Interview Notes

• Carol Wheeler, age 56, is single.
• Carol earned wages of $48,000 and was enrolled the entire year in a high deductible health plan (HDHP) with self-only coverage.
• During the year, Carol contributed $3,000 to her Health Savings Account (HSA) and her cousin also contributed $1,000 to Carols HSA account.
• Carols Form W-2 shows $600 in Box 12 with code W. She has Form 5498-SA showing $4,600 in Box 2.
• Carol took a distribution from her HSA to pay her unreimbursed expenses:
  • 2 visits to a physical therapist due to a car accident $300
  • unreimbursed doctor bills for $700
  • prescription medicine $400
  • replacement of a crown $1,500
  • over the counter sinus medication $80
  • 10 Zumba classes for $125
• Carol is a U.S. citizen with a valid Social Security number.

6. Carol can claim $__________ as her HSA contribution on Form 8889, Part 1