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Get IRS 1099-SA 2016

Ions From an HSA, Archer MSA, or Medicare Advantage MSA RECIPIENT'S identification number RECIPIENT'S name 1 Gross distribution 2 Earnings on excess cont. $ PAYER'S federal identification number $ 3 Distribution code 4 FMV on date of death $ Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) 5 HSA Archer MSA MA MSA Copy A For Internal Revenue Service Center File with Form 1096. For Privacy A.

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