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Form 5305B: Health Savings Trust Account
IRS Form 5305-B is a model trust account agreement used to establish a Health Savings Trust Account under section 223(a) of the Internal Revenue Code for paying qualified medical expenses. The additional tax on unused distributions increased from 10% to 20% for years after December 31, 2010.
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IRS Form 5305B - Health Savings Trust Account
IRS Form 5305-B is a model trust account agreement used to establish a Health Savings Trust Account under section 223(a) of the Internal Revenue Code for paying qualified medical expenses. The additional tax on unused distributions increased from 10% to 20% for years after December 31, 2010.
Risk Radar
Scan points- 1Do not file Form 5305-B with the IRS; keep this agreement solely in your records.
- 2Filing Form 5305-B with the IRS instead of keeping it in records.
- 3Not establishing a separate HSA account for each spouse who contributes.
- 4Missing the required signatures from both the account owner and trustee.
- 5Using an HDHP that does not meet minimum deductible requirements for the year.
Plain English
This form creates a formal agreement that establishes a Health Savings Account (HSA) through a trust structure. The account is designed specifically to hold funds used for paying or reimbursing qualified medical expenses for the owner, their spouse, and dependents. It ensures these specialized health savings funds are managed according to IRS rules.
Submission Date
- Filing date: 2017-02-08 00:00:00
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when establishing a Health Savings Trust Account (HSA) model trust account agreement approved by the IRS for paying qualified medical expenses.
- Do not use it when filing with the Internal Revenue Service; instead, keep the fully executed form with personal records.
- Check no other specific form number is referenced in the official source.
Form selector
Use this form or another form?
Setting up a basic HSA trust agreement
This form serves as the foundational model trust account agreement for establishing an HSA.
✓ Confirm the revision date reads Rev. 10-2016
Filing related to unrelated business taxable income (common fund)
An Employer Identification Number (EIN) is required on Form 5305-B if a return is filed for unrelated business taxable income or a common fund.
✓ Ensure the EIN is correctly recorded when applicable.
Establishing an HSA for married couples
For married persons, each spouse who is eligible to open and contribute must establish their own individual account.
✓ Do not assume one joint agreement covers both spouses.
Deadline or filing window
Contributions can occur at any time, provided they are submitted before the deadline for filing the account owner's federal income tax return for that year. The source does not specify an extension period.
Checklist
What you need before filling it out
Identification Number
The account owner’s social security number (SSN) · Form p.2
Qualified medical expenses
Amounts paid for medical care as defined in section 213(d) to the extent not compensated by insurance · Form p.2
Trustee requirements
Must be a bank, an insurance company, or another person approved by the IRS · Form p.2
Contribution limits
Contributions cannot exceed the maximum amount for family coverage plus the catch-up contribution · [Form p.1]
Tax penalty rates
The additional tax on distributions not used for qualified medical expenses increased from 10% to 20% for years beginning after December 31, 2010 · What's New
Before you submit
- 1Confirm that both the account owner and the trustee have signed the agreement and dated their respective signatures.
- 2Verify that the account owner meets all eligibility requirements, including being covered under a high deductible health plan (HDHP), not being enrolled in Medicare, and not being claimed as a dependent on another person’s tax return.
- 3Ensure that any additional cash contributions do not exceed the maximum amount for family coverage plus the catch-up contribution.
- 4Confirm that the account owner maintains records sufficient to substantiate that all distributions are for qualified medical expenses.
- 5Verify that the form is completed in the United States and remains with the filer’s records, as it must not be filed with the Internal Revenue Service.
- 6Check that the trustee is an approved entity or person, such as a bank, an insurance company, or someone previously approved by the IRS to be a trustee of an IRA or Archer MSA.
- 7Confirm the agreement includes Article IX and Articles X and XI, which control the provisions and allow for future amendments.
How to file this form
- 1Complete all required fields of the model trust account agreement, including the identification number and parties’ details.
- 2Have both the account owner and the trustee sign and date the document to finalize the HSA establishment.
- 3If applicable, have a witness execute the form by signing and dating the appropriate section.
- 4Keep the fully executed Form 5305-B with personal records for future reference.
Known limitations
- 1The account must be created in the United States for the exclusive benefit of the account owner [Form p.2].
- 2To establish an HSA, the account owner must be covered under a high deductible health plan (HDHP) [Form p.1].
- 3The account owner cannot also be covered by any other health plan that is not an HDHP, with certain exceptions for plans providing preventive care and limited types of permitted insurance and permitted coverage [Form p.1].
- 4The account owner must not be enrolled in Medicare [Form p.1].
- 5The account owner cannot be claimed as a dependent on another person’s tax return [Form p.1].
- 6If the beneficiary is not the account owner’s spouse, the HSA will cease to be an HSA as of the date of death [Form p.2].
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
Almost done reviewing the fields?
Fillable formOpen in Editor->The current edition is Revision 10-2016. The provided source does not indicate a page for the latest information, nor does it detail any recent revisions beyond stating that Article X allows amendments to comply with Code or IRS published guidance.
What changed or needs a fresh check
- Edition date — confirm the form revision reads Rev. 10-2016.
- Fee — Not stated in the official source.
- Mailing address — Not stated in the official source.
- Signature — Confirm the agreement is fully executed by both the account owner and the trustee.
Quick Facts
Downloads
After you file
- 1Do not file Form 5305-B with the Internal Revenue Service; instead, keep it with your records [Form p.2].
- 2The account owner must maintain records sufficient to show that any distribution is for qualified medical expenses and is tax-free, if required [Form p.1].
- 3An HSA only becomes established after the form is fully executed by both the account owner and the trustee [Form p.2].
- 4If filing an HSA return to report unrelated business taxable income, an employer identification number (EIN) is required [Form p.2].
Sources
- SRCForm 5305-B is a model trust account agreement used to establish an HSA under section 223(a) of the Internal Revenue Code (Rev. October 2016) [Form p.1].
- SRCThe additional tax on distributions not used for qualified medical expenses increased from 10% to 20% for years beginning after December 31, 2010 [Form p.2].
- SRCDo not file Form 5305-B with the Internal Revenue Service; keep it with your records instead [Form p.2].
- SRCThe account owner must maintain records to show that any distribution is for qualified medical expenses and is tax-free, if required [Form p.1].
- SRCFor married persons, each spouse who is eligible to open an HSA must establish his or her own separate account [Form p.2].
- SRCIf the beneficiary is not a spouse, the HSA will cease to be an HSA as of the date of death [Form p.2].
Common confusion points
Who must sign Form 5305-B?
The source lists signature lines for the Account owner, Trustee, and Witness [Form p.2].
Does the IRS determine if my distribution was qualified medical expenses?
No; only the account owner is responsible for substantiating that the distribution meets qualification requirements [Form p.1].
Can I contribute money if my current contributions are high?
Contributions cannot exceed the maximum amount set for family coverage plus the catch-up contribution [Form p.1].
What happens to the HSA funds after the account owner dies?
The handling of the account depends on the beneficiary: if it is a spouse, it becomes their HSA; otherwise, rules vary based on whether they are the estate or other beneficiaries [Form p.2].
If I am married and want an HSA, do we share one account?
No; each eligible spouse must establish his or her own separate account [Form p.2].
What is required if I file a return showing unrelated business taxable income?
An employer identification number (EIN) is required for the HSA in this situation [Form p.2].
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- The agreement must comply with IRS published guidance and section 223.
Questions about IRS Form 5305B
What is IRS Form 5305B used for?
This form creates a formal agreement that establishes a Health Savings Account (HSA) through a trust structure. The account is designed specifically to hold funds used for paying or reimbursing qualified medical expenses for the owner, their spouse, and dependents. It ensures these specialized health savings funds are managed according to IRS rules.
Who must file IRS Form 5305B?
The account owner (grantor) establishes this HSA, and a trustee must execute the form to establish the trust account.
What information does IRS Form 5305B require?
The form collects identifying information for both the account owner (grantor) and the appointed trustee. Required details include their names, dates of birth, and addresses or principal places of business.
When is IRS Form 5305B due?
Contributions may be made at any time before the deadline for filing the account owner’s federal income tax return for that year (without extensions).
Where do I file IRS Form 5305B?
The form should not be filed with the Internal Revenue Service; instead, the fully executed agreement must be kept with the account owner's records.
How do I complete IRS Form 5305B?
The form must be fully executed by both the account owner and the trustee. The agreement requires signatures from the account owner and the trustee; a witness signature may also be needed if required by law for either party.
What happens if IRS Form 5305B is filed incorrectly?
Contributions in excess of the maximum annual contribution limit are subject to an excise tax. Additionally, the additional tax on distributions not used for qualified medical expenses increased from 10% to 20% for years beginning after December 31, 2010.
Who must sign Form 5305-B?
The source lists signature lines for the Account owner, Trustee, and Witness [Form p.2].
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