Updated November 7, 2026. Quick answer: Box 4 of Form 5498-SA shows a rollover contribution into your HSA or Archer MSA during the calendar year: from an Archer MSA to the same kind of account, or from an HSA or Archer MSA to an HSA. The amount is not included in box 1, 2 or 3, and a direct trustee-to-trustee transfer is not a rollover and is not reported in box 4.
What the participant copy says
“Box 4. Shows any rollover contribution from an Archer MSA to this Archer MSA in the calendar year shown on this form or any rollover from an HSA or Archer MSA to this HSA.” It then sends you elsewhere: “See Form 8853 or Form 8889 and their instructions for information about how to report distributions.” And it is kept separate: “This amount isn’t included in box 1, 2, or 3.”
What the trustee reports
“Enter rollover contributions to the HSA or Archer MSA received by you during the calendar year. These amounts are not to be included in box 2.” The rollovers the instructions list are “the receipt of a rollover from one Archer MSA to another Archer MSA, and the receipt of a rollover from an Archer MSA or an HSA to an HSA in box 4”.
A transfer is not a rollover
Moving money trustee to trustee is treated differently: “Do not report a trustee-to-trustee transfer from one Archer MSA or MA MSA to another Archer MSA or MA MSA, from an Archer MSA to an HSA, or from one HSA to another HSA.” The instructions add that “contributions and rollovers do not include these transfers.” If your HSA moved providers by transfer, box 4 may be empty. One exception sits in box 2: “see Box 2, later, for the reporting of a trustee-to-trustee transfer from an IRA to an HSA.” See boxes 2 and 3.
Using box 4 on your return
The form keeps a rollover apart from the contribution boxes. The form that reports distributions and rollovers is Form 8889 for an HSA (Form 8889) and Form 8853 for an Archer MSA (Form 8853). Compare box 4 with the check or statement for the rollover, and keep the form with your records, since the participant copy says “Don’t attach Form 5498-SA to your income tax return. Instead, keep it for your records.”
Box 4 on the 2025 form
The 2025 form words it with the year: “Box 4. Shows any rollover contribution from an Archer MSA to this Archer MSA in 2025 or any rollover from an HSA or Archer MSA to this HSA.” The meaning is unchanged.
Edition
This page reads Form 5498-SA and the Instructions for Forms 1099-SA and 5498-SA as revised December 2026, with the 2025 form for comparison, all files irs.gov served on November 7, 2026 (sha256 in the kit data). Check the year printed on your own copy before you follow a box reference.
Common mistakes
- Adding box 4 to boxes 1, 2 and 3 when you total contributions. The copy says box 4 is not included in them.
- Expecting a trustee-to-trustee transfer to show in box 4. The instructions say not to report it as a rollover.
- Attaching the form to your return. Keep it with your records.
Related: Form 5498-SA instructions, Form 8889, and HSA after leaving your employer.
Find the right next step for your situation
About how much do you have invested? Pick the range that fits; your next step appears immediately below.
Compare vetted advisors for your finances
For U.S. investors with $250,000 or more in investable assets. WiserAdvisor is an independent service matching you with 2 to 3 vetted advisers. Its form asks for your ZIP code and answers to a few questions; a match is not guaranteed.
Free to request, with no obligation to hire. By submitting, you consent to calls, texts and emails from WiserAdvisor and up to three advisers. Advisers pay for introductions.
Clear Money Guide may earn a referral payment for a qualifying completed form. An introduction is not a Clear Money Guide recommendation.
Opens on WiserAdvisor’s site in a new tab.
Explore optional adviser matching today
Considering financial advice? Request an adviser introduction with no obligation to hire.
The form is run by Kapitalwise, our advisor-matching partner. Requesting an introduction is free. Submitting the form shares your contact details with advisers, so expect calls and texts. Advisers pay for introductions. Clear Money Guide may earn a referral payment for a qualifying submitted form, whether or not you hire anyone. A match is not guaranteed.
The Kapitalwise form opens here; you stay on this page.
What happens when you press the button
It asks about nine questions: age, investable assets, location; then your name, email and phone number, and verifies the phone by text. Nothing loads and nothing reaches Kapitalwise until you press the button.
Prefer flat-fee or hourly pricing instead? Compare ranges here.
Answer againSources
- Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA Information (Rev. December 2026): https://www.irs.gov/pub/irs-pdf/f5498sa.pdf
- Instructions for Forms 1099-SA and 5498-SA (Rev. December 2026): https://www.irs.gov/pub/irs-pdf/i1099sa.pdf
- Form 5498-SA (2025 revision): IRS archived PDF (irs.gov)
Read from the IRS documents linked above on November 7, 2026. General information, not tax advice. Your own facts decide the outcome, and a preparer, the account provider or the IRS is the right place to confirm anything consequential.