FORM 5498-SA TRUSTEE RECONCILIATION CHECKLIST
Reporting Year: ____________   Form Revision Date: 12/2026
Account Reference: ________________________________

SYSTEM QUERY PARAMETERS:
[ ] 1. Extract all credits/deposits from Jan 1 to Dec 31 of the reporting year.
[ ] 2. Extract all deposits from Jan 1 to Apr 15 of the subsequent year.
[ ] 3. Retrieve ending account balance (FMV) as of Dec 31.

TRANSACTION FILTERING & EXCLUSIONS:
[ ] Direct trustee-to-trustee transfers identified and EXCLUDED.
[ ] Permitted mistaken distribution repayments EXCLUDED from contributions.
[ ] Identify qualified IRA-to-HSA funding distributions (Include in Box 2).
[ ] Identify rollover contributions received (Map to Box 4 only).

BOX POPULATION MAPPING:
[ ] Box 1: Left BLANK (for HSA accounts).
[ ] Box 2: Total calendar-year regular contributions + prior-year designations received this year.
[ ] Box 3: Total subsequent-year contributions designated for the reporting year.
[ ] Box 4: Rollover contributions received.
[ ] Box 5: December 31 Fair Market Value.
[ ] Box 6: "HSA" checkbox selected.

FURNISHING & FILING TOLLGATES:
[ ] If participant TIN truncation is used, confirm permitted payee-copy masking and full IRS data.
[ ] Participant statements queued for the adjusted May deadline: June 1, 2027 for 2026 reporting.
[ ] IRS electronic filing configured (mandatory if filing 10+ total information returns).

Exceptions / Follow-up required:
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Prepared by: ________________________  Date: ____________