Form 1099-SA

Form name:

Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

IRC Section:

6047, 220(h), 408(i), 138, 106(b)

Link to form:

https://www.irs.gov/pub/irs-pdf/f1099sa.pdf

Payors must file Form 1099-SA for any distributions made from a health savings account (HSA), Archer medical savings account (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 separate return must be filed for each plan type.

• The name, address, taxpayer identification number and phone number of the trustee/payor,
• The name, address, and taxpayer identification number of the recipient,
• Account number,
• Gross distribution,
• Earnings on excess contribution,
• Distribution code,
• Fair market value on date of death,
• Checkbox for HSA, Archer MSA, or MA MSA,

 

Please see Form 1099-SA for all other information required to be reported

Reporting threshold: 

All amounts.

Due date to recipient: 

January 31.

Due date to IRS (paper filing)

February 28.

Due date to IRS (Electronic Filing)

March 31.