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Interview Notes • Rose Jones, age 57, is single. • Rose earned wages of $52,000 and was enrolled the entire year in a high deductible health plan (HDHP) with self-only coverage. • During the year, Rose contributed $2,000 to her Health Savings Account (HSA) and her mother also contributed $1,000 to Rose’s HSA. • Rose’s Form W-2 shows $850 in Box 12 with code W. She has Form 5498-SA showing $3,850 in Box 2. • Rose took a distribution from her HSA to pay her unreimbursed expenses: o 8 visits to a physical therapist after her knee surgery $400 o unreimbursed doctor bills for $1,100 o prescription medicine $280 o replacement of a crown $1,500 o deep cleaning for teeth: $300 o over the counter medication $40 o gym membership $240 • Rose is a U.S. citizen with a valid Social Security number. 6. Rose cannot include her mother’s contribution on Form 8889, Part 1. a. True b. False unanswered
SCIENCE
HEALTH SCIENCE
NURSING

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