⏱ About 15 minutes per account
SKIP THIS PAGE IFNeither of you had a Health Savings Account during 2026.
YOU NEED THIS PAGE IFEither of you had an HSA, including one nothing was paid into, if money came out of it.
WHAT THIS PAGE DOESReconciles each HSA: who owns it, the plan behind it, what went in from every source and what came out. Over-contributions are penalized every year they stay in, so the details matter.
HSAs belong to one person, even when spouses share a health plan. Complete a separate section for each account.
1 · Before you begin
Gather these first. Tick them off as you go.
2 · Completing the page
Work from the top of the organizer page to the bottom. Each section below matches a section on the page.
1No HSA?Check the box and move on
If noneCheck the box and continue to the next page.
2Account informationOne section per HSA
For each HSAOwner (Taxpayer or Spouse), the bank or custodian, coverage type (self-only or family high-deductible plan), and the number of months (0–12) you were covered by a qualifying high-deductible plan.
3ContributionsEvery source, separately
Employer or churchUsually shown on your W-2 in Box 12, Code W.
PayrollPre-tax payroll contributions, where asked.
Direct personal contributionsMoney you put in from your own bank account outside payroll. These often qualify for a deduction.
4Withdrawals and year-end valueFrom Forms 1099-SA and 5498-SA
DistributionsThe total from Form 1099-SA, even if it all went to qualified medical, dental or vision costs.
Year-end valueThe balance from Form 5498-SA.
5CommentsAnything out of the ordinary
Use the comments forTransfers between custodians, corrected excess contributions, contributions made after year-end for 2026, non-medical withdrawals, account closures, or Medicare enrollment during the year.
3 · Common mistakes that cause delays
The issues we see most often on this page.
Counting W-2 contributions twiceBox 12 Code W is already reported. Enter only extra money you put in yourself as a personal contribution.
Counting months the account was openUse months of qualifying high-deductible coverage, not months the account existed.
Contributing after Medicare startsEligibility generally ends when Medicare begins. Enter only eligible months, or add a note.
Missing contributions made after year-endInclude the amount and note the date in the comments.
Two family limitsSpouses on a family plan share one limit, even with two accounts.
Not reporting withdrawalsReport every withdrawal. Tell us about any non-medical use.
Missing tax formsSend both Form 1099-SA and Form 5498-SA.
4 · When you’re finished
- Each HSA listed with owner, coverage type and eligible months.
- Employer, payroll and personal contributions, withdrawals and year-end value entered.
- Continue to Page 22.
Please don’t email tax documents. Email isn’t encrypted. Upload everything together through CyberCabinet when your organizer is complete.