- Jenny Smith, age 57, is single. - Jenny eamed wages of $52,000 and was enrolled the entire year in a high deductible health plan (HDHP) with self-only coverage. - During the year, Jenny contributed \$2,000 to her Health Savings Account (HSA) and her mother also contributed S1,000 to Jenny's HSA account. - Jenny's Form W-2 shows $650 in Box 12 with code W. She has Form 5498-SA showing $3,650 in Box 2. - Jenny took a distribution from her HSA to pay her unreimbursed expenses: - 8 visits to a physical therapist after her knee surgery $400 - unreimbursed doctor bills for $900 - prescription medicine $200 - replacement of a crown $1,500 - over the counter medication $40 - gym membership $240 - Jenny is a U.S. citizen with a valid Social Security number. 6. Form 8889, Part 1 is used to report HSA contributions made by a. Jenny b. Jenny's employer c. Jenny's mother d. All of the above 7. Jenny is eligible to contribute an additional $1,000 to her HSA because she is age 55 or older. True False 8. What is the total unreimbursed qualified medical expenses reported on Form 8889 , Part II? a. $2,640 b. $3,000 c. $3,040 d. $3,280