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Payee s SSN or FEIN.. Payee s street address. Payee s city. Payee s state. Payee s ZIP code. Payee s region.. You became eligible for Medicare. HSA DISTRIBUTIONS Total HSA distribution received 1099-SA box 1. Distributions included above that were rolled over to another HSA. Months of coverage 1 November 2014. 1 December 2014. 1 January. 1 February. 1 March. 1 April.. 1 May. 2015 Overpayment repaid. State and local refunds 1 city or local income tax refund. Tax year for box 2 if not 2014 Box...
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Wertz Amp Company LLP is a limited liability partnership that offers services in the field of accounting and audit.
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