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KE A COPY FOR YOUR RECORDS BEFORE SENDING YOUR FORM TO EMPLOYEE BENEFITS. Employee Benefits Sign-Off: Date: 2017 HSA Contribution Change Form.

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Health Savings Account (HSA) 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.

Note: Do not attach Form 5498-SA to your income tax return. Instead, keep it for your records. Generally, contributions you make to your Fidelity HSA are made on a pretax basis via payroll deduction and are not deductible. Any contributions you make on an after-tax basis—via check, for example—are tax deductible.

The information on Form 5498 is submitted to the IRS by the trustee or issuer of your individual retirement arrangement (IRA) to report contributions, including any catch-up contributions, required minimum distributions (RMDs), and the fair market value (FMV) of the account.

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.

Go to .irs.gov, where you can download Instructions for Forms 8889, 1099-SA, 8853, and 5498-SA; IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans; and IRS Publication 502, Medical and Dental Expenses (Including the Health Coverage Tax Credit).

Box 2: Earnings on Excess Contributions The total earnings distributed with any excess HSA or Archer MSA contributions returned by the due date of the account holder's tax return.

Form 5498-SA is a report of contributions to a Health Savings Account (HSA), Archer Medical Savings Account, or Medicare Advantage Medical Savings Account sent by the account manager, or trustee, to their respective account holders.

What is Box 2 on Form 5498-SA? Box 2 lists the total contributions made to an HSA or Archer MSA for the current year. It should not include rollovers, which are noted in Box 4.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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
Health Savings Account (HSA) EMPLOYEE CONTRIBUTION FORM
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2019 OR Health Savings Account (HSA) Employee Contribution Form - Marion County
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