Form 8889 Examples Filled Out - Syair Sdy Apr 2026

Enter $1,000 (the amount used for qualified medical expenses).

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To help you with the legitimate part of your query, here is an example of how a standard Form 8889 is completed. 📋 Form 8889 Example Scenario Name: Jane Smith Coverage Type: Family HDHP Personal Contributions: $3,000 Enter $1,000 (the amount used for qualified medical

Enter $1,000 (the total distribution received from the HSA). 📋 Form 8889 Example Scenario Name: Jane Smith

Calculate your final HSA deduction to be carried over to your Form 1040. Part II: HSA Distributions

$1,500 (Reported on Form W-2, Box 12, Code W) Distributions Taken: $1,000 (Reported on Form 1099-SA) Qualified Medical Expenses: $1,000 ✍️ How to Fill Out the Form Part I: Contributions and Deductions Line 1: Check the Family box. Line 2: Enter $3,000 (your out-of-pocket contributions).

Enter $0 (subtract line 15 from 14a. Because all funds were used on qualified expenses, no tax is owed). IRS Form 8889 walkthrough (Health Savings Accounts)