Instructions For Forms 1099-Sa And 5498-Sa - 2013 printable pdf download

2013

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

account beneficiary then repays the mistaken distribution to the

otherwise noted.

HSA.

Future Developments

Under these circumstances, the distribution is not included in

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

For the latest information about developments related to Forms

payment is not subject to the excise tax on excess contributions. Do

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

not treat the repayment as a contribution on Form 5498-SA.

enacted after they were published, go to

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

and

beneficiaries to return a mistaken distribution to the HSA.

TIP

What's New

However, if you do allow the return of the mistaken

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

Pilot program for truncating an individual’s identifying number

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

on paper payee statements has ended. Filers of Form 1099-H

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

must show the recipient’s complete identifying number on all copies

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

of the form.

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

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

Reminder

Corrected Returns on Paper Forms in the 2013 General Instructions

for Certain Information Returns for more information.

General instructions. In addition to these specific instructions, you

should also use the 2013 General Instructions for Certain

Death of Account Holder

Information Returns. Those general instructions include information

about the following topics.

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

Backup withholding.

the designated beneficiary is the spouse:

Electronic reporting requirements.

The spouse becomes the account holder of the Archer MSA,

Penalties.

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

Who must file (nominee/middleman).

distribution purposes, and

When and where to file.

Distributions from these accounts are subject to the rules that

Taxpayer identification numbers.

apply to Archer MSAs.

Statements to recipients.

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

Corrected and void returns.

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

Other general topics.

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

You can get the general instructions from

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

form1099sa, form5498sa, or by calling

among them, as appropriate.

1-800-TAX-FORM (1-800-829-3676).

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

Specific Instructions for Form

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

form.

1099-SA

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

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

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

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

Medicare Advantage MSA, to report distributions made from an

Box 1, the gross distribution;

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

Box 3, code 4 (see page 2); and

distribution may have been paid directly to a medical service

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

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

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

each plan type.

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

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

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

Archer MSA or MA MSA to another Archer MSA or MA MSA, one

holder. Enter in:

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

Box 1, the gross distribution;

reporting purposes, contributions and rollovers do not include

Box 3, one of the following codes (see page 2):

transfers.

1—if the beneficiary is the spouse,

4—if the beneficiary is the estate, or

HSA mistaken distributions. If amounts were distributed during

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

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

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

reasonable cause, the account beneficiary may repay the mistaken

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

HSAs. When the account holder dies and:

beneficiary knew or should have known the distribution was a

The designated beneficiary is the surviving spouse, the spouse

mistake. For example, the account beneficiary reasonably, but

becomes the account holder of the HSA.

mistakenly, believed that an expense was a qualified medical

The spouse is not the designated beneficiary, the account ceases

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

to be an HSA on the date of the account holder's death. The FMV of

the account as of the date of death is required to be reported in

Sep 27, 2012

Cat. No. 38470S

Instructions For Forms 1099-Sa And 5498-Sa - 2013

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