This document is the IRS Form 5498‑SA for the 2018 tax year, issued by UMB Bank (the trustee) to participant Pamela Esparza‑Hernandez. It reports the participant’s Health Savings Account (HSA) details, including the trustee’s contact information, participant’s address, and tax identification numbers (masked for privacy). The form lists the contributions made in 2018 ($1,083.29 total), with $0.00 in employee/self‑employed Archer MSA contributions, $0.00 rollover contributions, and a fair market value of $3,418.98 at year‑end. The account type is marked as an HSA. The accompanying instructions explain the tax treatment of contributions to HSA, Archer MSA, and Medicare Advantage MSA, how employer contributions are reported, and references to related IRS forms (8853, 8889) and publications (Pub. 969). It also clarifies that the form is for IRS filing only and should be kept for records, not attached to the tax return.
Topics
Form 5498‑SA Overview: Reporting HSA/Archer MSA Information to the IRS
Provides the purpose of the form, trustee and participant identifiers, account number, and the fact that the information is furnished to the IRS.
2018 Contribution Summary for Participant
Details the monetary amounts reported in the form: $0.00 employee Archer MSA contributions, $1,083.29 total contributions, $0.00 rollover contributions, and $0.00 contributions made in 2019 for 2018.
Tax Treatment Guidance for HSA, Archer MSA, and MA MSA
Explains deductibility of contributions, employer contribution reporting, limits on contributions when employer contributions exist, and references to Forms 8853, 8889, and Pub. 969.
Record‑Keeping Instructions and IRS Reference Links
Instructs participants to keep the form for records, not attach it to the tax return, and provides the IRS website for updates.