Jenny Smith, age 57, is single.

Jenny earned 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 $1,000 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

1.) 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

2.) Jenny is eligible to contribute an additional $1,000 to her HSA because she is age 55 or older. a. True b. False

3.) 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