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






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