Utah Utah Medical Savings Account Reconciliation
Extracted from PDF file 2021-utah-form-tc-97m.pdf, last modified October 1999
Utah Medical Savings Account ReconciliationMedical Saving Account (MSA) Account Administrator Instructions Account administrators must remit to the Tax Commission all penalty funds withheld from MSA non-medical withdrawals subject to penalty along with a Utah Medical Savings Account Reconciliation, form TC-97M, on or before January 31 following the close of the taxable calendar year. In addition, account administrators must send to the Tax Commission a completed Statement of Withholding for Utah Medical Savings Account, form TC-675M (COPY A), for each account holder on or before January 31 following the close of the taxable calendar year. The account administrator must also provide a copy of form TC-675M (COPIES B and C) to the account holder on or before January 31, following the close of the taxable calendar year. The account administrators must retain (COPY D) with their records. Records must be maintained by the account administrator supporting the amounts listed on the TC-675M for the current year filing and three previous year filings. TC-675M instructions: 1-3. Enter identifying information in boxes 1, 2, and 3. 4. Enter BEGINNING BALANCE in the account at the beginning of the calendar year. 5. Enter amount contributed to the plan during the current calendar year. 6. Enter interest earnings. 7. Enter qualified medical distributions. 8. Enter non-medical distributions not subject to penalties. This includes withdrawals that occur when the balance of the account is greater than $4,000 dollars and the withdrawal does not result in the account balance dropping below $4,000. 9. Enter non-medical distributions subject to penalties. This includes withdrawals from the account for a purpose other than medical expenses at any time the balance is below $4,000. To determine the penalty, multiply the amount listed on this line by .10 (10%). This penalty amount must be withheld from the withdrawal and remitted to the Tax Commission. Report the penalty on line 12 below. 10. Enter account administrator's fee charged to the account. 11. Enter ENDING BALANCE in the account at the end of the calendar year. (ADD lines 4 through 6 and SUBTRACT lines 7 through 10). 12. Enter the 10% PENALTY amount withheld from the non-medical distributions on line 9. This amount must be reported and remitted to the Tax Commission on form TC-97M. Attach a copy of each individual account holder's TC-675M to the TC-97M and remit payments for penalties to the Tax Commission by January 31 following the close of the taxable calendar year. Detach coupon below and return to the Utah State Tax Commission. Utah Medical Savings Account Reconciliation (MSA), TC-97M Use this form to reconcile and report Statement of Withholding For Utah Medical Savings Account, TC-675M, and pay year-end penalties for non-medical withdrawals of MSA funds. A reconciliation must be filed, even if there are no penalties. Account administrator's name Federal ID number Account administrator's address Signature Date Total number of TC-675M's Total MSA penalty amount reported $ Total MSA penalty amount remitted $ Make check or money order payable to the Utah State Tax Commission. Do not send cash. Do not staple check to this coupon. Rev. 12/96 UTAH STATE TAX COMMISSION 210 N 1950 W SALT LAKE CITY UT 84134
More about the Utah Form TC-97M Other
Utah Medical Savings Account Reconciliation
We last updated the Utah Medical Savings Account Reconciliation in March 2022, and the latest form we have available is for tax year 2021. This means that we don't yet have the updated form for the current tax year. Please check this page regularly, as we will post the updated form as soon as it is released by the Utah State Tax Commission. You can print other Utah tax forms here.
Other Utah Other Forms:
|Form Code||Form Name|
|Form TC-420PC||Self-Insurer's Tax Payment Coupon|
|Form TC-42||Application for a Letter of Good Standing|
|Form TC-420C||Self Insurer's Classification Codes and Tax Rates|
|Form TC-49PC||Insurance Premium Tax Payment Coupon (replaces TC-670)|
|Form TC-97M||Utah Medical Savings Account Reconciliation|
Utah usually releases forms for the current tax year between January and April. We last updated Utah Form TC-97M from the State Tax Commission in March 2022.
Historical Past-Year Versions of Utah Form TC-97M
We have a total of eleven past-year versions of Form TC-97M in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
While we do our best to keep our list of Utah Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.