Form 1099-SA is provided to a taxpayer that has received certain distributions from a Health Savings Account, Archer Medical Savings Account or Medical Savings Account. These payments should be addressed when filing the tax return and may be subject to taxation. The following items are reported on a Form 1099-SA:
Box 1 – Gross distribution. This box shows the total amount distributed from the account during the tax year shown on the form.
Box 2 – Earnings on excess contributions. This box shows the earnings on any excess contributions distributed from an HSA or by the due date of the income tax return.
Box 3 – Distribution code. This code identifies the type of distribution that occurred. (1 – Normal Distribution; 2 – Excess Contributions; 3 – Disability; 4 – Death; 5 – Prohibited Transaction; and 6 – Death distributions after year of death to a nonspouse beneficiary).
Box 4– FMV on date of death. If the account holder died. this box shows the fair market value of the account as of the date of death.
Box 5 – HSA, Archer MSA, MA MSA. This box shows the type of account that is reported on this IRS Form 1099-SA. Based on the account type indicated, the information contained on the 1099-SA will be entered on Form 8889 – Health Savings Accounts or Form 8853 – Archer MSAs or Long Term Care Insurance Contracts.