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Form field | Folder > Screen | Field |
---|---|---|
Trustee's name | Health Care > 5498SA | Trustee Name |
Trustee's TIN | Health Care > 5498SA | EIN |
Participant's TIN, name, address | Health Care > 5498SA | Code the screen unit to T or S to indicate if the Recipient is the Taxpayer or the Spouse. |
Account number | Health Care > 5498SA | Account number |
Box 1 - Employee's or self-employed person's Archer MSA contributions made in 2023 and 2024 for 2023 | Health Care > 5498SA | Total HSA/MSA contributions for 2023 |
Box 2 - Total contributions made in 2023 | Health Care > 5498SA | Total HSA/MSA contributions for 2023 |
Box 3 - Total HSA or Archer MSA contributions made in 2024 for 2023 | Health Care > 5498SA | Total HSA/MSA contributions for 2023 |
Box 4 - Rollover contributions | Health Care > 5498SA | Rollover contribution |
Box 5 - Fair market value of HSA, Archer MSA, or MA MSA | Health Care > 5498SA | FMV of HSA, Archer MSA, or MA MSA |
Box 6 - HSA, Archer MSA, MA MSA | Health Care > 5498SA | Indicate type of health or medical savings account: HSA (Form 889), Archer MSA (Form 8853), Medicare Advantage MSA (Form 8853) |