Form 5498

2012

Cat. No. 50010C

IRA 

Contribution 

Information

Copy A

For 

Internal Revenue 

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0747

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2012 General

Instructions for

Certain

Information

Returns.

2828 VOID CORRECTED

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

TRUSTEE’S or ISSUER’S federal 

identification no.

PARTICIPANT’S social security 

number

PARTICIPANT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

1 IRA contributions (other 

than amounts in boxes 

2-4, 8-10, 13a, and 14a)

$

2 Rollover contributions

$

3 Roth IRA conversion 

amount

$

4 Recharacterized 

contributions

$

5 Fair market value of account

$

6 Life insurance cost included in 

box 1

$

7 IRA SEP SIMPLE Roth IRA

8 SEP contributions

$

9 SIMPLE contributions

$

10 Roth IRA contributions

$

11 Check if RMD for 2013

12a RMD date 12b RMD amount

$

13a Postponed contribution

$

13b Year 13c Code

14a Repayments

$

14b Code

Form 5498 www.irs.gov/form5498

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 5498

2012

IRA 

Contribution 

Information

Copy B

For 

Participant

Department of the Treasury - Internal Revenue Service

This information 

is being 

furnished to 

the Internal 

Revenue 

Service.

OMB No. 1545-0747

CORRECTED (if checked)

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

TRUSTEE’S or ISSUER’S federal 

identification no.

PARTICIPANT’S social security 

number

PARTICIPANT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

1 IRA contributions (other 

than amounts in boxes 

2-4, 8-10, 13a, and 14a)

$

2 Rollover contributions

$

3 Roth IRA conversion 

amount

$

4 Recharacterized 

contributions

$

5 Fair market value of account

$

6 Life insurance cost included in 

box 1

$

7 IRA SEP SIMPLE Roth IRA

8 SEP contributions

$

9 SIMPLE contributions

$

10 Roth IRA contributions

$

11 If checked, required minimum 

distribution for 2013

12a RMD date 12b RMD amount

$

13a Postponed contribution

$

13b Year 13c Code

14a Repayments

$

14b Code

Form 5498 (keep for your records) www.irs.gov/form5498
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.

Participant's identification number. For your protection, this form may show 

only the last four digits of your SSN, ITIN, or ATIN. However, the issuer has 

reported your complete identification number to the IRS, and, where applicable, 

to state and/or local governments.

Account number. May show an account or other unique number the trustee

assigned to distinguish your account.

Box 1. Shows traditional IRA contributions for 2012 you made in 2012 and

through April 15, 2013. 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, 13a, and 14a.

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, or qualified settlement income) to a Roth IRA you made in 2012. 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. For information on airline payments, see 

www.irs.gov/form5498.

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

IRA to a Roth IRA in 2012. 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. Shows for endowment contracts only 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 8. Shows SEP contributions made in 2012, including contributions made in

2012 for 2011, but not including contributions made in 2013 for 2012. 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 2012. 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 2012 and through April 15,

2013. Do not deduct on your income tax return.

Box 11. If the box is checked, you must take an RMD for 2013. An RMD may be

required even if the box is not checked. If you do not take the RMD for 2013,

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 2013.

Box 12b. Shows the amount of the RMD for 2013. 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,

2013.

Box 13a. Shows the amount of any postponed contribution made in 2012 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, qualified hazardous 

duty areas, or in direct support areas, shows the appropriate code. The codes 

are: EO13239 for Afghanistan and associated direct support areas, EO12744 for 

the Arabian peninsula areas, and EO13119 (or PL106-21) for the Yugoslavia 

operations areas. For additional information, including a list of locations within 

the designated combat zones, qualified hazardous duty areas, and direct 

support areas, see Pub. 3, Armed Forces' Tax Guide. For updates to the list of 

locations, go to www.irs.gov/form5498.

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.
Form 5498

2012

IRA 

Contribution 

Information

Copy C

For 

Trustee or Issuer

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0747

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2012 General

Instructions for

Certain

Information

Returns.

VOID CORRECTED

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

TRUSTEE’S or ISSUER’S federal 

identification no.

PARTICIPANT’S social security 

number

PARTICIPANT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

1 IRA contributions (other 

than amounts in boxes 

2-4, 8-10, 13a, and 14a)

$

2 Rollover contributions

$

3 Roth IRA conversion 

amount

$

4 Recharacterized 

contributions

$

5 Fair market value of account

$

6 Life insurance cost included in 

box 1

$

7 IRA SEP SIMPLE Roth IRA

8 SEP contributions

$

9 SIMPLE contributions

$

10 Roth IRA contributions

$

11 Check if RMD for 2013

12a RMD date 12b RMD amount

$

13a Postponed contribution

$

13b Year 13c Code

14a Repayments

$

14b Code

Form 5498 www.irs.gov/form5498
Instructions for Trustee or Issuer

We provide general and specific form instructions 

as separate products. The products you should 

use to complete Form 5498 are the 2012 General 

Instructions for Certain Information Returns and 

the 2012 Instructions for Forms 1099-R and 5498. 

To order these instructions and additional forms, 

visit IRS.gov or call 1-800-TAX-FORM 

(1-800-829-3676).

For the latest developments regarding Form 

5498 that may occur after these instructions are 

printed, visit www.irs.gov/form5498.

Caution: Because paper forms are scanned during 

processing, you cannot file with the IRS Forms 

1096, 1097, 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, 2013, but furnish fair market 

value information and RMD if applicable by 

January 31, 2013.

File Copy A of this form with the IRS by May 31, 

2013. If you file electronically, you must have 

software that generates a file according to the 

specifications in Pub. 1220, Specifications for 

Filing Forms 1097, 1098, 1099, 3921, 3922, 5498, 

8935, 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.