Form 5498 IRA Contribution Information

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TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code

1

IRA contributions (other
than amounts in boxes
2-4, 8-10, 13a, 14a, and
15a)

OMB No. 1545-0747

2009

$
2

Rollover contributions

$
3

TRUSTEE’S or ISSUER’S federal
identification no.

PARTICIPANT’S social security
number

Form
Roth IRA conversion
amount

$

5 Fair market value of account

6 Life insurance cost included in
box 1

7

SEP

SIMPLE

Roth IRA

9 SIMPLE contributions

$

$

10 Roth IRA contributions

11 Check if RMD for 2010

$
12a RMD date

12b RMD amount

$
City, state, and ZIP code

13a Postponed contribution

13b Year

$
14a Repayments

14b Code

D (blank box)

Copy A
For
Internal Revenue
Service Center
File with Form 1096.

$
IRA

8 SEP contributions

Street address (including apt. no.)

5498

4 Recharacterized contributions

$

$
PARTICIPANT’S name

IRA
Contribution
Information

13c Code

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2009 General
Instructions for
Forms 1099,
1098, 3921,
3922, 5498, and
W-2G.

$
Account number (see instructions)

15a Other contributions

15b Code

$
Form

5498

Cat. No. 50010C

Do Not Cut or Separate Forms on This Page

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

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Page 3 of 6 of Form 5498

11

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

CORRECTED (if checked)
TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code

1

IRA contributions (other
than amounts in boxes
2-4, 8-10, 13a, 14a, and
15a)

OMB No. 1545-0747

2009

$
2

Rollover contributions

$
3

TRUSTEE’S or ISSUER’S federal
identification no.

PARTICIPANT’S social security
number

Form
Roth IRA conversion
amount

$

5 Fair market value of account

6 Life insurance cost included in
box 1

7

Copy B
For
Participant

$
IRA

SEP

8 SEP contributions

Street address (including apt. no.)

5498

4 Recharacterized contributions

$

$
PARTICIPANT’S name

IRA
Contribution
Information

SIMPLE

Roth IRA

9 SIMPLE contributions

$

$

10 Roth IRA contributions

11 Check if RMD for 2010

$
12a RMD date

12b RMD amount

This information
is being
provided to
the Internal
Revenue
Service.

$
City, state, and ZIP code

13a Postponed contribution

13b Year

13c Code

$

D (blank box)

14a Repayments

14b Code

$
Account number (see instructions)

15a Other contributions

15b Code

$
Form

5498

(keep for your records)

Department of the Treasury - Internal Revenue Service

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Page 4 of 6 of Form 5498

11

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Participant

D

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 and 560.
What’s new. The size of Form 5498 has been increased to allow for separate entry
boxes for information that was previously reported in the blank box to the left of
box 10. See the instructions for boxes 12a–15b below.
Account number. May show an account or other unique number the trustee
assigned to distinguish your account.
Box 1. Shows traditional IRA contributions for 2009 you made in 2009 and through
April 15, 2010. 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, 14a, and 15a.
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, qualified settlement income, or airline payments) to a Roth IRA, you
made in 2009. 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. 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. For a qualified rollover to a Roth
IRA, also see Pub. 590.
Box 3. Shows the amount converted from a traditional IRA, SEP IRA, or SIMPLE
IRA to a Roth IRA in 2009. 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.
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. For endowment contracts only, shows the amount allocable to the cost of "DD"
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.

Box 8. Shows SEP contributions made in 2009, including contributions made in
2009 for 2008, but not including contributions made in 2010 for 2009. 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 9. Shows SIMPLE contributions made in 2009. 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 2009 and through April 15,
2010. Do not deduct on your income tax return.
Box 11. If the box is checked, you must take an RMD for 2010. An RMD may be
required even if the box is not checked. If you do not take the RMD for 2010, you
are subject to a 50% excise tax on the amount not distributed. See Pub. 590 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 2010.
Box 12b. Shows the amount of the RMD for 2010. 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.
February 1,
Box 13a. Shows the amount of any contribution made in 2009 for a prior year.
Box 13b. Shows the year to which the contribution in box 13a was credited.
Box 13c. For participants who made a postponed contribution due to an extension
of the contribution due date because of a presidentially designated disaster, shows
the code PD.
For participants who served in designated combat zones and made postponed
contributions, shows the code for the combat zone or hazardous duty area in
which the participant served. The codes are: AF—Allied Force; JE—Joint
Endeavor; EF—Enduring Freedom; and IF—Iraqi Freedom. For additional
information, including a list of locations within the designated combat zones and
qualified hazardous duty areas, see Pub. 3, Armed Forces’ Tax Guide.
Box 14a. Shows the amount of any repayment of a qualified reservist distribution
or presidentially designated disaster withdrawal repayment. See Pub. 590 for
reporting repayments.
Box 14b. Shows the code “QR” for the repayment of a qualified reservist
distribution or code “PD” for repayment of a presidentially designated disaster
distribution.
Box 15a. Shows the amount of any catch-up contributions you made in the case
of certain employer bankruptcies in lieu of the higher contribution limit for
individuals who are age 50 or older. See Pub. 590.
Box 15b. Shows the code “BK” for special catch-up contributions elected by the
participant in certain employer bankruptcies. See Pub. 590.

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2010

Page 5 of 6 of Form 5498

11

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

VOID

CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code

1

IRA contributions (other
than amounts in boxes
2-4, 8-10, 13a, 14a, and
15a)

OMB No. 1545-0747

2009

$
2

Rollover contributions

$
3

TRUSTEE’S or ISSUER’S federal
identification no.

PARTICIPANT’S social security
number

Form
Roth IRA conversion
amount

$

5 Fair market value of account

6 Life insurance cost included in
box 1

7

SEP

SIMPLE

For
Trustee or Issuer

Roth IRA

9 SIMPLE contributions

$

$

10 Roth IRA contributions

11 Check if RMD for 2010

$
12a RMD date

12b RMD amount

$
City, state, and ZIP code

Copy C

$
IRA

8 SEP contributions

Street address (including apt. no.)

5498

4 Recharacterized contributions

$

$
PARTICIPANT’S name

IRA
Contribution
Information

13a Postponed contribution

13b Year

13c Code

$
14a Repayments

14b Code

D (blank box)

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2009 General
Instructions for
Forms 1099,
1098, 3921,
3922, 5498, and
W-2G.

$
Account number (see instructions)

15a Other contributions

15b Code

$
Form

5498

Cat. No. 50010C

Do Not Cut or Separate Forms on This Page

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

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Page 6 of 6 of Form 5498

11

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Trustees and Issuers
We provide general and specific form instructions
as separate products. The products you should
use for 2009 are the General Instructions for
Forms 1099, 1098, 3921, 3922, 5498, and W-2G
and the 2009 Instructions for Forms 1099-R and
5498. To order these instructions and additional
forms, visit the IRS website at www.irs.gov or call
1-800-TAX-FORM (1-800-829-3676).
Caution: Because paper forms are scanned
during processing, you cannot file with the IRS
Forms 1096, 1098, 1099, 3921, 3922, or 5498 that
you print from the IRS website.

File Copy A of this form with the IRS by
June 1, 2010. If you file electronically, you must
have software that generates a file according to
the specifications in Pub. 1220, Specifications for
Filing Forms 1098, 1099, 3921, 3922, 5498, and
W-2G Electronically. 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). For TTY/TDD
D
equipment, call 304-267-3367 (not toll free).

Due dates. Furnish Copy B of this form to the
participant by June 1, 2010, but furnish fair
market value information and RMD if applicable
by February 1, 2010.

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