Homepage / Fill in a Valid IRS 1099-SA Template
Jump Links

For those navigating the often-complex world of health savings accounts (HSAs) and medical expense reimbursements, the IRS 1099-SA form plays a crucial role. This important tax document is issued by financial institutions that manage HSAs, Archer medical savings accounts, and distribution of funds from them. Generally, if you have made withdrawals or distributions from your HSA during the tax year, you can expect to receive this form detailing those transactions. The 1099-SA highlights the amount of money withdrawn and distinguishes between taxable and nontaxable distributions, making it vital for accurate tax reporting. Understanding the information contained within this form can not only help individuals gauge their tax liabilities but also ensure compliance with IRS regulations. Moreover, the 1099-SA provides essential details regarding the nature of the distributions, supporting taxpayers in maintaining proper records for medical expenses, which is especially relevant in a health care landscape where such accounts have become increasingly popular. Whether you are a seasoned taxpayer or new to managing health accounts, grasping the significance of the 1099-SA form can illuminate the path toward effective financial management and tax planning.

IRS 1099-SA Example

9494

VOID

CORRECTED

TRUSTEE'S/PAYER’S name, street address, city or town, state or province,

 

 

 

OMB No. 1545-1517

 

 

Distributions

country, ZIP or foreign postal code, and telephone number

 

 

 

 

Form 1099-SA

 

 

 

 

 

 

 

 

 

 

From an HSA,

 

 

 

 

 

 

(Rev. November 2019)

 

 

Archer MSA, or

 

 

 

 

 

 

 

Medicare Advantage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For calendar year

 

 

 

 

 

 

 

 

 

MSA

 

 

 

 

 

 

20

 

 

 

 

 

 

 

 

 

 

 

PAYER’S TIN

RECIPIENT’S TIN

 

1 Gross distribution

 

2 Earnings on excess cont.

Copy A

 

 

 

$

 

 

$

 

 

For

 

 

 

 

 

 

 

 

 

Internal Revenue

RECIPIENT’S name

 

 

3 Distribution code

 

4 FMV on date of death

 

 

 

 

 

Service Center

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

File with Form 1096.

 

 

 

 

 

 

$

 

 

For Privacy Act

 

 

 

 

 

 

 

 

 

and Paperwork

Street address (including apt. no.)

 

 

5

HSA

 

 

 

 

 

 

 

 

 

 

Reduction Act

 

 

 

 

Archer

 

 

 

 

 

 

 

 

 

 

 

 

Notice, see the

 

 

 

 

MSA

 

 

 

 

City or town, state or province, country, and ZIP or foreign postal code

 

 

 

 

 

current General

 

MA

 

 

 

 

 

 

 

 

 

 

 

 

Instructions for

 

 

 

 

MSA

 

 

 

 

 

 

 

 

 

 

 

 

Certain

Account number (see instructions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Information

 

 

 

 

 

 

 

 

 

Returns.

Form 1099-SA (Rev. 11-2019)

Cat. No. 38471D

www.irs.gov/Form1099SA

 

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on

This Page

— Do Not

Cut or Separate Forms

on This Page

CORRECTED (if checked)

TRUSTEE’S/PAYER’S name, street address, city or town, state or province,

 

OMB No. 1545-1517

 

 

Distributions

country, ZIP or foreign postal code, and telephone number

 

Form 1099-SA

 

 

 

 

 

 

 

From an HSA,

 

 

 

(Rev. November 2019)

 

 

Archer MSA, or

 

 

 

 

Medicare Advantage

 

 

 

 

 

 

 

 

For calendar year

 

 

 

 

 

 

MSA

 

 

 

20

 

 

 

 

 

 

 

 

PAYER’S TIN

RECIPIENT’S TIN

1 Gross distribution

2 Earnings on excess cont.

Copy B

 

 

$

$

 

 

For

RECIPIENT’S name

 

3 Distribution code

4 FMV on date of death

 

Recipient

 

 

 

$

 

 

 

 

 

 

 

 

 

 

Street address (including apt. no.)

 

5 HSA

 

 

 

 

 

 

Archer

 

 

 

This information

 

 

MSA

 

 

 

City or town, state or province, country, and ZIP or foreign postal code

 

 

 

is being furnished

MA

 

 

 

 

 

 

 

 

to the IRS.

 

 

MSA

 

 

 

 

 

 

 

 

 

Account number (see instructions)

 

 

 

 

 

 

 

 

 

 

 

Form 1099-SA (Rev. 11-2019)

(keep for your records)

www.irs.gov/Form1099SA

Department of the Treasury - Internal Revenue Service

Instructions for Recipient

Distributions from a health savings account (HSA), Archer medical savings account (MSA), or Medicare Advantage (MA) MSA are reported to you on Form 1099-SA. File Form 8853 or Form 8889 with your Form 1040 or 1040-SR to report a distribution from these accounts even if the distribution isn’t taxable. The payer isn’t required to compute the taxable amount of any distribution.

An HSA or Archer MSA distribution isn’t taxable if you used it to pay qualified medical expenses of the account holder or eligible family member or you rolled it over. An HSA may be rolled over to another HSA; an Archer MSA may be rolled over to another Archer MSA or an HSA. An MA MSA isn’t taxable if you used it to pay qualified medical expenses of the account holder only. If you didn’t use the distribution from an HSA, Archer MSA, or MA MSA to pay for qualified medical expenses, or in the case of an HSA or Archer MSA, you didn’t roll it over, you must include the distribution in your income (see Form 8853 or Form 8889). Also, you may owe a penalty.

You may repay a mistaken distribution from an HSA no later than April 15 following the first year you knew or should have known the distribution was a mistake, providing the trustee allows the repayment.

For more information, see the Instructions for Form 8853 and the Instructions for Form 8889. Also see Pub. 969.

Recipient’s taxpayer identification number (TIN). For your protection, this form may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). However, the issuer has reported your complete identification number to the IRS.

Spouse beneficiary. If you inherited an Archer MSA or MA MSA because of the death of your spouse, special rules apply. See the Instructions for Form 8853. If you inherited an HSA because of the death of your spouse, see the Instructions for Form 8889.

Estate beneficiary. If the HSA, Archer MSA, or MA MSA account holder dies and the estate is the beneficiary, the fair market value (FMV) of the account on the date of death is includible in the account holder’s gross income. Report the amount on the account holder’s final income tax return.

Nonspouse beneficiary. If you inherited the HSA, Archer MSA, or MA MSA from someone who wasn’t your spouse, you must report as income on your tax return the FMV of the account as of the date of death. Report the FMV on your tax return for the year the account owner died even if you received the distribution from the account in a later year. See the Instructions for Form 8853 or the Instructions for Form 8889. Any earnings on the account after the date of death (box 1 minus box 4 of Form 1099-SA) are taxable. Include the earnings on the “Other income” line of your tax return.

Account number. May show an account or other unique number the payer assigned to distinguish your account.

Box 1. Shows the amount received this year. The amount may have been a direct payment to the medical service provider or distributed to you.

Box 2. Shows the earnings on any excess contributions you withdrew from an HSA or Archer MSA by the due date of your income tax return. If you withdrew the excess, plus any earnings, by the due date of your income tax return, you must include the earnings in your income in the year you received the distribution even if you used it to pay qualified medical expenses. This amount is included in box 1. Include the earnings on the “Other income” line of your tax return. An excise tax of 6% for each tax year is imposed on you for excess individual and employer contributions that remain in the account. See Form 5329, Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts.

Box 3. These codes identify the distribution you received: 1—Normal distribution; 2—Excess contributions; 3—Disability; 4—Death distribution other than code 6; 5—Prohibited transaction; 6—Death distribution after year of death to a nonspouse beneficiary.

Box 4. If the account holder died, shows the FMV of the account on the date of death. Box 5. Shows the type of account that is reported on this Form 1099-SA. Future developments. For the latest information about developments related to

Form 1099-SA and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form1099SA.

VOID

CORRECTED

TRUSTEE’S/PAYER’S name, street address, city or town, state or province,

 

OMB No. 1545-1517

 

 

Distributions

country, ZIP or foreign postal code, and telephone number

 

 

Form 1099-SA

 

 

 

 

 

 

 

 

From an HSA,

 

 

 

 

(Rev. November 2019)

 

 

Archer MSA, or

 

 

 

 

 

Medicare Advantage

 

 

 

 

For calendar year

 

 

 

 

 

 

 

MSA

 

 

 

 

20

 

 

 

 

 

 

 

 

 

PAYER’S TIN

RECIPIENT’S TIN

 

1 Gross distribution

2 Earnings on excess cont.

Copy C

 

 

 

$

$

 

 

For

RECIPIENT’S name

 

 

3 Distribution code

4 FMV on date of death

 

Trustee/Payer

 

 

 

 

$

 

 

For Privacy Act

 

 

 

 

 

 

and Paperwork

Street address (including apt. no.)

 

 

5 HSA

 

 

 

Reduction Act

 

 

 

Archer

 

 

 

Notice, see the

 

 

 

 

 

 

current General

City or town, state or province, country, and ZIP or foreign postal code

MSA

 

 

 

MA

 

 

 

Instructions for

 

 

 

 

 

 

Certain

 

 

 

MSA

 

 

 

Account number (see instructions)

 

 

 

 

 

 

Information

 

 

 

 

 

 

Returns.

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 1099-SA (Rev. 11-2019)

 

www.irs.gov/Form1099SA

Department of the Treasury - Internal Revenue Service

Instructions for Trustee/Payer

To complete Form 1099-SA, use:

The current General Instructions for Certain Information Returns, and

The current Instructions for Forms 1099-SA and 5498-SA.

To get or to order these instructions, go to www.irs.gov/Form1099SA.

Filing and furnishing. For filing and furnishing instructions, including due dates, and to request filing or furnishing extensions, see the current General Instructions for Certain Information Returns.

To file electronically, you must have software that generates a file according to the specifications in Pub. 1220.

Need help? If you have questions about reporting on Form 1099-SA, call the information reporting customer service site toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not toll free).

File Breakdown

Fact Name Details
Purpose The IRS 1099-SA form is used to report distributions from a Health Savings Account (HSA), Archer Medical Savings Account (MSA), or a Medicare Advantage MSA.
Who Receives It Individuals who have received distributions from these accounts during the tax year receive the 1099-SA form from their account custodian or trustee.
Filing Deadline The form must be provided to individuals by January 31 of the following year. The IRS also requires that forms be filed electronically or by paper by the end of February.
Tax Implications Distributions reported on the 1099-SA form may be subject to taxes. If funds are used for qualified medical expenses, they may be tax-exempt. Non-qualified withdrawals may incur penalties.

Guide to Using IRS 1099-SA

Once you have your IRS 1099-SA form ready, you will need to complete it accurately to ensure that your reporting is correct. Each step is important and will help you successfully navigate the process without missing any critical information.

  1. Obtain the IRS 1099-SA form from the IRS website or your tax software.
  2. In the top left corner, fill in your name, address, city, state, and ZIP code. This identifies you as the recipient of the funds.
  3. In the box labeled "Payer's name," enter the name of the organization or financial institution that issued the distribution.
  4. Next, include the payer's address in the same format as your own, including city, state, and ZIP code.
  5. In the box labeled "Account number," enter your specific account number if applicable. This helps to identify your account uniquely.
  6. Now, you need to fill in the amount of the distribution in the appropriate box. This amount reflects the total distribution paid during the tax year.
  7. In the "Distribution Code" box, select the correct code that describes the type of distribution you received. A list of codes is often provided on the form or instructions.
  8. Finally, review the form for accuracy. Make sure all names, amounts, and codes are correctly entered before you submit or file it with your tax return.

Taking the time to ensure each section of the form is filled out correctly will help prevent any delays in processing or potential issues with your tax return. If needed, consult with a tax professional for clarity on your specific situation.

Get Answers on IRS 1099-SA

What is the IRS 1099-SA form?

The IRS 1099-SA form is used to report distributions from Health Savings Accounts (HSAs), Archer Medical Savings Accounts (MSAs), and Medicare Advantage MSAs. This form provides information that helps taxpayers understand the amounts distributed from these accounts during a tax year.

Who receives a 1099-SA form?

Individuals who receive distributions from their HSA, Archer MSA, or Medicare Advantage MSA will receive a 1099-SA form. Financial institutions or administrators of these accounts are responsible for issuing the form to account holders, typically by January 31 of the following year.

What information is reported on a 1099-SA form?

The 1099-SA form contains several important pieces of information:

  1. Box 1: Total distributions made during the year.
  2. Box 2: Indicates the type of account from which the distribution was made.
  3. Box 3: Identifies the purpose of the distribution, such as a qualified medical expense or other reasons.
  4. Box 4: Reports any earnings on the original contribution, if applicable.

How do I report my 1099-SA distributions on my tax return?

When filing your tax return, the amount from Box 1 of the 1099-SA should be reported on IRS Form 8889 if it's an HSA. For Archer MSAs and Medicare Advantage MSAs, if you have distributions to report, you will need to use the appropriate forms specific to those accounts. Be sure to keep the form for your records even if the distributions were used for qualified medical expenses.

What happens if I do not receive a 1099-SA form but had distributions?

If you had distributions from an HSA or similar account but did not receive a 1099-SA, you should first contact your account administrator or financial institution. They may have not yet issued the form or it might have been sent to the wrong address. Regardless, you are still responsible for accurately reporting the distributions on your tax return, even without the form.

Can I receive an electronic version of my 1099-SA form?

Yes, many financial institutions offer the option to receive electronic versions of tax documents, including the 1099-SA. Check with your account provider to see if they offer this option and how to sign up for electronic delivery.

What should I do if my 1099-SA form has incorrect information?

If you notice any errors on your 1099-SA, such as incorrect amounts or personal information, contact the issuer of the form immediately. They can issue a corrected form, known as a 1099-SA corrected form, to ensure that the information reported to the IRS is accurate.

How does a distribution from an HSA affect my taxes?

Distributions from an HSA are generally tax-free if they are used for qualified medical expenses. If the funds are used for non-qualified expenses, those distributions may be subject to income tax and a possible penalty, typically 20%. It's important to keep records of how distributions are used to avoid tax complications.

Common mistakes

When filling out the IRS 1099-SA form, many individuals make common mistakes that can lead to complications in tax reporting. Understanding these pitfalls can help ensure accuracy and compliance. One prevalent error is failing to report the correct type of distribution. The form is used to report distributions from Health Savings Accounts (HSAs), Archer Medical Savings Accounts (MSAs), and Medicare Advantage MSA plans. Misclassifying the nature of the distribution can create issues later on.

Another frequent mistake is incorrect data entry. It's essential to double-check all personal information such as names, addresses, and taxpayer identification numbers. A simple typo can result in serious delays or rejections from the IRS, potentially leading to financial consequences. Always ensure the information matches what the IRS has on file.

The amount reported on the form is also sometimes inaccurate. Distributions that were not used to pay for qualified medical expenses should not be reported as such. This can lead to underpayment or overpayment of taxes. Be sure to review the expenses carefully to ensure they qualify under IRS guidelines.

Many people forget to consider the recipient’s requirements. If you're issuing the 1099-SA to someone else, it is necessary to supply them with a copy for their records. Failing to do so can result in a lack of accountability and misunderstanding about tax obligations.

A significant mistake is neglecting to retain copies of the 1099-SA. It's advisable to keep these records for at least three years, as the IRS can audit returns for this time period. Keeping accurate records can protect you in case of disputes or questions about your tax filings.

Lastly, some individuals may overlook the deadlines for submission. Understanding the due dates for filing and delivering the form to recipients is crucial. Missing these deadlines can lead to penalties. Planning ahead can help prevent unnecessary stress and ensure timely compliance with the IRS.

Documents used along the form

The IRS 1099-SA form is used to report distributions from Health Savings Accounts (HSAs) and other similar accounts. When dealing with this form, there are several related documents that individuals may encounter. Here’s a brief overview of five important forms and documents often associated with the IRS 1099-SA.

  • Form 8889: This form is used to report Health Savings Account (HSA) contributions and distributions. It helps taxpayers report their HSA activity on their federal tax return.
  • Form W-2: This form is the wage and tax statement that employers provide to employees. It shows the amount of wages earned and taxes withheld, which may be relevant for those contributing to or withdrawing from an HSA.
  • Form 1040: This is the standard individual income tax return form used to report personal income to the IRS. The information from Forms 1099-SA and 8889 will be included when completing the 1040.
  • Form 5498-SA: This form reports contributions made to an HSA. It is typically issued by the financial institution holding the account and can help keep track of contributions throughout the year.
  • Account statements: These documents from HSA providers detail account activity, including contributions, distributions, and balances. They are essential for verifying amounts reported on tax forms.

Understanding these documents can simplify the process of reporting HSA transactions accurately for tax purposes. Keeping all related paperwork organized ensures compliance with IRS regulations and can prevent potential issues during tax season.

Similar forms

  • IRS Form 1099-MISC: This form is utilized to report various types of income payments. Like the 1099-SA, it is often used by individuals or businesses to report non-employment income, including payments made to independent contractors.
  • IRS Form 1099-INT: This document is issued to report interest income earned from savings accounts, certificates of deposit, or other investments. Both forms require reporting of various income types that could affect a recipient's tax liability.
  • IRS Form 1099-DIV: This form reports dividends and distributions. Similar to the 1099-SA, it concerns payments made to individuals, informing them about income they need to declare on their tax returns.
  • IRS Form 1099-R: Used to report distributions from retirement accounts, this form shares similarities with the 1099-SA in that it also relates to tax implications of distributions, albeit from retirement rather than health savings.
  • IRS Form 1099-S: This form reports proceeds from real estate transactions. Both the 1099-SA and this form inform individuals of significant financial events requiring attention during tax filing.
  • IRS Form 1099-G: This form reports taxable grants and unemployment compensation. Like the 1099-SA, the 1099-G informs taxpayers about payments they received that may impact their overall tax owed.

Dos and Don'ts

When filling out the IRS 1099-SA form, it is important to follow specific guidelines to ensure accuracy and compliance. Here are some key dos and don'ts:

  • Do provide accurate information about distributions from health savings accounts (HSAs), medical savings accounts (MSAs), or Archer MSAs.
  • Do check that your Social Security number (or Employer Identification Number) is correct to avoid any processing delays.
  • Do report the correct distribution amounts in Box 1 of the form to reflect what you actually received.
  • Do use the appropriate tax year for the transactions you are reporting.
  • Don't leave any fields blank; all relevant sections must be completed.
  • Don't forget to make a copy of the completed form for your records before submitting.
  • Don't submit the form without signing and dating it; digital signatures are also acceptable if filing electronically.
  • Don't ignore any IRS instructions accompanying the form, as they provide essential guidance.

Misconceptions

Understanding the IRS 1099-SA form is essential for managing health savings accounts (HSAs) and high-deductible health plans (HDHPs). Many misunderstand the requirements and implications associated with this form. Below are five common misconceptions:

  • Only health savings account (HSA) holders receive this form. In reality, individuals with Archer Medical Savings Accounts and Medicare Advantage MSA accounts will also receive a 1099-SA.
  • Receiving a 1099-SA means you owe taxes. This is not necessarily true. If distributions from your account were used for qualified medical expenses, you may not owe taxes on that amount.
  • All distributions are reported as income. Not all distributions are treated as taxable income. Qualified medical expenses typically do not increase your taxable income.
  • The form is only necessary for the IRS. While the IRS requires this form for reporting income, you also need it to accurately prepare your tax return and substantiate any claims.
  • You cannot correct errors on this form. This is a misconception. If there is an error, you can contact the issuer to request a corrected form.

By clarifying these misconceptions, individuals can manage their health accounts more effectively and avoid unexpected tax consequences.

Key takeaways

  • Purpose of the Form: The IRS 1099-SA form is used to report distributions from Health Savings Accounts (HSAs), Archer Medical Savings Accounts (MSAs), and Medicare Advantage Accounts. Understanding its purpose is crucial for accurate tax reporting.
  • Recipient Information: Ensure you provide accurate information for the recipient, including their name, address, and taxpayer identification number. Errors can lead to complications with tax processing.
  • Distribution Amounts: Report the total distribution amount accurately. This figure should reflect all withdrawals made throughout the year to avoid discrepancies with the IRS.
  • Tax Implications: Be aware that depending on how the funds are used, distributions might be taxable. Use the form to help inform your tax return and determine any taxes owed.
  • Filing Deadline: The IRS requires that the 1099-SA form be sent to recipients by January 31st of the year following the distribution. Timeliness is key to ensure compliance.
  • Record Keeping: Keep a copy of the 1099-SA form along with any supporting documentation. Good record-keeping practices help in the event of an audit or for future reference.
  • Distribution Categories: Familiarize yourself with the categories of distributions reported on the form, including regular distributions and excess contributions. Different categories can influence tax implications.