HSA Scenario 5 Peggy Walker Directions Use the interview notes, taxpayer documents, and reference materials needed for this scenario Please complete Form 1040 through line 15, and the appropriate forms (including Form 8889), schedules, or work sheets Answer the questions following the scenario Note When entering Social Security numbers (SSNs) or Employer Identification Numbers (EINs), replace the Xs as directed, or with any four digits of your choice Interview Notes Peggy Walker, age 48, is a single parent raising her son, Marcus Marcus is a full time student and had no income Peggy qualifies to file as Head of Household Peggy does not have enough deductions to itemize For the last five years, Peggy has had family health coverage through a High Deductible Health Plan (HDHP) from her employer Peggy has had an HSA for several years In 2018, she contributed $1,500 to her HSA Peggys grandmother helped her out and contributed $1,000 to her HSA in 2018 Peggys employer also contributed $600 to her HSA in 2018 Peggy paid the following expenses in 2018 using money from her HSA Urgent care bill for Peggy $615 Prescription medicine for Peggy $125 Insulin for Marcus $140 Dancing lessons for Peggy $200 Doctor visits for Marcus $400 Peggy and Marcus are U S citizens and have valid Social Security numbers Health Savings Accounts (HSA) 135 136 Health Savings Accounts (HSA) Health Savings Accounts (HSA) 137 138 Health Savings Accounts (HSA) 12 The amount of Peggy Walker's HSA deduction on Form 8889, line 13 is $2,500 T F 13 How much of Peggy's HSA distribution is taxable A $0 B $125 C $140 D $200 14 The amount of qualified medical expenses reported on Form 8889, line 15 is $ (Do not enter dollar signs, commas, periods, or decimal points in your answer ) 15 What is the amount of the additional 20 tax reported on Form 8889, line 17b A $0 B $40 C $108 D $188

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HSA Scenario 5: Peggy Walker Directions Use the interview notes, taxpayer documents, and reference materials needed for this scenario . Please complete Form 1040 through

HSA Scenario 5: Peggy Walker Directions

Use the interview notes, taxpayer documents, and reference materials needed for this scenario . Please complete Form 1040 through line 15, and the appropriate forms (including Form 8889), schedules, or work- sheets . Answer the questions following the scenario .

Note: When entering Social Security numbers (SSNs) or Employer Identification Numbers (EINs), replace the Xs as directed, or with any four digits of your choice.

Interview Notes

Peggy Walker, age 48, is a single parent raising her son, Marcus .
Marcus is a full-time student and had no income .
Peggy qualifies to file as Head of Household.
Peggy does not have enough deductions to itemize .
For the last five years, Peggy has had family health coverage through a High Deductible Health Plan (HDHP) from her employer .
Peggy has had an HSA for several years .
In 2018, she contributed $1,500 to her HSA .
Peggys grandmother helped her out and contributed $1,000 to her HSA in 2018 .
Peggys employer also contributed $600 to her HSA in 2018 .
Peggy paid the following expenses in 2018 using money from her HSA:
- Urgent care bill for Peggy - $615
- Prescription medicine for Peggy - $125
- Insulin for Marcus - $140
- Dancing lessons for Peggy - $200
- Doctor visits for Marcus - $400
Peggy and Marcus are U .S . citizens and have valid Social Security numbers .

Health Savings Accounts (HSA) 135

136 Health Savings Accounts (HSA)

Health Savings Accounts (HSA) 137

138 Health Savings Accounts (HSA)

12. The amount of Peggy Walker's HSA deduction on Form 8889, line 13 is $2,500. T/F

13. How much of Peggy's HSA distribution is taxable?

A. $0

B. $125

C. $140

D. $200

14. The amount of qualified medical expenses reported on Form 8889, line 15 is $________. (Do not enter dollar signs, commas, periods, or decimal points in your answer.)