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  • Health Savings Account Hsa Payroll Contribution Form

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Health Savings Account (HSA) Payroll Contribution Form Employee Number: Employee Name: Home Address: City: State: Zip Code: Daytime Phone: Location: Change Options All changes will be effective after.

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Does Form 5498-SA include employer contributions? Form 5498-SA documents total contributions. Employer contributions, if any, are noted on Form W-2, box 12.

Don't forget that your employer's contributions count toward your total contribution limit. If you have single coverage and your employer adds $1,000 into your HSA, then you can only add up to the remaining $2,850.

Your employees can put money into their HSA through pre-tax payroll deduction, deposits or transfers. As the amount grows over time, they can continue to save it or spend it on eligible expenses. The money in the HSA belongs to the employee and is theirs to keep, even if they switch jobs.

You will receive the IRS Form 1099-SA and IRS Form 5498-SA either by mail or electronically (based upon your elected delivery preference). These IRS tax forms are also available in the Member Website. IRS Form 1099-SA is provided for each HSA distribution you made in the current tax year.

The 5498-SA form reports all contributions to your HSA for the prior year, including those contributed between Jan. 1 and the tax filing deadline of the current year. It also reports your HSA balance as of Dec. 31 of the prior year.

Note: Box 2 on Form 5498-SA will include all amounts contributed during 2022, even if you elected to apply a portion of those contributions to the 2021 tax year.

While employer contributions to an HSA may be excluded from the employee's income, all employer contributions, including those made by the employee through a cafeteria plan, must be reported in box 12 of the employee's W-2.

Form 5498-SA reports your annual contributions to these tax-free accounts that you use to pay for medical expenses. Contributions to similar accounts, such as Archer Medical Savings Accounts and Medicare Advantage MSAs will also warrant a Form 5498-SA. This form must be mailed to participants and the IRS by May 31.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232