Form 5498 IRA Contribution Information

2828

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, and 14a)

OMB No. 1545-0747

2010

$

f
o
s
a
9
t
0
f
0
a
2
r
/
D /14
5
0
2

Rollover contributions

$
3

TRUSTEE’S or ISSUER’S federal
identification no.

PARTICIPANT’S name

PARTICIPANT’S social security
number

Form

Roth IRA conversion
amount

5498

4 Recharacterized contributions

$

$

5 Fair market value of account

6 Life insurance cost included in
box 1

$

$

7

IRA

SEP

8 SEP contributions

Street address (including apt. no.)

IRA
Contribution
Information

SIMPLE

Roth IRA

9 SIMPLE contributions

$

$

11 Check if RMD for 2011

$

12b RMD amount

$

City, state, and ZIP code

13a Postponed contribution

13b Year

$

14a Repayments

14b Code

For
Internal Revenue
Service Center
File with Form 1096.

10 Roth IRA contributions

12a RMD date

Copy A

13c Code

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2010 General
Instructions for
Forms 1099,
1098, 3921,
3922, 5498, and
W-2G.

$

Account number (see instructions)

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

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, and 14a)

OMB No. 1545-0747

2010

$

f
o
s
a
9
t
0
f
0
a
2
r
/
D /14
5
0
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 If checked, required minimum
distribution for 2011.

$

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

$

14a Repayments

14b Code

$

Account number (see instructions)

Form

5498

(keep for your records)

Department of the Treasury - Internal Revenue Service

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 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–14b 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 2010 you made in 2010 and
through April 15, 2011. 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, and 13a.
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 2010. 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 8. Shows SEP contributions made in 2010, including contributions made in
2010 for 2009, but not including contributions made in 2011 for 2010. 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 2010. 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 2010 and through April 15,
2011. Do not deduct on your income tax return.
Box 11. If the box is checked, you must take an RMD for 2011. An RMD may be
required even if the box is not checked. If you do not take the RMD for 2011,
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 2011.
Box 12b. Shows the amount of the RMD for 2011. 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,
2011.
Box 13a. Shows the amount of any postponed contribution made in 2010 for a
prior year.
Box 13b. Shows the year to which the postponed 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 federally designated
disaster, shows the code FD.
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.

f
o
s
a
9
t
0
f
0
a
2
r
/
D /14
5
0

Box 3. Shows the amount converted from a traditional IRA, SEP IRA, or SIMPLE
IRA to a Roth IRA in 2010. 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 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 14a. Shows the amount of any repayment of a qualified reservist
distribution or federally 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 DD for repayment of a federally designated disaster
distribution.

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, and 14a)

OMB No. 1545-0747

2010

$
2

Rollover contributions

f
o
s
a
9
t
0
f
0
a
2
r
/
D /14
5
0
$
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 2011

$

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

$

14a Repayments

14b Code

13c Code

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2010 General
Instructions for
Forms 1099,
1098, 3921,
3922, 5498, and
W-2G.

$

Account number (see instructions)

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

f
o
s
a
9
t
0
f
0
a
2
r
/
D /14
5
0

Instructions for Trustees and Issuers

We provide general and specific form instructions
as separate products. The products you should
use for 2010 are the General Instructions for
Forms 1099, 1098, 3921, 3922, 5498, and W-2G
and the 2010 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.
Due dates. Furnish Copy B of this form to the
participant by May 31, 2011, but furnish fair
market value information and RMD if applicable
by January 31, 2011.

File Copy A of this form with the IRS by
May 31, 2011. 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
equipment, call 304-579-4827 (not toll free). The
hours of operation are Monday through Friday
from 8:30 a.m. to 4:30 p.m., Eastern time.

Printed on recycled paper