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This version of the form is not currently in use and is provided for reference only. Download this version of
IRS Form 5498-SA
for the current year.
IRS Form 5498-SA Hsa, Archer Msa, or Medicare Advantage Msa Information
What Is IRS Form 5498-SA?
IRS Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA Information , is a form filed with the Internal Revenue Service (IRS) by a trustee or custodian of a Health Savings Account (HSA), Medicare Advantage MSA (MA MSA), or Archer Medical Savings Account (Archer MSA). Download a fillable IRS Form 5498-SA through the link below or through the IRS official website. This form was last revised in 2019 .
What Is the Purpose of Form 5498-SA?
The purpose of IRS Form 5498-SA is to report amounts contributed (including transfers and rollovers), as well as the Fair Market Value (FMV) of accounts for the calendar year. Trustees or custodians are required to file a separate form for each type of plan and for each person for whom they maintained one of these savings accounts.
IRS Form 5498-SA Instructions
The current Form 5498-SA due date is on June 1. If you do not timely file Copy A of this form, a penalty of $50 per return shall be applied (if the failure is not justified by reasonable cause). However, if the due date is a holiday, Saturday or Sunday, you may file this return the next business day. It is possible to request a 30-day extension for filing by completing Form 8809 and sending it on paper before the due date. Copy B of this form must be furnished to the participant by June 1. You may also request an extension to furnish Copy B by sending a letter to the Internal Revenue Service, Attn: Extension of Time Coordinator, 240 Murall Drive, Mail Stop 4360, Kearneysville, West Virginia 25430.
If you are filing less than 250 forms on paper, you may send a black-and-white Copy A of the 5498-SA together with IRS Form 1096, Annual Summary and Transmittal of U.S. Information Returns. If you are required to send more than 250 forms, you must file electronically through the Filing Information Returns Electronically System (FIRE System).
IRS Form 1099-SA, Distributions From an HSA, Archer MSA, or Medicare Advantage MSA, and Form 5498-SA are both related to health savings accounts. The purpose of Form 1099-SA is reporting distributions to an account, while Form 5498-SA is for reporting contributions to an account.
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Download IRS Form 5498-SA Hsa, Archer Msa, or Medicare Advantage Msa Information
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