Two tax forms will be sent to you and to the IRS. The first is Form 1099-SA. This form is sent no later than January 31.
The second form sent to you each year is Form 5498-SA. This form is sent out no later than May 15, but definitely after the tax filing deadline of April 15. Form 5498-SA cannot be sent any earlier because taxpayers have until April 15 to make contributions to the prior year’s HSA.
Box 1. Employee or Self-Employed Person’s Archer MSA Contributions Made in 2009 and 2010 for 2009
No HSA information is to be reported in box 1. Enter the employee’s or self-employed person’s regular contributions to the Archer MSA made in 2009 and through April 15, 2010, for 2009. Report gross contributions, including any excess contributions, even if the excess contributions were withdrawn.
Box 2. Total Contributions Made in 2009
Enter the total HSA or Archer MSA contributions made in 2009. Include any contribution made in 2009 for 2008. Also include qualified HSA funding distributions (trustee-to-trustee transfers from an IRA to an HSA under section 408(d)(9)) received by you during 2009. You may, but you are not required to, report the total MA MSA contributions the Secretary of Health and Human Services or his or her representative made in 2009. Do not include amounts reported in box 4.
Box 3. Total HSA or Archer MSA Contributions Made in 2010 for 2009
Enter the total HSA or Archer MSA contributions made in 2010 for 2009.
Box 4. Rollover Contributions
Enter rollover contributions to the HSA or Archer MSA received by you during 2009. Include qualified HSA distributions (direct transfers of contributions form employers FSAs and HRAs to an HSA under section 106(e). These amount s are not to be included in box 2.
Box 5. Fair Market Value of HSA, Archer MSA, or MA MSA
Enter the FMV of the account on December 31, 2009.
Box 6. Checkbox
Check the box to indicate if this account is an HSA, Archer MSA, or MA MSA.
