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  • Hsa Employer Contribution Form - Avidia Bank

Get Hsa Employer Contribution Form - Avidia Bank

CONTRIBUTION FORM InstrucBons: Complete form either type or print clearly. Social Security or Account Number, Contribu:on Year must be provided. Send materials and check (payable to Avidia Bank) for.

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While employer contributions to an HSA may be excluded from the employee's income, all employer contributions, including those made by the employee through a cafeteria plan, must be reported in box 12 of the employee's W-2.

For example, while contributions to Health Savings Arrangements (HSA) are not to be reported in Box 12, Code DD, certain HSA contributions are reported in Box 12, Code W (see General Instructions for Forms W-2 and W-3PDF).

If additional assistance is needed, please contact us at 855.248.6311 or hsainfo@avidiabank.com, and we will send the forms directly to you.

You are responsible for monitoring the amount deposited into your HSA each calendar year. Keep in mind that if your employer contributes funds, those also count toward the maximum. If you exceed the maximum contribution limit, there is a penalty imposed by the IRS.

The 5498-SA form reports all contributions to your HSA for the prior year, including those contributed between Jan. 1 and the tax filing deadline of the current year. It also reports your HSA balance as of Dec. 31 of the prior year. You'll get an email once this form is available.

An HSA—or a health savings account—is an account made up of both employee- and employer-contributed funds that can be used to pay for approved healthcare expenses, such as vision and dental care, prescriptions, and your annual deductible.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232