IRS Form 1040, Schedule 2 & Form 8889 - Mock Example (Scenario 2, TY2023)
Form 1040 - Page 1 & 2 (Key Lines)
1 Wages $25000.00
8 Other income (non-qualified HSA distributions) $500.00
9 Adjusted Gross Income (AGI) $25500.00
12 Standard Deduction (MFS) $-13850.00
15 Taxable Income $11650.00
16 Tax from Tax Tables $1285.00
23 Other taxes (Sched 2 - HSA Penalty) $100.00
24 Total Tax $1385.00
33 Amount You Owe (no withholding) $1385.00
Schedule 2 - Additional Taxes (Part I)
1 Tax on IRAs, other qualified retirement plans
2 Excess advance premium tax credit repayment
8 Additional tax on non-qualified HSA distributions (20%) $100.00
21 Total Additional Taxes $100.00
Form 8889 - Health Savings Accounts (HSA)
14 Total HSA Distributions $2500.00
15 Qualified Medical Expenses $2000.00
16 Taxable HSA Distributions $500.00
17 Additional 20% penalty (non-qualified) $100.00
