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  • HSA Spreadsheet

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    wlindgren
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    This document appears to be a monthly statement for employee health savings or flexible spending accounts. It lists 5 employee names and numbers along with their employer fees, employer contributions, and total for each. The bottom of the statement provides payment instructions, requesting checks be made payable to Sterling HSA and mailed to an address in Oakland, California.

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    HSA spreadsheet

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    This document appears to be a monthly statement for employee health savings or flexible spending accounts. It lists 5 employee names and numbers along with their employer fees, employer contributions, and total for each. The bottom of the statement provides payment instructions, requesting checks be made payable to Sterling HSA and mailed to an address in Oakland, California.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    16 views1 page

    HSA Spreadsheet

    Uploaded by

    wlindgren
    This document appears to be a monthly statement for employee health savings or flexible spending accounts. It lists 5 employee names and numbers along with their employer fees, employer contributions, and total for each. The bottom of the statement provides payment instructions, requesting checks be made payable to Sterling HSA and mailed to an address in Oakland, California.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Jane Doe

    Smith Valley Road For: January, 2011


    Somewhere State Zip

    Contact: Name Phone:


    Email: Email Fax:

    Employee Name Employee # Employer Fee Employer Contr. Total


    First Last
    1
    2
    3
    4
    5

    $0.00 $0.00 $0.00

    Make Check
    payable to: Sterling HSA
    PO Box 71107
    Oakland, CA 94612-7207

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