Form 5498-ESA Form 5498-ESA Coverdell ESA Contribution Information

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the
official IRS form. Do not file copy A downloaded from this website. The official printed
version of this IRS form is scannable, but the online version of it, printed from this website,
is not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the
current General Instructions for Certain Information Returns for more information about
penalties.
To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order Information
Returns and Employer Returns Online, and we’ll mail you the scannable forms and other
products.
See IRS Publications 1141, 1167, 1179 and other IRS resources for information about
printing these tax forms.

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TRUSTEE’S or ISSUER'S name, street address, city or town, state or
province, country, and ZIP or foreign postal code

1 Coverdell ESA contributions OMB No. 1545-1815

$
2 Rollover contributions

$

2015

Coverdell ESA
Contribution
Information

Form 5498-ESA

Copy A

TRUSTEE’S/ISSUER’S federal identification no. BENEFICIARY'S social security number

For
Internal Revenue
Service Center

BENEFICIARY'S name

File with Form 1096.
Street address (including apt. no.)

For Privacy Act and
Paperwork Reduction
Act Notice, see the
2015 General
Instructions for
Certain Information
Returns.

City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-ESA

Cat. No. 34011J

www.irs.gov/form5498esa

Department of the Treasury - Internal Revenue Service

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

CORRECTED
TRUSTEE’S or ISSUER'S name, street address, city or town, state or
province, country, and ZIP or foreign postal code

1 Coverdell ESA contributions OMB No. 1545-1815

$
2 Rollover contributions

$

2015

Coverdell ESA
Contribution
Information

Form 5498-ESA

Copy B

TRUSTEE’S/ISSUER’S federal identification no. BENEFICIARY'S social security number

For Beneficiary

BENEFICIARY'S name

This information
is being furnished
to the Internal
Revenue Service.

Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-ESA

(keep for your records)

www.irs.gov/form5498esa

Department of the Treasury - Internal Revenue Service

Instructions for Beneficiary

The information on Form 5498-ESA is furnished to you by
the trustee or issuer of your Coverdell education savings
account (ESA) by May 2, 2016. Form 5498-ESA reports
contributions and rollover contributions made for you for
2015. For more information about Coverdell ESAs, see
Pub. 970, Tax Benefits for Education.
Beneficiary's identification number. For your protection,
this form may show only the last four digits of your social
security number (SSN), individual taxpayer identification
number (ITIN), adoption taxpayer identification number
(ATIN), or employer identification number (EIN). However,
the issuer has reported your complete identification
number to the IRS.
Account number. May show an account or other unique
number the trustee/issuer assigned to distinguish your
account.
Box 1. Shows Coverdell ESA contributions made in 2015
and through April 18, 2016, for 2015, on your behalf. Do
not deduct these amounts on your income tax return.

If the total contributions made to all your Coverdell ESAs
for 2015 exceeded $2,000, you must withdraw the excess,
plus earnings, by May 31, 2016, or you may owe a penalty.
You must keep track of your Coverdell ESA basis
(contributions and distributions).
Box 2. Shows any rollover (including a direct rollover and
contribution of a military death gratuity) you made in 2015.
Generally, any amount rolled over from one Coverdell ESA
to another Coverdell ESA for the benefit of the named
beneficiary or a member of the beneficiary’s family who is
under age 30 (except for a beneficiary with special needs)
is not taxable.
Future developments. For the latest information about
developments related to Form 5498-ESA and its
instructions, such as legislation enacted after they were
published, go to www.irs.gov/form5498esa.

VOID

CORRECTED

TRUSTEE’S or ISSUER'S name, street address, city or town, state or
province, country, and ZIP or foreign postal code

1 Coverdell ESA contributions OMB No. 1545-1815

$
2 Rollover contributions

$

Form 5498-ESA

Copy C

TRUSTEE’S/ISSUER’S federal identification no. BENEFICIARY'S social security number

For Trustee

BENEFICIARY'S name

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2015 General
Instructions for
Certain
Information
Returns.

Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form 5498-ESA

2015

Coverdell ESA
Contribution
Information

www.irs.gov/form5498esa

Department of the Treasury - Internal Revenue Service

Instructions for Trustee or Issuer
To complete Form 5498-ESA, use:
• the 2015 General Instructions for Certain Information
Returns, and
• the 2015 Instructions for Form 5498-ESA.
To order these instructions and additional forms, go
to www.irs.gov/form5498esa or call 1-800-TAX-FORM
(1-800-829-3676).
Caution. Because paper forms are scanned during
processing, you cannot file Forms 1096, 1097, 1098,
1099, 3921, 3922, or 5498 that you download and print
from the IRS website.
Due dates. Furnish Copy B of this form to the
beneficiary (participant) by May 2, 2016.

File Copy A of this form with the IRS by May 31, 2016.
To file electronically, you must have software that
generates a file according to the specifications in Pub.
1220, Specifications for Electronic Filing of Forms 1097,
1098, 1099, 3921, 3922, 5498, and W-2G. The IRS does
not provide a fill-in form option.
Need help? If you have questions about reporting on
Form 5498-ESA, call the information reporting customer
service site toll free at 1-866-455-7438 or 304-263-8700
(not toll free). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).