Fillable Printable Form 5498
Fillable Printable Form 5498
Form 5498
Attention:
Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded and printed and used to satisfy the requirement to provide the information to
the recipient.
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the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms
. Click on
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Information returns may also be filed electronically using the IRS Filing Information Returns
Electronically (FIRE) system (visit www.IRS.gov/FIRE
) or the IRS Affordable Care Act
Information Returns (AIR) program (visit www.IRS.gov/AIR).
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
Form 5498
2017
Cat. No. 50010C
IRA
Contribution
Information
Copy A
For
Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0747
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2017 General
Instructions for
Certain
Information
Returns.
2828
VOID CORRECTED
TRUSTEE’S or ISSUER’S name, street address,
city or town, state or
province, country, and ZIP or foreign postal code
TRUSTEE’S or ISSUER’S federal
identification no.
PARTICIPANT’S social security
number
PARTICIPANT’S name
Street address (including apt. no.)
C
ity or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 IRA contributions (other
than amounts in boxes
2–4, 8–10, 13a, and 14a)
$
2 Rollover contributions
$
3 Roth IRA conversion
amount
$
4 Recharacterized
contributions
$
5
Fair market value of account
$
6
Life insurance cost included in
box 1
$
7 IRA SEP SIMPLE Roth IRA
8 SEP contributions
$
9 SIMPLE contributions
$
10 Roth IRA contributions
$
11 Check if RMD for 2018
12a RMD date 12b RMD amount
$
13a Postponed contribution
$
13b Year 13c Code
14a Repayments
$
14b Code
15a FMV of certain specified
assets
$
15b Code(s)
Form 5498
www.irs.gov/form5498
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 5498
2017
IRA
Contribution
Information
Copy B
For
Participant
Department of the Treasury - Internal Revenue Service
This information
is being
furnished to
the Internal
Revenue
Service.
OMB No. 1545-0747
CORRECTED (if checked)
TRUSTEE’S or ISSUER’S name, street address,
city or town, state or
province, country, and ZIP or foreign postal code
TRUSTEE’S or ISSUER’S federal
identification no.
PARTICIPANT’S social security
number
PARTICIPANT’S name
Street address (including apt. no.)
C
ity or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 IRA contributions (other
than amounts in boxes
2–4, 8–10, 13a, and 14a)
$
2 Rollover contributions
$
3 Roth IRA conversion
amount
$
4 Recharacterized
contributions
$
5
Fair market value of account
$
6
Life insurance cost included in
box 1
$
7
IRA SEP SIMPLE Roth IRA
8 SEP contributions
$
9 SIMPLE contributions
$
10 Roth IRA contributions
$
11
If checked, required minimum
distribution for 2018
12a RMD date 12b RMD amount
$
13a Postponed contribution
$
13b Year 13c Code
14a Repayments
$
14b Code
15a FMV of certain specified
assets
$
15b Code(s)
Form 5498
(keep for your records) www.irs.gov/form5498
Instructions for Participant
The information on Form 5498 is submitted to the Internal Revenue Service by the
trustee or issuer of your individual retirement arrangement (IRA) to report
contributions, including any catch-up contributions, required minimum distributions
(RMDs), and the fair market value (FMV) of the account. For information about IRAs,
see Pubs. 590-A, 590-B, and 560.
Participant’s taxpayer identification number. For your protection, this form may
show only the last four digits of your SSN, ITIN, ATIN, or EIN. However, the trustee or
issuer has reported your complete identification number to the IRS.
Account number. May show an account or other unique number the trustee or issuer
assigned to distinguish your account.
Box 1. Shows traditional IRA contributions for 2017 you made in 2017 and through
April 17, 2018. These contributions may be deductible on your Form 1040 or 1040A.
However, if you or your spouse was an active participant in an employer’s pension
plan, these contributions may not be deductible. This box does not include amounts in
boxes 2–4, 8–10, 13a, and 14a.
Box 2. Shows any rollover, including a direct rollover to a traditional IRA or Roth IRA, or a
qualified rollover contribution (including a military death gratuity, SGLI payment, or qualified
settlement income) to a Roth IRA you made in 2017. It does not show any amounts you
converted from your traditional IRA, SEP IRA, or SIMPLE IRA to a Roth IRA. They are shown in
box 3. It does not show any late rollover contributions. They are shown in box 13a. See the
Form 1040 or 1040A instructions for information on how to report rollovers. If you have ever
made any nondeductible contributions to your traditional IRA or SEP IRA and you did not roll
over the total distribution, use Form 8606 to figure the taxable amount. If property was rolled
over, see Pub. 590-A. For a qualified rollover to a Roth IRA, also see Pub. 590-A.
Box 3. Shows the amount converted from a traditional IRA, SEP IRA, or SIMPLE IRA
to a Roth IRA in 2017. Use Form 8606 to figure the taxable amount.
Box 4. Shows amounts recharacterized from transferring any part of the contribution
(plus earnings) from one type of IRA to another. See Pub. 590-A.
Box 5. Shows the FMV of all investments in your account at year end. However, if a
decedent’s name is shown, the amount reported may be the FMV on the date of
death. If the FMV shown is zero for a decedent, the executor or administrator of the
estate may request a date-of-death value from the financial institution.
Box 6. Shows for endowment contracts only the amount allocable to the cost of life
insurance. Subtract this amount from your allowable IRA contribution included in box 1
to compute your IRA deduction.
Box 7. May show the kind of IRA reported on this Form 5498.
Boxes 8 and 9. Shows SEP (box 8) and SIMPLE (box 9) contributions made in 2017,
including contributions made in 2017 for 2016, but not including contributions made in
2018 for 2017. If made by your employer, do not deduct on your income tax return. If
you made the contributions as a self-employed person (or partner), they may be
deductible. See Pub. 560.
Box 10. Shows Roth IRA contributions you made in 2017 and through April 17, 2018.
Do not deduct on your income tax return.
Box 11. If the box is checked, you must take an RMD for 2018. An RMD may be
required even if the box is not checked. If you do not take the RMD for 2018, you are
subject to a 50% excise tax on the amount not distributed. See Pub. 590-B for details.
Box 12a. Shows the date by which the RMD amount in box 12b must be distributed to
avoid the 50% excise tax on the undistributed amount for 2018.
Box 12b. Shows the amount of the RMD for 2018. If box 11 is checked and there is no
amount in this box, the trustee or issuer must provide you the amount or offer to
calculate the amount in a separate statement by January 31, 2018.
Box 13a. Shows the amount of a late rollover contribution made in 2017 and certified by
the participant, or a postponed contribution made in 2017 for a prior year.
Box 13b. Shows the year to which the postponed contribution in box 13a was credited.
If a late rollover contribution is shown in box 13a, this box will be blank.
Box 13c. For participants who made a postponed contribution due to an extension of the
contribution due date because of a federally designated disaster, shows the code FD.
For participants who served in designated combat zones, qualified hazardous duty
areas, or in direct support areas, shows the appropriate code. The codes are:
EO13239 for Afghanistan and associated direct support areas, EO12744 for the
Arabian Peninsula areas, and EO13119 (or PL106-21) for the Yugoslavia operations
areas. For additional information, including a list of locations within the designated
combat zones, qualified hazardous duty areas, and direct support areas, see Pub. 3.
For updates to the list of locations, go to www.irs.gov/form5498.
For a participant who has used the self-certification procedure for a late rollover
contribution, shows the code SC.
Box 14a. Shows the amount of any repayment of a qualified reservist distribution or
federally designated disaster withdrawal repayment. See Pub. 590-A for reporting
repayments.
Box 14b. Shows the code QR for the repayment of a qualified reservist distribution or
code DD for repayment of a federally designated disaster distribution.
Box 15a. Shows the FMV of the investments in the IRA that are specified in the
categories identified in box 15b.
Box 15b. The following codes show the type(s) of investments held in your account for
which the FMV is required to be reported in box 15a.
A—Stock or other ownership interest in a corporation that is not readily tradable on an
established securities market.
B—Short- or long-term debt obligation that is not traded on an established securities market.
C—Ownership interest in a limited liability company or similar entity (unless the
interest is traded on an established securities market).
D—Real estate.
E—Ownership interest in a partnership, trust, or similar entity (unless the interest is
traded on an established securities market).
F—Option contract or similar product that is not offered for trade on an established
option exchange.
G—Other asset that does not have a readily available FMV.
H—More than two types of assets (listed in A through G) are held in this IRA.
Future developments. For the latest information about developments related to Form
5498 and its instructions, such as legislation enacted after they were published, go to
www.irs.gov/form5498.
Form 5498
2017
IRA
Contribution
Information
Copy C
For
Trustee or Issuer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0747
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2017 General
Instructions for
Certain
Information
Returns.
VOID CORRECTED
TRUSTEE’S or ISSUER’S name, street address,
city or town, state or
province, country, and ZIP or foreign postal code
TRUSTEE’S or ISSUER’S federal
identification no.
PARTICIPANT’S social security
number
PARTICIPANT’S name
Street address (including apt. no.)
C
ity or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 IRA contributions (other
than amounts in boxes
2–4, 8–10, 13a, and 14a)
$
2 Rollover contributions
$
3 Roth IRA conversion
amount
$
4 Recharacterized
contributions
$
5
Fair market value of account
$
6
Life insurance cost included in
box 1
$
7
IRA SEP SIMPLE Roth IRA
8 SEP contributions
$
9 SIMPLE contributions
$
10 Roth IRA contributions
$
11 Check if RMD for 2018
12a RMD date 12b RMD amount
$
13a Postponed contribution
$
13b Year 13c Code
14a Repayments
$
14b Code
15a FMV of certain specified
assets
$
15b Code(s)
Form 5498
www.irs.gov/form5498
Instructions for Trustee or Issuer
To complete Form 5498, use:
• The 2017 General Instructions for Certain
Information Returns, and
• The 2017 Instructions for Forms 1099-R and
5498.
To order these instructions and additional forms,
go to www.irs.gov/form5498.
Caution: Because paper forms are scanned during
processing, you cannot file Forms 1096, 1097,
1098, 1099, 3921, 3922, or 5498 that you print
from the IRS website.
Due dates. Furnish Copy B of this form to the
participant by May 31, 2018, but furnish fair market
value information and RMD if applicable by
January 31, 2018.
File Copy A of this form with the IRS by
May 31, 2018. If you file electronically, you must
have software that generates a file according to
the specifications in Pub. 1220. The IRS does not
provide a fill-in form option.
Need help? If you have questions about reporting
on Form 5498, call the information reporting
customer service site toll free at 1-866-455-7438
or 304-263-8700 (not toll free). Persons with a
hearing or speech disability with access to TTY/
TDD equipment can call 304-579-4827 (not toll
free).
