Health Savings Accounts
Wolters Kluwer Financial Services offers HSA solutions that allow you to focus on growing your business.
Documents
To help you address the ever-changing HSA regulations and comfortably offer the options that consumers and businesses want, Wolters Kluwer Financial Services provides documents in a variety of formats, including paper, electronic, and Internet.
HSA Organizers (HSA-CUS-ORG, HSA-T-ORG) HSA-BKL7-C, HSA-BKLT-T)
The HSA Organizer contains documents necessary to establish an HSA and supplies the IRS model Form 5305-B or Form 5305-C to officially establish an HSA. It helps you collect necessary information about your HSA owner and includes an application and disclosure statement. You can document the HSA owner’s beneficiary designation and the initial contribution amount on the application. HSA owners can add or change beneficiaries after account establishment using HSA Designation or Change of Beneficiary Form (HSA-CNG-BEN).
HSA Booklets (HSA-BKL7-C, HSA-BKLT-T)
The HSA Booklet supplies the IRS model Form 5305-S or Form 5305-SA to officially establish an HSA and includes a disclosure statement. The HSA Booklet is available in custodial (includes self direction) and trust versions.
HSA Booklets are designed for use with the Health Savings Account (HSA) Application (HSA-APP).
HSA Contribution Instructions (HSA-CONTINST)
These instructions provide a convenient way to obtain necessary contribution information, such as the type of contribution and the tax year of the contribution.
HSA Contribution Receipt (HSA-CONTRCPT)
This form may be used to document an HSA contribution.
HSA Rollover Review (HSA-ROLL-REV)
This document is designed to assist you in rolling over only eligible assets.
Request for Transfer to an HSA (HSA-REQ-TRAN)
This form will assist you in the movement of assets from one HSA to another HSA or from an Archer Medical Savings Account (MSA) to an HSA.
Request for a Qualified Health Savings Account Funding Distribution for Traditional and Roth IRAs (IRA-QHSAFD)
The Request for a Qualified Health Savings Account Funding Distribution for Traditional, Roth, Traditional Beneficiary, and Roth Beneficiary IRAs form is designed to request assets from an individual retirement account (IRA) for transfer to an HSA.
HSA Distribution Form (HSA-DIS)
The HSA-DIS helps make documenting distributions a simple process. It records the amount withdrawn and the reason for the withdrawal, as well as identifies payment instructions (if applicable).
HSA Earnings Calculation Work Sheet (HSA-EARNCALC)
This document assists in calculating the earnings to be removed with an excess HSA contribution.
HSA Amendment (Standard-Custodial, Trust), (Conversion-Custodial, Trust)
Standard HSA amendments include the applicable IRS series 5305 form and are used to update HSA owner documentation when there are significant changes to HSA rules and regulations and/or as directed by the IRS. Includes a built-in cover letter explaining the changes to the HSA owner.
Conversion HSA amendments are designed for use when an HSA custodian/trustee changes HSA document providers. Sending a conversion amendment to existing HSA owners will ensure that all accounts are being administered under the same provisions.
Straight Answers to Your HSA Questions (HSA-BRO)
This brochure explains the provisions of Health Savings Accounts in question and answer format.
Marketing Materials
Health Savings Account Business Brochures (HSAP1-BRO2B, HSAP1-BRO4B)
This brochure explains the provisions of Health Savings Accounts to business owners.
Health Savings Account Consumer Brochures (HSAP1-BRO2C, HSAP1-BRO4C)
Employers may use this brochure to explain the provisions of Health Savings Accounts to their employees.
If interested in more information on our Health Savings Accounts Documents or purchasing, please complete our Request More Information Form or use our IRA Document Order Form.
