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Hi Billy and Sherrie,
We just want to thank you for using TurboTax this year! It's our goal to make
your taxes easy and accurate, year after year.
We reviewed over 350 deductions and credits so you can be sure you
didn't miss a thing and that you got the maximum refund - guaranteed.
Your Deductions and Credits:
Also included:
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Rockwall TX 75087
2
145,609.
236.
21.
21.
145,866.
154.
154.
145,712.
BAA REV 02/07/13 TTW
145,712.
23,031.
122,681.
7,600.
115,081.
20,828.
20,828.
20,828.
20,828.
26,438.
26,438.
5,610.
5,610.
3 1 1 9 7 2 7 0 4
0 1 1 0 3 4 9 8 8 0 0 5
Regional VP (972)961-0314
Homemaker
SELF PREPARED
For Paperwork Reduction Act Notice, see Form 1040 instructions. BAA REV 01/10/13 TTW Schedule A (Form 1040) 2012
Form 8889 Health Savings Accounts (HSAs)
OMB No. 1545-0074
2012
▶ Information about Form 8889 and its separate instructions is available at www.irs.gov/form8889.
Department of the Treasury Attachment
▶ Attach to Form 1040 or Form 1040NR.
Internal Revenue Service Sequence No. 53
Name(s) shown on Form 1040 or Form 1040NR Social security number of HSA
beneficiary. If both spouses have
Billy Kulwicki HSAs, see instructions ▶ 465-11-8925
Before you begin: Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required.
Part I HSA Contributions and Deduction. See the instructions before completing this part. If you are filing jointly
and both you and your spouse each have separate HSAs, complete a separate Part I for each spouse.
1 Check the box to indicate your coverage under a high-deductible health plan (HDHP) during
2012 (see instructions). . . . . . . . . . . . . . . . . . . . . . . . ▶ Self-only Family
2 HSA contributions you made for 2012 (or those made on your behalf), including those made
from January 1, 2013, through April 15, 2013, that were for 2012. Do not include employer
contributions, contributions through a cafeteria plan, or rollovers (see instructions) . . . . . 2 0.
3 If you were under age 55 at the end of 2012, and on the first day of every month during 2012,
you were, or were considered, an eligible individual with the same coverage, enter $3,100
($6,250 for family coverage). All others, see the instructions for the amount to enter . . . . 3 6,250.
4 Enter the amount you and your employer contributed to your Archer MSAs for 2012 from Form
8853, lines 1 and 2. If you or your spouse had family coverage under an HDHP at any time
during 2012, also include any amount contributed to your spouse’s Archer MSAs . . . . . 4 0.
5 Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . 5 6,250.
6 Enter the amount from line 5. But if you and your spouse each have separate HSAs and had
family coverage under an HDHP at any time during 2012, see the instructions for the amount to
enter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6,250.
7 If you were age 55 or older at the end of 2012, married, and you or your spouse had family
coverage under an HDHP at any time during 2012, enter your additional contribution amount
(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1,000.
8 Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . 8 7,250.
9 Employer contributions made to your HSAs for 2012 . . . . 9 7,250.
10 Qualified HSA funding distributions . . . . . . . . . . 10
11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . 11 7,250.
12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . 12 0.
13 HSA deduction. Enter the smaller of line 2 or line 12 here and on Form 1040, line 25, or Form
1040NR, line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 0.
Caution: If line 2 is more than line 13, you may have to pay an additional tax (see instructions).
Part II HSA Distributions. If you are filing jointly and both you and your spouse each have separate HSAs, complete
a separate Part II for each spouse.
14a Total distributions you received in 2012 from all HSAs (see instructions) . . . . . . . . 14a 5,998.
b Distributions included on line 14a that you rolled over to another HSA. Also include any excess
contributions (and the earnings on those excess contributions) included on line 14a that were
withdrawn by the due date of your return (see instructions) . . . . . . . . . . . . 14b
c Subtract line 14b from line 14a . . . . . . . . . . . . . . . . . . . . . . 14c 5,998.
15 Unreimbursed qualified medical expenses (see instructions) . . . . . . . . . . . . 15 5,998.
16 Taxable HSA distributions. Subtract line 15 from line 14c. If zero or less, enter -0-. Also,
include this amount in the total on Form 1040, line 21, or Form 1040NR, line 21. On the dotted
line next to line 21, enter “HSA” and the amount . . . . . . . . . . . . . . . . 16 0.
17a If any of the distributions included on line 16 meet any of the Exceptions to the Additional
20% Tax (see instructions), check here . . . . . . . . . . . . . . . . . ▶
b Additional 20% tax (see instructions). Enter 20% (.20) of the distributions included on line 16
that are subject to the additional 20% tax. Also include this amount in the total on Form 1040,
line 60, or Form 1040NR, line 59. On the dotted line next to Form 1040, line 60, or Form
1040NR, line 59, enter “HSA” and the amount . . . . . . . . . . . . . . . . . 17b
For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 11/13/12 TTW Form 8889 (2012)
Form 8889 (2012) Page 2
Part III Income and Additional Tax for Failure To Maintain HDHP Coverage. See the instructions before
completing this part. If you are filing jointly and both you and your spouse each have separate HSAs,
complete a separate Part III for each spouse.
18 Last-month rule . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Estimated Tax Payments for 2012 (If more than 4 payments for any state or locality, see Tax Help)
Tot Estimated
Payments
Totals:
Part III Contribution Carryovers to 2013
Total Cash and Other Capital Gain
Non-Capital Gain Property Property
(a) (b) (c) (d) (e) (f)
Total RESERVED 50% 30% 30% 20%
Limit Limit Limit Limit
1 2012 contributions 14,001. 14,001.
2 2012 contributions
allowed 14,001. 14,001. 0. 0. 0.
3 Carryovers from:
a 2011 tax year
b 2010 tax year
c 2009 tax year
d 2008 tax year
e 2007 tax year
4 Carryovers
allowed in 2012 0. 0. 0. 0. 0.
5 Carryovers
disallowed in 2012 0. 0. 0. 0. 0.
6 Carryovers to 2013:
a From 2012 0. 0. 0. 0. 0.
b From 2011
c From 2010
d From 2009
e From 2008
f From 2007 (expired)
1 Enter the total interest you paid in 2012 on qualified student loans 1 507.
(see Form 1040 instructions).
2 Enter the smaller of line 1 or $2,500 2 507.
3 Modified AGI 3 145,866.
Note: If line 3 is $75,000 or more if single, head of household, or qualifying
widow(er) or $155,000 or more if married filing jointly, stop here. You cannot
take the deduction.
4 Enter: $60,000 if single, head of household, or qualifying widow(er);
$125,000 if married filing jointly 4 125,000.
5 Subtract line 4 from line 3. If zero or less, enter -0- here and on line 7, skip
line 6, and go on to line 8 5 20,866.
6 Divide line 5 by $15,000 or $30,000 if married filing jointly.
Enter the result as a decimal (rounded to at least three places) 6 0.6955
7 Multiply line 2 by line 6 7 353.
8 Student loan interest deduction. Subtract line 7 from line 2. Enter the result
here and on Form 1040, line 33. Do not include this amount in figuring any
other deduction on your return (such as on Schedule A, C, E, etc.) 8 154.
* Modified AGI is the amount from Form 1040, line 22, increased by any excludable income from Puerto
Rico, or of bona fide residents of American Samoa, Guam, or the Commonwealth of the Northern
Mariana Islands, and foreign earned income/housing exclusion, and decreased by amounts on
Form 1040, lines 23 through 32 and any write-in amount next to line 36, not including the
Foreign housing deduction on line A of the Other Adjustments to Income Smart Worksheet.
Federal Carryover Worksheet 2012
G Keep for your records
2011 State and Local Income Tax Information (See Tax Help)
Totals
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before April 20, 2013. If your return is submitted after April 20, 2013, a new time stamp is issued to
reflect that your return was submitted after the IRS deadline and, consequently, is no longer considered
to have been filed on time.
If you request an automatic six-month extension, your return must be electronically postmarked by
midnight October 15, 2013 If your federal tax return is rejected, the IRS will still consider it filed on time
if the electronic postmark is on or before October 15, 2013, and the corrected return is submitted and
accepted by October 20, 2013.