Instructions For Form 8889 (2015) (Page 6 of 6) in pdf

You do not claim an exclusion from

due date, including extensions, of your

Becomes disabled (see Disabled,

return. See the instructions for line 13,

income for the amount of the withdrawn

earlier), or

earlier.

contributions, and

Turns age 65.

You also withdraw any income

Line 15

earned on the withdrawn contributions

If any of the exceptions apply to any

and include the earnings in “Other

of the distributions included on line 16,

Only include on line 15

income” on your tax return for the year

check the box on line 17a. Enter on

distributions from your HSA

you withdraw the contributions and

line 17b only 20% (.20) of any amount

that were used to pay you for

CAUTION

earnings.

included on line 16 that does not meet

qualified medical expenses (see

any of the exceptions.

Qualified Medical

Expenses, earlier) not

Note. If you timely filed your return

reimbursed by insurance or other

Example 1. You turned age 63 in

without withdrawing the excess

coverage and that you incurred after the

2015 and received a distribution from an

contributions, you can still make the

HSA was established. Do not include

HSA that is included in income. Do not

withdrawal no later than 6 months after

the distribution of an excess contribution

check the box on line 17a because you

the due date of your tax return,

taken out after the due date, including

(the account beneficiary) did not meet

excluding extensions. If you do, file an

extensions, of your return even if used

the age exception for the distribution.

amended return with “Filed pursuant to

for qualified medical expenses.

Enter 20% of the amount from line 16 on

section 301.9100-2” written at the top.

line 17b.

In general, include on line 15

Include an explanation of the

distributions from all HSAs in 2015 that

Example 2. You turned age 65 in

withdrawal. Make all necessary

were used for the qualified medical

2015. You received distributions that are

changes on the amended return (for

expenses (see

Qualified Medical

included in income both before and after

example, if you reported the

Expenses, earlier) of:

you turned age 65. Check the box on

contributions as excess contributions on

line 17a because the additional 20% tax

your original return, include an amended

1. Yourself and your spouse.

does not apply to the distributions made

Form 5329 reflecting that the withdrawn

2. All dependents you claim on your

after the date you turned age 65.

contributions are no longer treated as

tax return.

However, the additional 20% tax does

having been contributed).

3. Any person you could have

apply to the distributions made on or

claimed as a dependent on your return

before the date you turned age 65.

Deducting an Excess Contribution

except that:

Enter on line 17b, 20% of the amount of

in a Later Year

a. The person filed a joint return.

these distributions included in line 16.

You may be able to deduct excess

b. The person had gross income of

Part III—Income and

contributions for previous years that are

$4,000 or more.

still in your HSA. The excess

Additional Tax for Failure

c. You, or your spouse if filing

contributions you can deduct in the

to Maintain HDHP

jointly, could be claimed as a dependent

current year is the lesser of the following

on someone else's return.

Coverage

two amounts.

Your maximum HSA contribution limit

For this purpose, a child of

Use Part III to figure any income and

for the year minus any amounts

parents that are divorced,

additional tax that must be reported on

TIP

contributed to your HSA for the year.

separated, or living apart for

Form 1040 or Form 1040NR for failure

The total excess contributions in your

the last 6 months of the calendar year is

to be an eligible individual during the

HSA at the beginning of the year.

treated as the dependent of both

testing period for:

parents whether or not the custodial

Last-month rule (see

Last-month

Any excess contribution remaining at

parent releases the claim to the child's

rule, earlier), or

the end of the tax year is subject to the

exemption.

A qualified HSA funding distribution

additional tax. See Form 5329.

(see the

instructions for line

10, earlier).

You cannot take a deduction on

Part II—HSA Distributions

Schedule A (Form 1040) for

See the discussions indicated to

any amount you include on

determine the testing period for these

Line 14a

CAUTION

line 15.

items. Include the amount in income in

Enter the total distributions you received

the year in which you fail to be an

Lines 17a and 17b

in 2015 from all HSAs. Your total

eligible individual.

distributions include amounts paid with

Additional 20% Tax

Line 18

a debit card that restricts payments to

HSA distributions included in income

health care and amounts withdrawn by

You can use the

Line 3 Limitation Chart

(line 16) are subject to an additional

other individuals that you have

and Worksheet

for the year the

20% tax unless one of the following

designated. These amounts should be

contribution was made to determine the

exceptions applies.

shown in box 1 of Form 1099-SA.

contribution you could have made if the

last-month rule did not apply. Enter on

Line 14b

Exceptions to the Additional 20%

line 18 the excess of the amount

Include on line 14b any distributions you

contributed over the redetermined

Tax

received in 2015 that qualified as a

amount. Examples of this computation

The additional 20% tax does not apply

rollover contribution to another HSA.

are in Pub. 969.

to distributions made after the account

See Rollovers, earlier. Also include any

Line 19

beneficiary:

excess contributions (and the earnings

Dies,

on those excess contributions) included

Enter the total of any qualified HSA

on line 14a that were withdrawn by the

funding distribution (see Line 10).

-6-

Form 8889 (2015)

Instructions For Form 8889 (2015) Page 6

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