PDF document
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                                       Attention: 

Copy A of this form is provided for informational purposes only. Copy A appears in red, 
similar to the official IRS form. The official printed version of Copy A of this IRS form is 
scannable, but the online version of it, printed from this website, is not. Do not print and file 
copy A downloaded from this website; a penalty may be imposed for filing with the IRS 
information return forms that can’t be scanned. See part O in the current General 
Instructions for Certain Information Returns, available at IRS.gov/Form1099, for more 
information about penalties.

Please note that Copy B and other copies of this form, which appear in black, may be 
downloaded and printed and used to satisfy the requirement to provide the information to 
the recipient.

If you have 10 or more information returns to file, you may be required to file e-file. Go to 
IRS.gov/InfoReturn for e-file options. 

If you have fewer than 10 information returns to file, we strongly encourage you to e-file. If 
you want to file them on paper, you can place an order for the official IRS information 
returns, which include a scannable Copy A for filing with the IRS and all other applicable 
copies of the form, at IRS.gov/EmployerForms. We’ll mail you the forms you request and 
their instructions, as well as any publications you may order. 

See Publications 1141,1167  , and 1179 for more information about printing these forms.



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          2828                      VOID              CORRECTED
TRUSTEE’S or ISSUER’S name, street address, city or town, state or      1   IRA contributions (other  OMB No. 1545-0747
province, country, and ZIP or foreign postal code                            than amounts in boxes 
                                                                             2–4, 8–10, 13a, and 14a)                                  IRA 
                                                                                                      2024                             Contribution 
                                                                        $
                                                                        2   Rollover contributions                                     Information
                                                                        $                                  Form 5498
                                                                        3   Roth IRA conversion       4   Recharacterized 
                                                                             amount                        contributions               Copy A
TRUSTEE’S or ISSUER’S TIN           PARTICIPANT’S TIN                   $                             $                                For 
                                                                        5   FMV of account            6   Life insurance cost included Internal Revenue 
                                                                                                           in box 1                    Service Center
                                                                        $                             $                                File with Form 1096.
PARTICIPANT’S name                                                      7    IRA     SEP              SIMPLE        Roth IRA
                                                                        8   SEP contributions         9   SIMPLE contributions
                                                                        $                             $                                For Privacy Act 
Street address (including apt. no.)                                     10   Roth IRA contributions   11   Check if RMD for 2025       and Paperwork 
                                                                                                                                       Reduction Act 
                                                                        $
                                                                        12a RMD date                  12b RMD amount                   Notice, see the 
                                                                                                                                       2024 General 
City or town, state or province, country, and ZIP or foreign postal code
                                                                                                      $                                Instructions for 
                                                                        13a Postponed/late contrib.   13b Year  13c Code               Certain 
                                                                        $                                                              Information 
                                                                        14a Repayments                14b Code                         Returns.

                                                                        $
Account number (see instructions)                                       15a FMV of certain specified  15b Code(s)
                                                                             assets
                                                                        $
Form 5498                           Cat. No. 50010C                     www.irs.gov/Form5498          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



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                                                            CORRECTED (if checked)
TRUSTEE’S or ISSUER’S name, street address, city or town, state or       1   IRA contributions (other  OMB No. 1545-0747
province, country, and ZIP or foreign postal code                             than amounts in boxes 
                                                                              2–4, 8–10, 13a, and 14a)                                   IRA 
                                                                                                       2024                              Contribution 
                                                                         $
                                                                         2   Rollover contributions                                      Information
                                                                         $                                  Form 5498
                                                                         3   Roth IRA conversion       4   Recharacterized 
                                                                              amount                        contributions                Copy B
TRUSTEE’S or ISSUER’S TIN           PARTICIPANT’S TIN                    $                             $
                                                                         5   FMV of account            6   Life insurance cost included  For 
                                                                                                            in box 1                     Participant
                                                                         $                             $
PARTICIPANT’S name                                                       7  IRA       SEP              SIMPLE        Roth IRA            This information 
                                                                         8   SEP contributions         9   SIMPLE contributions          is being 
                                                                         $                             $                                 furnished to 
Street address (including apt. no.)                                      10   Roth IRA contributions   11   If checked, required minimum the IRS.
                                                                                                        distribution for 2025
                                                                         $
                                                                         12a RMD date                  12b RMD amount
City or town, state or province, country, and ZIP or foreign postal code                               $
                                                                         13a Postponed/late contrib.   13b Year  13c Code
                                                                         $
                                                                         14a Repayments                14b Code

                                                                         $
Account number (see instructions)                                        15a FMV of certain specified  15b Code(s)
                                                                              assets
                                                                         $
Form 5498                           (keep for your records)              www.irs.gov/Form5498          Department of the Treasury - Internal Revenue Service



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Instructions for Participant                                                              Box 13a. Shows the amount of a late rollover contribution (more than 60 days after 
The information on Form 5498 is submitted to the IRS by the trustee or issuer of your     distribution) made in 2024 and certified by the participant, or a postponed contribution 
individual retirement arrangement (IRA) to report contributions, including any catch-up   made in 2024 for a prior year. This amount is not reported in box 1 or 2.
contributions, rollovers, repayments, required minimum distributions (RMDs), and the      Box 13b. Shows the year to which the postponed contribution in box 13a was 
fair market value (FMV) of the account. For information about IRAs, including reporting   credited. If a late rollover contribution is shown in box 13a, this box will be blank.
rollovers, repayments, and potential deductibility of contributions, see the instructions Box 13c. Shows the applicable code for a postponed contribution amount shown in 
for Forms 1040, 1040-SR, and 8606; and Pubs. 560, 590-A, and 590-B.                       box 13a: FD (due to an extension of the contribution due date because of a federally 
Participant’s taxpayer identification number (TIN). For your protection, this form        designated disaster), PO (a rollover of a qualified plan loan offset), and SC (the self-
may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). However, the    certification procedure for a late rollover contribution).
trustee or issuer has reported your complete TIN to the IRS.                              For participants who served in designated combat zones, qualified hazardous duty 
Account number. May show an account or other unique number the trustee   or issuer        areas, or direct support areas, the codes are EO13239 for Afghanistan and associated 
assigned to distinguish your account.                                                     direct support areas, EO12744 for the Arabian Peninsula areas, PL115-97 for the Sinai 
Box 1. Shows traditional IRA contributions for 2024 you made in 2024 and through          Peninsula of Egypt, and EO13119 (or PL106-21) for the Yugoslavia operations areas. 
April 15, 2025. This box does not include amounts in boxes 2–4, 8–10, 13a, and 14a.       For additional information, including a list of locations within the designated combat 
                                                                                          zones, qualified hazardous duty areas, and direct support areas, see Pub. 3. For 
Box 2. Shows rollover contributions, including direct rollover contributions, you made    updates to the list of locations, go to www.irs.gov/Newsroom/Combat-Zones. 
in 2024 to an IRA (other than conversions done through a rollover contribution from a     Box 14a. Shows the amount of any repayment of a distribution related to a qualified 
traditional IRA or traditional SIMPLE IRA to a Roth IRA or Roth SIMPLE IRA, which are     reservist, qualified disaster, qualified birth or adoption, emergency personal expense, 
reported on Box 3). Include a military death gratuity or SGLI payment to a Roth IRA.      domestic abuse victim, or terminally ill individual.
Any late rollover contributions are shown in box 13a. 
Box 3. Shows the amount converted from traditional IRAs or traditional SIMPLE IRAs        Box 14b. Shows the applicable repayment code for the amount shown in box 14a: QR 
to Roth IRAs or Roth SIMPLE IRAs in 2024.                                                 (qualified reservist), DD (qualified disaster), BA (qualified birth or adoption), EP 
                                                                                          (emergency personal expense), DA (domestic abuse victim), or TI (terminally ill 
Box 4. Shows amounts recharacterized from transferring any part of the contribution       individual).
(plus earnings) from one type of IRA to another.                                          Box 15a. Shows the FMV of the investments in the IRA that are specified in the 
Box 5. Shows the FMV of all investments in your account at year end. However, if a        categories identified in box 15b.
decedent’s name is shown, the amount reported may be the FMV on the date of               Box 15b. The following codes show the type(s) of investments held in your account for 
death. If the FMV shown is zero for a decedent, the executor or administrator of the      which the FMV is required to be reported in box 15a.
estate may request a date-of-death value from the financial institution.
Box 6. Shows for endowment contracts only the amount allocable to the cost of life        A—Stock or other ownership interest in a corporation that is not readily tradable on an 
insurance. Subtract this amount from your allowable IRA contribution included in box 1    established securities market.
to compute your IRA deduction.                                                            B—Short- or long-term debt obligation that is not traded on an established securities 
Box 7. May show the kind of IRA reported on this Form 5498.                               market. 
Boxes 8 and 9. Show SEP (box 8) and SIMPLE (box 9) contributions made in 2024,            C—Ownership interest in a limited liability company or similar entity (unless the 
including contributions made in 2024 for 2023, but not including contributions made in    interest is traded on an established securities market). 
2025 for 2024.                                                                            D—Real estate.
Box 10. Shows Roth IRA contributions (and rollovers from a QTP) you made in 2024          E—Ownership interest in a partnership, trust, or similar entity (unless the interest is 
and through April 15, 2025. Do not deduct on your income tax return.                      traded on an established securities market). 
Box 11. If the box is checked, you must take an RMD for 2025. An RMD may be               F—Option contract or similar product that is not offered for trade on an established 
required even if the box is not checked. If you do not take the RMD for 2025, you are     option exchange.
subject to an excise tax on the amount not distributed.                                   G—Other asset that does not have a readily available FMV.
Box 12a.Shows the date by which the RMD amount in box 12b must be distributed to          H—More than two types of assets (listed in A through G) are held in this IRA.
avoid the excise tax on the undistributed amount for 2025.
Box 12b.Shows the amount of the RMD for 2025. If box 11 is checked and there is no 
amount in this box, the trustee or issuer must provide you the amount or offer to 
calculate the amount in a separate statement by January 31, 2025.






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