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The trustee of your MA MSA is not required to but may show 2015. Box 4. Shows any rollover contribution from an Archer MSA to this Archer MSA in 2015 or any rollover from an HSA or Archer MSA to this HSA. VOID CORRECTED TRUSTEE S name street address city or town state or province country ZIP or foreign postal code and telephone number 1 Employee or self-employed person s Archer MSA contributions made in 2015 and 2016 for 2015 OMB No. 1545-1518 2 Total contributions made in 2015 Form 5498-SA...
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