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MORE Guidance - Deductions - Refunds

Instructions for 1099-SA - Form 1099-SA
Form 5498-SA and Form 5498-SA Instructions


Overview 1099-Sa

The Instructions are on a 2 page pdf file.

File form 1099-SA, Distributions from an HSA, Archer MSA, or Medicare Advantage MSA (MA MSA).
The distribution may have been paid directly to a medical service provider or to the account holder.  A seperate return must be filed for each plan type.

Download and print Form 1099-SA  Instructions and Form 5498-SA Instructions.
Download and print Form 1099 SA - Download and print Form 5498-SA. (not for filing)

The sections to fill out on the Form 1099-SA are:

  • Trustee's/Payer's - Name, address, city , state etc. and telephone number

  • Payer's Federal Identification Number

  • Recipients Identification number

  • Recipients name, address, Apt #, city , state, zip

  • Account number (see Instructions)
  1. Gross distribution

  2. Earnings on excess cont.

  3. Distribution Code

  4. FMV on date of death

  5. Choose HSA - Archer MSA - MA MSA

Form 5498-SA

The sections to fill out on the Form 5498 are:

  • Trustee's name, street address, city, state, and Zip

  • Trustee's federal ID number

  • Participant's social security number

  • Participants name, street address, Apt #, city, state, and zip

  • Account number (see instructions)

  1. Employee or serlf-employedperson's Archer MSA contributionsmade in (year)
    and (following year) for (year)

  2. Total contributions mad in (year)

  3. Total HSA or Archer MSAcontributions made in 9following year) for (current year)

  4. Rollover contributions

  5. Fair market value of HSA, Archer MSA, or MA MSA

  6. Tick Box - HSA - Archer MSA - MA MSA

You can avoid the paper problems and use

 
 
Click on and read this Disclaimer - The downloaded 1099 Forms from this website do not conform to IRS standards and cannot be accepted if filed. There are penalties if you do so. See Part O in the general instructions. Read the warning at the top of each form under the words in red that say Attention: