2003 HTML Instructions for Form 8853,

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Table of Contents

Purpose of Form

Use Form 8853 to:

Report Archer MSA contributions (including employer contributions);
Figure your Archer MSA deduction;
Report distributions from Archer MSAs or Medicare+Choice MSAs;
Report taxable payments from long-term care (LTC) insurance contracts; or
Report taxable accelerated death benefits from a life insurance policy.

Additional information. See Pub. 969, Medical Savings Accounts (MSAs), for more details on MSAs.

Who Must File

You must file Form 8853 if any of the following apply.

You (or your employer) made contributions for 2003 to your Archer MSA.
You are filing a joint return and your spouse (or his or her employer) made contributions for 2003 to your spouse's Archer MSA.
You (or your spouse, if filing jointly) received Archer MSA or Medicare+Choice MSA distributions in 2003.
You acquired an interest in an Archer MSA or a Medicare+Choice MSA because of the death of the account holder. See Death of Account Holder on this page.
You (or your spouse, if filing jointly) were a policyholder who received payments under an LTC insurance contract or received any accelerated death benefits from a life insurance policy on a per diem or other periodic basis in 2003. See the instructions for Section C, beginning on page 5.

General Instructions