available at

Electronic reporting requirements.

ar08.html. Do not report the mistaken distribution on Form 1099-SA.

Corrected and void returns.

Correct any filed Form 1099-SA with the IRS and the account

Statements to recipients.

beneficiary as soon as you become aware of the error. See

Taxpayer identification numbers.

Corrected Returns on Paper Forms in the 2017 General Instructions

Backup withholding.

for Certain Information Returns for more information.

Penalties.

Other general topics.

HSA Closure Under the USA PATRIOT Act

You can get the general instructions from

General Instructions for

Certain Information

Returns, , and

If an HSA is closed at any time by the HSA trustee or custodian due

to a failure of the participant to satisfy the Customer Identification

Program requirements described in section 326 of the USA

Online fillable form. Due to the very low volume of paper Forms

PATRIOT Act, the distribution from the HSA must be reported.

1099-SA and 5498-SA received and processed by the IRS each

year, these forms have been converted to an online fillable format.

If a regular contribution is made to the HSA that is closed, and a

You may fill out the forms, found online at

distribution is made to the participant, enter the gross distribution in

and , and send Copy B to the recipient. For

box 1. If no earnings are distributed, enter zero in box 2. If earnings

filing with the IRS, follow the applicable procedures for filing

are distributed, enter the amount of earnings in box 2. Enter code 2

electronically if you are filing 250 or more forms. For Forms

in box 3. See the instructions for boxes 1 through 3, later.

1099-SA and 5498-SA only, if you are filing these forms on paper,

you may send in the black and white Copy As with Form 1096 that

In addition, Form 5498-SA must be filed to report any rollover

you print from the IRS website.

(qualified HSA funding distributions (trustee-to-trustee transfers from

an IRA to an HSA under section 408(d)(9))) contributions to the HSA

Specific Instructions for Form

subsequently closed by the trustee or custodian. See the Specific

Instructions for Form 5498-SA, later.

1099-SA

Death of Account Holder

File Form 1099-SA, Distributions From an HSA, Archer MSA, or

Medicare Advantage MSA, to report distributions made from a

Archer MSAs and MA MSAs. When the account holder dies and

health savings account (HSA), Archer medical savings account

the designated beneficiary is the surviving spouse, the following

(Archer MSA), or Medicare Advantage MSA (MA MSA). The

apply.

distribution may have been paid directly to a medical service

The spouse becomes the account holder of the Archer MSA.

provider or to the account holder. A separate return must be filed for

An MA MSA is treated as an Archer MSA of the spouse for

each plan type.

distribution purposes.

Distributions from these accounts are subject to the rules that

Transfers. Do not report a trustee-to-trustee transfer from one

apply to Archer MSAs.

Archer MSA or MA MSA to another Archer MSA or MA MSA, from

If the designated beneficiary is not the spouse or there is no

an Archer MSA to an HSA, or from one HSA to another HSA. For

named beneficiary, the account ceases to be an MSA as of the date

reporting purposes, contributions and rollovers do not include

of death and the fair market value (FMV) on that date is reported.

transfers.

If there is more than one recipient, the FMV should be allocated

HSA mistaken distributions. If amounts were distributed during

among them, as appropriate.

the year from an HSA because of a mistake of fact due to

reasonable cause, the account beneficiary may repay the mistaken

If the beneficiary is the estate, enter the estate's name and

distribution no later than April 15 following the first year the account

taxpayer identification number (TIN) in place of the recipient's on the

beneficiary knew or should have known the distribution was a

form.

Jun 23, 2016

Cat. No. 38470S

Instructions For Forms 1099sa And 5498sa - 2017

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