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registered with the IRS FIRE (Filing Information Returns
Distributions from a health savings
account (HSA), Archer MSA, or Medicare Advantage (MA) MSA are
reported to you on Form 1099-SA. File Form 8853 or Form 8889 with
your Form 1040 to report a distribution from these accounts even if
the distribution is not taxable. The payer is not required to
compute the taxable amount of any distribution.
An HSA or Archer MSA distribution is
not taxable if you used it to pay qualified medical expenses of the
account holder and family 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 is not taxable if you used
it to pay qualified medical expenses of the account holder only. If
you did not 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 did not roll it over, you must include the
distribution in your income (see Form 8853 or Form 8889). Also, you
may owe a penalty.
Furnish Copy B of this form to the
payer by January 31.
File Copy A of this form with the IRS
by February 28. If you file electronically, the due date is
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