VOID CORRECTED

IRA contributions (other

than amounts in boxes 2,

3, and 7–10)

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

IRA

Contribution

Information

$

2 Rollover contributions

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Roth conversion amount

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

2828

Cat. No. 50010C

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2000 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

Form 5498

OMB No. 1545-0747

6 IRA SEP SIMPLE

7 SEP contributions 8 SIMPLE contributions

$ $

9 Roth IRA contributions 10 Ed IRA contributions

$ $

Roth IRA Rechar. Ed IRA

Life insurance cost

included in box 1

5

$

Do NOT Cut or Separate Forms on This Page — Do NOT Cut or Separate Forms on This Page

2000
CORRECTED (if checked)

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

$

2 Rollover contributions

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Roth conversion amount

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

For

Participant

Copy B

(Keep for your records.)

IRA contributions (other

than amounts in boxes 2,

3, and 7–10)

Form 5498

OMB No. 1545-0747

IRA

Contribution

Information

6

7 SEP contributions 8 SIMPLE contributions

$ $

9 Roth IRA contributions 10 Ed IRA contributions

$ $

IRA SEP SIMPLE

This information

is being

furnished to

the Internal

Revenue

Service.

Life insurance cost

included in box 1

5

$

Roth IRA Rechar. Ed IRA

2000
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 and the fair market value of the account. For

information about IRAs, see Pub. 590, Individual Retirement

Arrangements (IRAs), and Pub. 560, Retirement Plans for Small Business.

Box 5. 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 4. Shows the fair market value of your account at year end.

Box 1. Shows traditional IRA contributions for 2000 you made in 2000

and through April 16, 2001. 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, 3, and 7-10.

Box 2. Shows any rollover, including a direct rollover to a traditional IRA,

you made in 2000. It also shows amounts recharacterized from one type

of IRA to another. However, it does not show any amounts you converted

from your traditional IRA, simplified employee pension (SEP), or savings

incentive match plan for employees (SIMPLE) 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 and you did not roll over the

total distribution, use Form 8606, Nondeductible IRAs, to figure the

taxable amount. If property was rolled over, see Pub. 590.

Box 6. May show the kind of IRA reported on this Form 5498. If

“Rechar.” is checked, the contribution is a recharacterization of a prior

contribution from one type of IRA to another.

Box 7. Shows simplified employee pension (SEP) contributions made in

2000, including contributions made in 2000 for 1999, but not including

contributions made in 2001 for 2000. 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 8. Shows savings incentive match plan for employees (SIMPLE)

contributions made in 2000. 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 education IRA (Ed IRA) contributions made in 2000 on

your behalf. Do not deduct on your income tax return. If the total of all

contributions made to all your Ed IRAs this year exceeded $500, you

should withdraw the excess, plus earnings, generally by April 16, or you

may owe a penalty. You must keep track of your Ed IRA basis

(contributions and distributions). See Pub. 590.

Box 9. Shows Roth IRA contributions you made in 2000 and through

April 16, 2001. Do not deduct on your income tax return.

Box 3. Shows the amount converted from a traditional IRA, SEP, or

SIMPLE to a Roth IRA in 2000. Use Form 8606 to figure the taxable

amount.

Instructions to Participant

Reminder: If you converted from a traditional IRA, SEP, or SIMPLE to a

Roth IRA in 1998 and you elected to spread the taxable income over 4

years, you must include one-fourth of the taxable amount converted in

your income in 2000. See your Form 1040 instructions.
VOID CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

$

2 Rollover contributions

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Roth conversion amount

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

For

Trustee or Issuer

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2000 General

Instructions for

Forms 1099,

1098, 5498, and

W-2G.

Copy C

IRA contributions (other

than amounts in boxes 2,

3, and 7–10)

Form 5498

OMB No. 1545-0747

IRA

Contribution

Information

6

7 SEP contributions 8 SIMPLE contributions

$ $

9 Roth IRA contributions 10 Ed IRA contributions

$ $

IRA SEP SIMPLE

$

Life insurance cost

included in box 1

5

Roth IRA Rechar. Ed IRA

2000
Trustees and Issuers, Please Note—

To help make it easier for you to get only the

information you need to complete the Forms

1099, 1098, 5498, and W-2G you file, we are now

providing general and specific form instructions

as separate products. The new products you

should use for 2000 are the General Instructions

for Forms 1099, 1098, 5498, and W-2G, which

contains general information concerning Form

5498 and forms in the 1099 series, and the

separate specific instructions for each information

return you file. Specific information needed to

complete this form is given in the 2000

Instructions for Forms 1099-R and 5498. You

can order those instructions and additional forms

by calling 1-800-TAX-FORM (1-800-829-3676).

You can also get forms and instructions from the

IRS’s Internet Web Site at www.irs.gov.

Due dates. For an education IRA (Ed IRA), furnish

Copy B of this form to the participant by January

31, 2001. For all other types of accounts, furnish

Copy B by May 31, 2001, but furnish fair market

value information by January 31, 2001.

File Copy A of this form with the IRS by May

31, 2001.

Caution: Because the IRS processes paper forms

by machine (optical character recognition

equipment), you cannot file with the IRS Forms

1096, 1098, 1099, or 5498 that you print from the

IRS’s Internet Web Site.