health savings account - first american bank · 2020. 8. 12. · first american bank is pleased to...

Health Savings Account Interest Rates and Annual Percentage Yields are current as of Tuesday, August 12, 2020. For current rate information call (847) 952-3700.

Minimum Deposit Needed to Open Account $ 0.00 ACCOUNT OPENING AND USAGE

Monthly Fee

Excess Contribution Fee

Account Transfer fee

$0.00

$20.00

$25.00

Per occurrence

If you transfer your HSA to another financial institution

HSA Transaction Corrections $20.00 Includes prior year corrections

Interest Paid on Entire Balance if your Balance is:

Tier: $0.01-$999.99 Interest Rate 0.01% Annual Percentage Yield (APY) 0.01%

Tier: $1,000-$4,999.99 Interest Rate 0.01% Annual Percentage Yield (APY) 0.01%

Tier: $5,000-$49,999.99 Interest Rate 0.03% Annual Percentage Yield (APY) 0.03%

Tier:

Tier:

$50,000-$99,999.99

$100,000-$999,999.99

Interest Rate

Interest Rate

0.05%

0.10%

Annual Percentage Yield (APY)

Annual Percentage Yield (APY)

0.05%

0.10%

At First American's discretion, the interest rate and APY may change at any time. Interest is earned on the collected balance each calendar day using the daily balance method. This method multiplies the daily periodic rate times the collected balance plus any previously earned and unpaid interest compounding earnings daily. Interest earned is paid monthly. You must maintain a minimum balance of $0.01 in the account each day to obtain the disclosed APY. Interest earned and not paid will be forfeited when the account is closed unless the entire balance is transferred to another First American account. Interest will be reported to the IRS.

Interest begins to accrue no later than the business day we receive credit for the deposits of

ACCRUAL OF INTEREST ON NONCASH DEPOSITS noncash items (for example, checks).

TRANSACTION LIMITATIONS:

The minimum amount you may deposit: $.01

The minimum amount you may withdraw : $.01

ATM FEES:

First American ATM Withdrawal FREE

Other ATM Withdrawal $3.00 At ATMs not owned by First American Bank

ATM Balance Inquiry $2.00

ADDITIONAL ACCOUNT FEES:

Paper Statement Fee*

Check Image Fee

$3.95

$0.00

Front only (fronts and backs $7.50). Minimum daily or combined average balance of $2,000 between the HSA and another checking, savings or money market account waives the check image and paper statement fee. Combined balances would include this acct plus any others owned by the primary accountholder.

Other Fees Schedule of Fees

*For accounts opened online: eStatements will automatically be selected. Please enroll in our Online Banking service to view youreStatements. For accounts opened at a branch: To select eStatements, within the first 30 days after your account is opened youmust enroll in our Online Banking service and accept our Online Banking Agreement which verifies your ability to access electronicstatements and provides your consent to receive electronic statements. Once enrolled, you must log in and select "Profile", then"eStatement Preference" and change the delivery option for each desired account to "Electronic". If you fail to select eStatementswithin the first 30 days of account opening, or if an owner elects to receive paper statements at any time, a paper statement fee mayapply. Please see the applicable Schedule of Fees.

Transactions may not be processed in the order

PROCESSING POLICIES

they occurred. The order in which they are processed by us may affect the total amount of overdraft fees you incur. Any item that exceeds your available balance is an insufficient funds item. We may pay or return any insufficient funds item at

Posting Order our discretion. Regardless of the action we take, The order in which withdrawals and deposits are you may be charged an overdraft fee or return item

processed fee. If at the close of any business day the

© First American Bank

https://www.firstambank.com/FirstAmericanBank/media/PDFs/ScheduleOfFees.pdfhttps://www.firstambank.com/FirstAmericanBank/media/PDFs/ScheduleOfFees.pdf

Governing Deposit Accounts (page 8)

available balance in your account is negative, you may be charged a continuous overdraft fee. See Schedule of Fees. See Payment of Items in the Rules and Regulations Governing First American Bank Governing Deposit Accounts (page 4)

Funds Availability Policy When funds deposited to your a ccount are available

Our p olicy is to make funds from your c heck deposits available to you on the first business day after the day we receive your d eposit. Electronic direct deposits, wire transfers, and cash will be available on the day we receive the deposit. Once the funds are available, you can withdraw them in cash and we will use the funds to pay checks that you have written. See Your Ability to Withdraw Funds in the Rules and Regulations Governing First American Bank

DISPUTE RESOLUTION

Dispute Resolution Agreement

You and we agree that any dispute arising under o r relating in any way to your a ccount or transactions will be resolved by binding, and not through litigation in any court (except for matters in small claims c ourt). This arbitration agreement is entered into pursuant to the Federal Arbitration Act, 9 U.S.C. §§ 1-16 ("FAA"). See Arbitration in the Rules and Regulations Governing First American Bank Governing Deposit Accounts (page 6)

DEFINITIONS AND LIMITATIONS

This account is intended for the purpose of paying medical expenses associated with high deductible health plans. Please check with your employer to confirm eligibility to contribute to an HSA. Please check with your tax advisor to determine the maximum contribution you are allowed to make. First American Bank is required to report all distributions and contributions to the IRS, including transactions made in error.

Schedule of Fees

Rules and Regulations Governing First American Bank Deposit Accounts

First American Bank

P.O. Box 0794

Elk Grove Village, IL 60009

Member FDIC © First American Bank 03/2020

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P.O. Box 0794 Elk Grove Village, IL 60009

Dear Valued Customer,

First American Bank is pleased to announce our new Health Account Services Group to better manage your Health Savings Account. The following pages describe changes that will take effect September 23, 2020. Please review the guide in its entirety as there is important information you will need to know prior to the migration.

If you would like a printed copy sent to you, please give us a call at 847-952-3700.

Sincerely,

Mitch Rosenbloom

Vice President, Health Account Services

www.FirstAmBank.com

WELCOME TO HEALTH ACCOUNT

SERVICES

Your Health Savings Account is About to Get Even Better

Health Account Services Migration Guide

Important information you need to know before September 23, 2020.

WELCOME to First American Bank Health Account Services! First American Bank is pleased to announce our new Health Account Services Group to better manage your Health Savings Account (HSA). This will allow us to expand our services to include a suite of Consumer Directed Health (CDH) benefit accounts. Implementation of this new technology will require your assistance in four steps. Step One: Begin using your new First American Bank Health Account Services debit card as of 12 noon CT on September 23, at which time your old card will be disabled shortly thereafter. If you have any automatic payments using your current HSA debit card, you will need to contact the merchants to update those payments to use your new debit card information. Access to your money will only be possible after activating your new debit card. Step Two: Beginning on September 23, 2020, you will need to access your HSA through the new Health Account Services Consumer Portal by visiting FirstAmBank.com, click Login and select “Health Account Services” from the drop-down menu. A new mobile app, FAB Health, will become functional at the same time. You will be able to download it from the App stores beginning September 23, 2020. Step Three: All existing automatic payments will be cancelled. You will need to re-establish them through the new Health Account Services Consumer Portal starting on September 23, 2020. Step Four: HSA deposits will not be accepted at First American branches after September 22, 2020. Please send them to:

First American Bank Health Account Services PO Box 2843

Fargo, ND 58108-284 You are now ready! Please review this Migration Guide for more information about the new features, what is changing, important dates, and access to the new Health Account Services Consumer Portal and mobile app.

First American Bank Health Account Services Migration Guide 3

What’s Inside

Important Information You Should Know .................................................................................................... 4

Online Access 4

Online Bill Pay 6

Mobile App 6

HSA Checkbook 6

HSA Deposits / Contributions 7

Debit Card 7

Debit Card Transactions 7

Electronic / Automated Transactions 7

Wire Transfers 8

Power of Attorney / Authorized Signer 8

Beneficiary 8

Statement Frequency and Interest Payment Dates 8

Account Number 8

Routing Number 8

Dedicated Account Support 8

Changes Regarding Your HSA ..................................................................................................................... 9

Terms and Conditions ................................................................................................................................... 9

Health Savings Account Custodial Agreement 10

Health Savings Account Disclosure Statement 14

Health Savings Account Deposit Agreement 19


Important Information You Should Know We are excited to introduce you to our new Health Account Services. This guide provides helpful information you will need.

Online Access

Beginning September 23, 2020, you will be able to access your HSA through the new First American Bank Health Account Services Consumer Portal. Only the accountholder will have access to the Consumer Portal. Authorized Signers, or representatives or a person to whom you have given Power of Attorney, will not have online access to your account through the Consumer Portal. Please note, if you have additional accounts at First American Bank, you will continue to access those accounts through Online Banking at www.FirstAmBank.com.

To establish online access to your HSA: Navigate to www.FirstAmBank.com, click Login and select ‘Health Account Services’ from the drop-down. For your first-time login, click the ‘Create your new username and password’ link. A 'User Identification' box will appear. Follow the onscreen instructions, filling in your first name, last name, zip code and your Social Security Number. Click, Next.

You have the option to create your username and are required to create a new password. The password must: Have a minimum of 8 characters, contain upper and lowercase letters, at least one number and a special character. Click, Next.

Select and answer five security questions and click Submit to complete the process. For security reasons, you may be asked one of these questions when completing certain account functions or after logging in to your account.

Lastly, you will be prompted to read and agree to the terms and conditions for an HSA. Click ‘Read and agree’ to open each agreement, after scrolling through and reading click the box that says, ‘I have read and agree…’ or ‘I have read this notice’ and submit when all are completed. Please note, the HSA is not fully active until you complete this step. Additionally, the Health Savings Account Custodial Agreement, Disclosure Statement, and Deposit Agreement have been included at the end of this guide.

Once you have successfully logged in, you will see a link to the Health Account Services Consumer Portal Quick Reference Guide for detailed information on how to use the portal.

HSA Plus Investment Access: As a feature of the new platform, access to your HSA Plus investments will be integrated with your access to the Consumer Portal. You will only need to remember one username and password.

What is changing? • Once the transition occurs, your current Non-Deposit Investment Addendum will be replaced in its entirety

by the Health Savings Account Custodial Agreement, effective September 23, 2020. • Your new investment customer service phone number is (866) 449-1150. • The following two funds will be added to your investment alternatives.

Mutual Fund Name Ticker Symbol Gross Expense Ratio Status Vanguard High-Yield Corporate VWEAX 0.13 New fund added Schwab Government Money Market SNVXX 0.47 New fund added

http://www.firstambank.com/http://www.firstambank.com/


Below is a timeline of important dates to be aware of: • September 15, 2020 - The last day to request transactions within your current HSA investment account. • September 17, 2020 - Transition date of your HSA investment account from the current portal to the new

Consumer Portal. • September 23, 2020 - You will be able to access and fully manage your HSA investments online.

HSA Investment Transfers: Transfers between your current HSA and your investment account will need to be reestablished in the new Consumer Portal. You will have two options to choose from: 1. Opt into Auto Investment Transfers - automatically move funds between your investment account and your

cash account anytime the balance varies more than $100 above or below the cash minimum, or target balance you define. However, the minimum target balance you can define is $1,000.

2. Initiate a One-Time Transfer to/from Investments - funds will only be moved between your investments when you log in and initiate the request to move money.

Account-to-Account Transfers: As of September 16, 2020, access to schedule HSA account-to-account transfers will be suspended on our current system. Any transfers scheduled to be processed after September 23, 2020, will be cancelled. Therefore, once you are enrolled in the Consumer Portal, you will need to reestablish all future transfers.

You will be able to connect your First American Bank checking account or accounts at other banks through the Consumer Portal to set-up one-time or recurring transfers.

Transaction History: Your HSA account transaction history since January 1, 2019, will be carried over to the new Consumer Portal.

eStatements: Past eStatements will not carry over to the new Consumer Portal. However, you may continue to log into First American Bank’s Online Banking system until November 23, 2020, to retrieve prior eStatements.

If you are receiving paper statements by mail, remember you can elect to receive electronic statements and avoid the monthly fee for the Monthly HSA Account Summary Fee (Paper Statement). Please refer to our HSA Schedule of Fees for further details.

With the Consumer Portal, you will have access 24/7 to your account information and many new self-service capabilities including the ability to: • Paperless administration, including online account summary reports and tax documents • Consolidate all out-of-pocket expenses that are available via online or mobile expense/receipt “virtual

shoebox” entries, claims that have been filed, debit card transactions and distributions initiated through the Consumer Portal attributable to qualified health expenses

• Conveniently access investments and investment guidance • View the balance, historical and pending activity, and debit card transactions • Complete payments to service providers electronically, and initiate reimbursements to your bank accounts

electronically • Set-up automated contributions through pre-authorized one-time or recurring electronic payments to your

HSA • View/Update personal data, sign up for and manage contributions to your account and your debit card

status, and sign up for text and email alerts


Online Bill Pay

Because we are migrating to a new platform, online bill payments that you have scheduled to be paid after 4:00 p.m. CT September 22, 2020, will be cancelled. To retain your history, please download or print payee information.

Once you are enrolled in the Consumer Portal, you will need to schedule new payments. You can conveniently make payments by using your debit card, or set-up transfers between your HSA and your checking account. You can also request a payment be mailed to yourself or someone else (like your doctor) through the Consumer Portal. Please refer to our HSA Schedule of Fees for further details.

Mobile App

Beginning September 23, 2020, you will be able to access your HSA through the new First American Bank Health Account Services Mobile App, called FAB Health. After you have initiated access to the Consumer Portal and set-up a new password, download the FAB Health app for your chosen device from the Apple App Store or Google Play.

Our new FAB Health app makes it easy for you to manage your benefit plans on your iOS (iPhone, iPod Touch, iPad), or Android-powered devices. You can: • Use the Eligible Expense Scanner to scan a product barcode to determine if its purchase is a qualified

medical expense before you get to the checkout lane • Initiate an HSA distribution or contribution • View HSA investment details • Report debit card as lost or stolen via the Consumer Portal or mobile app • Use biometrics to access account with ease • Check balances and account details • View account summary to obtain key account info • Access account funds to pay yourself or someone else, such as a doctor • View important messages about account • Retrieve forgotten username/password

HSA Checkbook

A checkbook will no longer be offered. Please stop using any checks in your possession beginning on September 23, 2020 and destroy your remaining supply of checks.

As an alternative, you can conveniently make payments by using your debit card, or set-up transfers between your HSA and your First American Bank checking account. You can also request a payment be mailed to yourself or someone else (like your doctor) through the Consumer Portal. Please refer to our HSA Schedule of Fees for further details.

We will continue to honor any outstanding checks until March 23, 2021, after that date any checks presented for payment will be returned.


HSA Deposits / Contributions

Deposits to your HSA will no longer be accepted at First American Bank branch locations or ATM, or through the mobile app. Effective September 23, 2020, please mail all check deposits to:

First American Bank Health Account Services PO Box 2843

Fargo, ND 58108-2843

Alternatively, you can contribute to your HSA through the FAB Health mobile app or the Consumer Portal by selecting the Make HSA Transaction link from the Home Tab and transfer the funds from your linked account.

Debit Card

Primary account owners and others authorized to act on your behalf who currently have an active HSA debit card, will receive a new First American Bank Health Account Services Prepaid Mastercard® debit card and Cardholder Agreement by September 23, 2020. All debit card(s) will be mailed to the address of the account owner. With the new Consumer Portal, you can add a dependent or Authorized Signer to your account and request a debit card for their use. Fees may apply, please refer to our HSA Schedule of Fees for further details.

When you receive our new card, activate it immediately by following the instructions included. During the activation process, you will be required to select your new Personal Identification Number (PIN). Please note, the debit card will have a new card number. If you have automatic payments set up using your current HSA debit card, please be sure to contact any merchants to update those payments to your new First American Bank Health Account Services debit card number.

Begin using your new First American Bank Health Account Services debit card as of 12:00 p.m. CT on September 23, at which time you should discontinue using your old card.

Debit Card Transactions

The new First American Bank Health Account Services debit card can be used for payment at merchants where Mastercard® is accepted. Your new debit card is equipped with new security features to ensure purchases are limited to qualified healthcare expenses. Payments for goods or services that are not considered a qualified expense may be denied. Similarly, our new card may not be used to withdraw cash or make a deposit at an ATM, or obtain a cash advance.

Electronic / Automated Transactions

All Automated Clearing House (ACH) or electronic transfers pre-approved by you and directed to your account, will continue uninterrupted. This typically includes direct deposit, such as payroll deductions or similar contributions by you or your employer, as well as pre-authorized payments, such as insurance premiums.

Please notify your providers that the routing number is changing to 067015928. Unless we notify you to the contrary, and there are no restrictions on your account, we will continue to accept ACH transactions as they are currently defined.


Wire Transfers

We will no longer accept incoming or outgoing wire transfer requests.

Power of Attorney / Authorized Signer

Only the primary account owner will have Consumer Portal access.

When correctly documented, your agent with a Power of Attorney will continue to have the ability to order debit cards, transact on the account, obtain account information, and make changes to the account information. Someone designated as an Authorized Signer, will continue to have the ability to order debit cards, transact on the account, and obtain account information, but will not be able to make changes to account information.

Beneficiary

You now will have easy access to update your beneficiary information directly from within the Consumer Portal. When you log into the Consumer Portal, please ensure your beneficiary information is complete and up to date.

Statement Frequency and Interest Payment Dates

Beginning on September 30, 2020, we will begin paying interest to your account on the last day of each month. On that date your Account Summary, or Statement, will be changed to cover a calendar month. Thereafter, your interest payment and statement dates will be the last day of each month.

Account Number

Your account number will not change.

Routing Number

The routing number for your HSA will change effective, September 23, 2020. The new routing number is: 067015928.

Dedicated Account Support

We have a team of dedicated Health Account Services professionals to answer all of your questions.

Phone: (866) 449-1150 (Monday-Friday, 7:00 a.m. – 7:00 p.m. CT)

Fax: 1-833-950-1240

Email: [email protected]

Mail: First American Bank Health Account Services PO Box 2843 Fargo, ND 58108-2843


Changes Regarding Your HSA The stated interest rates and annual percentage yields are good as of September 23, 2020. The actual interest rate and annual percentage yield you earn may vary, as we may adjust the interest rate on variable rate accounts at any time, and from time to time.

Health Savings Account Minimum to Open $0.00 Minimum Balance to Earn Interest $0.01

Interest Paid on Entire Balance if your Balance is: Interest Rate Annual Percentage Yield $0.01 - $999.99 0.01% 0.01%

$1,000 - $4,999.99 0.01% 0.01% $5,000 - $49,999.99 0.05% 0.05%

$50,000 - $99,999.99 0.10% 0.10% $100,000 - $999,999.99 0.15% 0.15%

Health Savings Account Schedule of Fees Monthly HSA Account Summary Fee (Paper Statement) $3.95 Debit Card Issuance Fee (first card is free, each additional card) $5.00 HSA Investment Service Fee 30 basis points1 Dormant Fee (per month) $10.00 Returned Item Fee2 (per item) $39.50 HSA Closure Fee (Account Transfer) $25.00 HSA Check Distribution Fee (per check) $2.00

1-Prior to the end of each calendar quarter, we deduct a custodial management fee from your Investment Account in an amount of (.075%) per quarter or equal to an annual fee of (0.30%) on balances invested in mutual funds in your Investment Account.

2-Applies to Checks and ACH transactions presented for payment and that the Bank must return because the account balance is not sufficient to cover the amount of the payment.

Terms and Conditions The pages that follow are the terms and conditions of your Health Savings Account at First American Bank.

• Health Savings Account Custodial Agreement

• Health Savings Account Disclosure Statement

• Health Savings Account Deposit Agreement


Health Savings Account Custodial Agreement This Health Savings Account Custodial Agreement (“Agreement”), together with amendments, applications, beneficiary designations, our Disclosure Statement, Health Savings Account Deposit Agreement, and other documentation, if any, set forth the terms and conditions governing your Health Savings Account (“HSA”) relationship with us. Articles I through X below incorporate the Internal Revenue Service (“IRS”) Form 5305-C under section 223(a) of the Internal Revenue Code. The Disclosure Statement sets forth various IRS rules and regulations that govern your HSA. The Health Savings Account Deposit Agreement sets forth various First American Bank terms and conditions that govern your HSA. Unless it would be inconsistent to do so, words and phrases used in this document should be construed so the singular includes the plural and the plural includes the singular.

References in this Agreement to "you," "your," and "HSA owner" will mean the account owner, and "we," "us," and "our" will mean the custodian. Upon your death, your spouse beneficiary, if applicable, becomes "you" for purposes of this Agreement. In the event you appoint a third party or have a third party appointed on your behalf to handle certain transactions affecting your HSA, such third party will be considered your agent and, therefore, "you" for purposes of this Agreement. Additionally, references to "HSA" will mean the custodial account.

Article I. 1. The custodian will accept additional cash

contributions for the tax year made by the account owner or on behalf of the account owner (by an employer, family member or any other person). No contributions will be accepted by the custodian for any account owner that exceeds the maximum amount for family coverage plus the catch-up contribution.

2. Contributions for any tax year may be made at any time before the deadline for filing the account owner's federal income tax return for that year (without extensions).

3. Rollover contributions from an HSA or an Archer Medical Savings Account (Archer MSA) (unless prohibited under this Agreement) need not be in cash and are not subject to the maximum annual contribution limit set forth in Article II.

4. Qualified HSA distributions from a health flexible spending arrangement or health reimbursement arrangement must be completed in a trustee-to-trustee transfer and are not subject to the maximum annual contribution limit set forth in Article II.

5. Qualified HSA funding distributions from an individual retirement account must be completed in a trustee-to-trustee transfer and are subject to the maximum annual contribution limit set forth in Article II.

Article II. 1. For calendar year 2011, the maximum annual

contribution limit for an account owner with single coverage is $3,050. This amount increases to $3,100 in 2012. For calendar year 2011, the maximum annual contribution limit for an account owner with family coverage is $6,150. This amount increases to $6,250 in 2012. These limits are subject to cost-of-living adjustments after 2012.

2. Contributions to Archer MSAs or other HSAs count toward the maximum annual contribution limit to this HSA.

3. For calendar year 2009 and later years, an additional $1,000 catch-up contribution may be made for an account owner who is at least age 55 or older and not enrolled in Medicare.

4. Contributions in excess of the maximum annual contribution limit are subject to an excise tax. However, the catch-up contributions are not subject to an excise tax.

Article III. It is the responsibility of the account owner to determine whether contributions to this HSA have exceeded the maximum annual contribution limit described in Article II. If contributions to this HSA exceed the maximum annual contribution limit, the account owner shall notify the custodian that there exist excess contributions to the HSA. It is the responsibility of the account owner to request the withdrawal of the excess contribution and any net income attributable to such excess contribution. Article IV. The account owner's interest in the balance in this custodial account is nonforfeitable. Article V. 1. No part of the custodial funds in this account may be

invested in life insurance contracts or in collectibles as defined in section 408(m).

2. The assets of this account may not be commingled with other property except in a common trust fund or common investment fund.

3. Neither the account owner nor the custodian will engage in any prohibited transaction with respect to this account (such as borrowing or pledging the account or engaging in any other prohibited transaction as defined in section 4975).

Article VI. 1. Distributions of funds from this HSA may be made

upon the direction of the account owner. 2. Distributions from this HSA that are used exclusively

to pay or reimburse qualified medical expenses of the


account owner, his or her spouse, or dependents are tax-free. However, distributions that are not used for qualified medical expenses are included in the account owner's gross income and are subject to an additional 20 percent tax on that amount. The additional 20 percent tax does not apply if the distribution is made after the account owner's death, disability, or reaching age 65.

3. The custodian is not required to determine whether the distribution is for the payment or reimbursement of qualified medical expenses. Only the account owner is responsible for substantiating that the distribution is for qualified medical expenses and must maintain records sufficient to show, if required, that the distribution is tax-free.

Article VII. If the account owner dies before the entire interest in the account is distributed, the entire account will be disposed of as follows: 1. If the beneficiary is the account owner’s spouse, the

HSA will become the spouse's HSA as of the date of death.

2. If the beneficiary is not the account owner's spouse, the HSA will cease to be an HSA as of the date of death. If the beneficiary is the account owner's estate, the fair market value of the account as of the date of death is taxable on the account owner's final return. For other beneficiaries, the fair market value of the account is taxable to that person in the tax year that includes such date.

Article VIII. 1. The account owner agrees to provide the custodian

with information necessary for the custodian to prepare any report or return required by the IRS.

2. The custodian agrees to prepare and submit any report or return as prescribed by the IRS.

Article IX. Notwithstanding any other article that may be added or incorporated in this Agreement, the provisions of Articles I through VIII and this sentence are controlling. Any additional article in this Agreement that is inconsistent with section 223 or IRS published guidance will be void. Article X. This Agreement will be amended from time to time to comply with the provisions of the Internal Revenue Code or IRS published guidance. Other amendments may be made with the consent of the persons whose signatures appear on the Application that accompanies this Agreement. Article XI. 1. Additional Provisions. Additional provisions may be

attached to, and made a part of, this Agreement by either party. The provisions must be in writing, agreed to by us, and in a format acceptable to us.

2. Our Fees and Expenses. We may charge reasonable fees and are entitled to reimbursement for any expenses we incur in establishing and maintaining your HSA. We may change the fees at any time by providing you with notice of such changes. We will provide you with fee disclosures and policies. We may deduct fees directly from your HSA assets or bill you separately. The payment of fees has no effect on your contributions. Additionally, we have the right to liquidate your HSA assets to pay such fees and expenses.

3. Amendments. We may amend your HSA in any respect and at any time, including retroactively, to comply with applicable laws governing HSAs and the corresponding regulations. Any other amendments shall require your consent, by action or no action, and will be preceded by written notice to you. Unless otherwise required, you are deemed to automatically consent to an amendment, which means that your written approval is not required for the amendment to apply to the HSA. In certain instances, the governing law or our policies may require us to secure your written consent before an amendment can be applied to the HSA. If you want to withhold your consent to an amendment, you must provide us with a written objection within thirty (30) days of the receipt date of the amendment.

4. Notice. Any notice provided under this Agreement shall comply with the terms of the section titled “Notices” of the Health Savings Account Deposit Agreement.

5. Applicable Laws. This Agreement will be construed and interpreted in accordance with the laws of, and venued in, our state of domicile.

6. Disqualifying Provisions. Any provision of this Agreement that would disqualify the HSA will be disregarded to the extent necessary to maintain the account as an HSA.

7. Interpretation. If any question arises as to the meaning of any provision of this Agreement, then we shall be authorized to interpret any such provision, and our interpretation will be binding upon all parties.

8. Representations and Indemnity. You represent that any information you and/or your agents provide to us is accurate and complete, and that your actions comply with this Agreement and applicable laws governing HSAs. You understand that we will rely on the information provided by you, and that we have no duty to inquire about or investigate such information. We are not responsible for any losses or expenses that may result from your information, direction, or actions, including your failure to act. You agree to hold us harmless, to indemnify, and to defend us against any and all actions or claims arising from, and liabilities and losses incurred by reason of your information, direction, or actions. Additionally, you represent that


it is your responsibility to seek the guidance of a tax or legal professional for your HSA issues. We are not responsible for determining whether any contributions or distributions comply with this agreement and/or the federal laws governing HSAs. We are not responsible for any taxes, judgments, penalties, or expenses incurred in connection with your HSA, or any losses that are a result of events beyond our control. We have no responsibility to process transactions until after we have received appropriate direction and documentation, and we have had a reasonable opportunity to process the transactions. We are not responsible for interpreting or directing beneficiary designations or divisions.

9. Investment of HSA Assets. a. Investment of Contributions. You may invest

HSA contributions in any HSA investments we offer. If you fail to provide us with investment direction for a contribution, we will return or hold all, or part of such contribution based on our policies and procedures. This can include depositing your contribution in your deposit account. We will not be responsible for any loss of HSA income associated with your failure to provide appropriate investment direction.

b. Directing Investments. All investment directions must be in a format or manner acceptable to us. You may invest in any HSA investments that you are qualified to purchase, and that we are authorized to offer and do offer at the time of the investment selection, and that are acceptable under the applicable laws governing HSAs. Your HSA investments will generally be registered in our name or our nominee's name (if applicable) for the benefit of your HSA. Specific investment information may be provided at the time of the investment. Based on our policies, we may allow you to delegate the investment responsibility of your HSA to an agent by providing us with written notice of delegation in a format acceptable to us. We will not review or guide your agent's decisions, and you are responsible for the agent's actions or failure to act. We are not responsible for directing your investments, or providing investment advice, including guidance on the suitability or potential market value of various investments. For investments in securities, we will exercise voting rights and other similar rights only at your direction, and according to our then current policies and procedures.

c. Investment Fees and Asset Liquidation. Certain investment-related fees, which apply to your HSA, must be charged to your HSA and cannot be paid by you. We have the right to liquidate your HSA assets to pay fees and expenses, federal tax levies, or other assessments on your HSA.

Investments made to certain funds may charge fees and expenses as stated in each mutual fund's prospectus. Some mutual funds may impose exchange fees and/or redemption fees. Some or all of the mutual funds available as options for investments may make payments to the Custodian as distribution fees.

d. Deposit Investments. The deposit investments provided by us may include savings, and/or money market accounts, and certificates of deposit (CDs), and will earn a reasonable rate.

e. Non-deposit Investments. Non-deposit investments may include investments in property, annuities, mutual funds, stocks, bonds, and government, municipal and U.S. Treasury securities, and other similar investments. Most, if not all, of the investments we offer are subject to investment risks, including possible loss of the principal amount invested.

f. Self-Directed HSA Investments. If your HSA is self-directed, you may invest your contributions and HSA assets in various deposit and non-deposit investments. We may offer investments to you in accordance with this Agreement. Materials provided to us in connection with investment alternatives are distributed to you with the understanding that they do not constitute or include legal, tax, or other professional advice. We assume no responsibility for tax or other consequences to anyone arising from your investment direction. We are not required to perform any additional services unless specifically agreed to under this Agreement. We have no duty other than to follow your investment directions and have no duty to question such instructions. We may assign certain responsibilities to other entities, including record keeping. Before you make any investment, carefully review the fund's prospectus, and consider its objectives, associated risks and any fees or expenses that may apply. Investing entails the risk of loss of principal. You acknowledge and agree that a prospectus has been made available to you either electronically or through each mutual fund’s toll-free phone number prior to and following the purchase of any investments. We may transfer funds invested in a particular Investment to another investment if such investment ceases to be offered as an alternative. We and the registered investment advisor reserve the right to assign your position in an investment to another like investment in the event that the investment fails to perform in the manner consistent with the objectives stated in the investment policy statement; or should the investment company no longer wish to participate


in the program for any reason. We will notify you of any changes to your investment thirty (30) days prior to the effective date. You have consulted with an attorney or other qualified tax professional regarding legal and tax issues related to your investment directions. We are not your fiduciary and no fiduciary duties are imposed by this Agreement. Investments may be aggregated in the Custodian's investment custodial account for investment purposes with the assets of other account owners. Investment trade orders must be submitted through the Website no later than 3:00 p.m. CST for same business day execution. However, if you submit a buy and sell order on the same business day, the sell order will be executed same business day and the buy order will be executed the following business day. Settlement of such transactions will occur on the third business day.

10. Distributions. Withdrawal requests must be in a format acceptable to us, and/or on forms provided by us. We may require you, or your beneficiary after your death, to provide documentation and a proper tax identification number before we process a distribution. These withdrawals may be subject to taxes, withholding, and penalties. Distributions will generally be in cash or in kind based on our policies. In-kind distributions will be valued according to our policies at the time of the distribution. Any distribution by check, debit card or other method approved by us will be reported as a normal distribution, unless we inform you otherwise or unless - at the time of the distribution - we provide you with a means to state otherwise and you in fact state otherwise. Our policies may permit us to accept the return of a mistaken distribution.

11. Cash or In-Kind Contributions. We may accept transfers, rollovers, and other similar contributions in cash or in kind from other HSAs, Archer Medical Savings Accounts (MSAs), and as allowed by law. Prior to completing such transactions, we may require that you provide certain information in a format acceptable to us. In-kind contributions will be valued according to our policies and procedures at the time of the contribution.

12. Reports and Records. We will maintain the records necessary for IRS reporting on this HSA. Required reports will be provided to you, or your beneficiary after your death, and the IRS. If you believe that your report is inaccurate or incomplete you must notify us in writing within thirty (30) days following the receipt date. Your investments may require additional state and federal reporting.

13. Termination. You may terminate this Agreement without our consent by providing us with a written notice of termination. A termination and the resulting distribution or transfer will be processed and

completed as soon as administratively feasible following the receipt of proper notice. At the time of termination, we may retain the sum necessary to cover any fees and expenses, taxes, or investment penalties.

14. Our Resignation. We can resign at any time by providing you with thirty (30) days written notice prior to the resignation date, or within five (5) days of our receipt of your written objection to an amendment. In the event you materially breach this Agreement, we can terminate this Agreement by providing you with five (5) days prior written notice. Upon our resignation, you must appoint a qualified successor custodian or trustee. Your HSA assets will be transferred to the successor custodian or trustee once we have received appropriate direction. Transfers will be completed within a reasonable time following our resignation notice and the payment of your remaining HSA fees or expenses. At the time of resignation, we may retain the sum necessary to cover any fees and expenses, taxes, or investment penalties. If you fail to provide us with acceptable transfer direction within thirty (30) days from the date of the notice, we can transfer the assets to a successor custodian or trustee of our choice, distribute the assets to you in kind, or liquidate the assets and distribute them to you in cash.

15. Successor Organization. If we merge with, purchase, or are acquired by, another organization, such organization, if qualified, may automatically become the successor custodian or trustee of your HSA.

16. Tax Year of Contributions. Any transaction, including a remote transaction - such as a computer or internet transaction - that results in a regular contribution to the HSA is considered a current tax year contribution or distribution unless you notify us in writing that such transaction should be ascribed to a different tax year and we have sufficient time to record it as such prior to any required reporting to the IRS.


Health Savings Account Disclosure Statement This Disclosure Statement provides you, and your beneficiaries after your death, with a summary of the rules and regulations governing your First American Bank Health Savings Account (“HSA”).

Definitions. The Health Savings Account Custodial Agreement contains many definitions. The definitions found in that agreement apply to this agreement. You are referred to as the account owner, and us as the custodian. References to "you," "your," and "HSA owner" will mean the account owner, and "we," "us," and "our" will mean the custodian. Upon your death, your spouse beneficiary, if applicable, becomes "you" for purposes of this Disclosure Statement. In the event you appoint a third party, or have a third party appointed on your behalf to handle certain transactions affecting your HSA, such third party will be considered your agent and, therefore, "you" for purposes of this Disclosure Statement. Additionally, references to "HSA" will mean the custodial account including bank deposits and investments.

For Additional Guidance. It is in your best interest to seek the guidance of a tax or legal professional before completing any HSA establishment documents. Your first reference for questions concerning your HSA should be Internal Revenue Code (IRC) Section 223, other relevant IRC sections, and all additional Internal Revenue Service (IRS) guidance; IRS publications that include information about HSAs; any additional provisions or amendments to such documents; and this Disclosure Statement. For more information, you can also refer to the instructions to your federal income tax return, your local IRS office, or the IRS's website at www.irs.gov.

1. IRS Form 5305-C. This Disclosure Statement and IRS Form 5305-C, amendments, application, and the Deposit Agreement set forth the terms and conditions governing your HSA and constitute the Agreement.

2. Individual/Family Benefit. This HSA is established for the exclusive benefit of you, your spouse, and your dependents and, upon your death, your beneficiaries. The HSA must be established in your name and not in the name of your beneficiary, living trust, or another party or entity.

3. Beneficiary Designation. You may designate any person(s) as your beneficiary to receive your HSA assets upon your death. You may also change or revoke an existing designation in such manner and in accordance with such rules as we prescribe for this purpose. If there is no beneficiary designation on file at the time of your death, or if none of the beneficiaries on file are alive at the time of your death, your HSA assets will be paid to your estate. We may rely on the latest beneficiary designation on file at the time of your death, will be fully protected in doing so, and will have no liability whatsoever to any person making a claim to the HSA assets under a subsequently filed designation or for any other reason.

4. Prohibition Against Life Insurance and Commingling. None of your HSA assets may be invested in life insurance contracts, or commingled with other property, except in a common trust fund or common investment fund.

5. No forfeitability. The assets in your HSA are not forfeitable. 6. Collectibles. Generally, none of your HSA assets may be invested in collectibles, including any work of art, rug, or

antique, metal or gem, stamp or coin, alcoholic beverage, or any other tangible personal property. If we allow, you may invest your HSA assets in the following coins and bullion: certain gold, silver, and platinum coins minted by the United States; a coin issued under the laws of any state; and any gold, silver, platinum, and palladium bullion of a certain fineness, and only if such coins and bullion are held by us. For additional guidance on collectibles, see Section 408(m) of the Internal Revenue Code (IRC).

7. Cash or In-Kind Rollovers. You may be eligible to make a rollover contribution of your HSA or Archer MSA distribution, in cash or in kind, to an HSA. These and other potential rollovers to and from HSAs are described in greater detail elsewhere in this Disclosure Statement.

8. No Prohibited Transactions. If you engage in a prohibited transaction, the HSA loses its tax-exempt status as of the first day of the year. You must include the fair market value of your HSA as of that first day in your gross income for the year during which the prohibited transaction occurred and pay all applicable taxes and penalties.

9. No Pledging. If you pledge all or a portion of your HSA as security for a loan, the portion pledged will be treated as a distribution to you, and the taxable amount will be included in gross income, and may be subject to the 20 percent early-distribution tax.

10. State Laws. State laws may affect your HSA in certain situations, including deductions, beneficiary designations, agency relationships, consent, taxes, tax withholding, and reporting.

11. Eligibility for an HSA. You are an eligible individual and may make or receive an HSA regular contribution if, with respect to any month, you:


a. are covered under a high-deductible health plan (HDHP). b. are not covered by any other type of health plan that is not an HDHP (with certain exceptions for plans providing

preventive care and limited types of permitted insurance and permitted coverage). c. are not enrolled in Medicare; and d. may not be claimed as a dependent on another person's tax return.

12. High-Deductible Health Plan. Generally, an HDHP is a health plan that provides significant benefits and satisfies certain requirements with respect to deductibles and out-of-pocket expenses. For purposes of this HSA, a high- deductible health plan is a plan with a minimum annual deductible and an out-of-pocket expense limit as detailed in IRS Publication 969 available at: https://www.irs.gov/pub/irs-pdf/p969.pdf. A plan shall not fail to be treated as an HDHP by reason of failing to have a deductible for preventive care. An HDHP may therefore provide preventive care benefits without a deductible or with a deductible below the minimum annual deductible.

13. Permitted Insurance. You are eligible for an HSA if you have coverage for any benefit provided by permitted insurance. An example of permitted insurance is insurance for a specific disease or illness, such as cancer insurance. In addition, you are eligible for an HSA if you have coverage (whether provided through insurance or otherwise) for accidents, disability, dental care, vision care, or long-term care.

14. HSA Contributions. a. Who Can Make Regular or Annual Contributions. If you meet the eligibility requirements for an HSA, you, your

employer, your family members, or any other person (including nonindividuals) may contribute to your HSA. This is true whether you are self-employed or unemployed.

b. Regular or Annual Contributions. Contributions to your HSA by any means (e.g., point of sales credits) are considered regular contributions for the current year, unless you provide us with instruction otherwise. i. Maximum Annual Contributions. In general, the maximum annual contribution is the contribution limit based

on HDHP coverage. Your maximum annual contribution is generally determined by adding together your monthly contribution limits for the year. Your monthly contribution limit is determined on the first day of each month that you are an eligible individual. A monthly contribution limit is 1/12 of the annual contribution limit based on your health plan coverage (self-only or family) for such month. However, your maximum annual contribution may be a greater amount if you are an eligible individual on the first day of the last month (December 1 for calendar-year taxpayers). If so, you are treated as an eligible individual for all months of the tax year and you may contribute up to such tax year's annual contribution limit based on your HDHP coverage (self-only or family) on December 1 (for calendar year taxpayers). If your maximum contribution amount determined under this method is greater than your monthly-determined maximum, and you contribute the greater amount, a testing period applies. The testing period for this provision begins with the last month of the contribution year and ends on the last day of the 12th month following such month (December 31 for calendar-year taxpayers). If you do not continue to be an eligible individual for the entire testing period, unless you die or become disabled, the difference between your monthly-determined maximum and the amount you contributed is includable in your gross income for the year of failure and is subject to a 10 percent penalty tax. For example, if you are an eligible individual and enroll in self-only HDHP coverage on January 1 but change to family HDHP coverage on November 1 and retain family HDHP coverage through December 31 of the same year, you may be able to contribute up to the full annual contribution limit for family coverage (plus catch-up if you are eligible) because it is greater than the sum of the monthly contribution limits (10/12 of the self-only annual limit plus 2/12 of the family limit).

ii. Qualified HSA Funding Distribution. If you are an eligible HSA individual, you may elect to take a qualified HSA funding distribution from your IRA (not including ongoing SEP and SIMPLE IRAs) to the extent such distribution is contributed to your HSA in a trustee-to- trustee transfer. This amount is aggregated with all other annual HSA contributions and is subject to your annual HSA contribution limit. The contribution is made for the tax year of the distribution. A qualified HSA funding distribution election is irrevocable and is generally available once in your lifetime. A testing period applies. The testing period for this provision begins with the month of the contribution to your HSA and ends on the last day of the 12th month following such month. If you are not an eligible individual for the entire testing period, unless you die or become disabled, the amount of the contribution made under this provision will be includable in gross income for the tax year of the month you are not an eligible individual, and is subject to a 10 percent penalty tax.

https://www.irs.gov/pub/irs-pdf/p969.pdf


iii. Annual Contributions Aggregated. If you have more than one HSA, the aggregate annual contributions to all the HSAs are subject to the contribution limit. This limit is decreased by the aggregate contributions to an Archer MSA. The same annual contribution limit applies whether the contributions are made by you, your employer, your family members, or any other person (including nonindividuals). Contributions may be made on your behalf even if you have no compensation or if the contributions exceed your compensation.

iv. Catch-Up Contributions. Catch-up contributions are regular HSA contributions made in addition to any other regular HSA contributions. You are eligible to make catch-up contributions if you meet the eligibility requirements for regular contributions and are age 55 or older by the end of your taxable year and not enrolled in Medicare. As with the annual contribution limit, the catch-up contribution is generally computed monthly. However, you may be eligible to contribute the entire catch-up contribution amount even if you are not an eligible individual for the entire tax year using the same first day of the last month eligibility rules and testing period applicable to the annual contribution limit.

c. One or Both Spouses Have Family Coverage. You and your spouse are treated as having family coverage if one or both of you has family coverage. The contribution limit is divided equally between you and your spouse unless each of you agree on a different division. The family coverage limit is reduced further by any contribution to an Archer MSA. However, each of you may make the catch-up contributions to your own separate HSA without exceeding the family coverage limit.

15. Contribution Deductibility. a. Your Contributions. Contributions made by you to an HSA, which do not exceed the maximum annual contribution

amount, are deductible by you when determining your adjusted gross income. You are not required to itemize deductions to take this deduction. However, you cannot also deduct the contributions as medical expenses under Internal Revenue Code (IRC) Section 213. Contributions by family members or any other person (including nonindividuals) on your behalf are also deductible by you. A contribution of a qualified HSA funding distribution from an IRA is not deductible.

b. Employer Contributions. Employer contributions are treated as employer-provided coverage for medical expenses under an accident or health plan and are excludable from your gross income. The employer contributions are not subject to withholding from wages for income tax or subject to the Federal Insurance Contributions Act (FICA), the Federal Unemployment Tax Act (FUTA), or the Railroad Retirement Tax Act. Contributions to your HSA through a cafeteria plan are treated as employer contributions. You cannot deduct employer contributions on your federal income tax return as HSA contributions or as medical expense deductions under IRC Section 213.

16. Contribution Deadline. You or your employer may make regular (including catch-up) HSA contributions any time for a taxable year up to and including your federal income tax return due date, excluding extensions, for that taxable year. The due date for most taxpayers is April 15. The deadline may be extended in some situations. Examples include a federally declared disaster, a terroristic or military action, or service in a combat zone.

17. Return of Mistaken Distribution. If you mistakenly distribute assets from the HSA, our policies may allow you to return the assets to the HSA. If you are able to return a mistaken distribution, you must notify us of the return and be prepared to provide the IRS with clear and convincing evidence that the HSA distribution was the result of a mistake of fact due to reasonable cause. A mistaken distribution can be returned no later than April 15 following the first year you knew or should have known the distribution was a mistake.

18. Moving Assets to and From HSAs. There are a variety of transactions that allow you to move assets to and from your HSA in cash or in kind based on our policies. We have sole discretion on whether we will accept, and how we will process, movements of assets to and from HSAs. We or the other financial organization involved in the transaction may require documentation for such activities. a. HSA-to-HSA Transfers. You may transfer all or a portion of your HSA assets from one HSA to another HSA. An

HSA transfer means that the HSA assets move from one HSA to another HSA in a manner that prevents you from cashing or liquidating the HSA assets, or even depositing the assets anywhere except in the receiving HSA. Transfers are not taxable or reportable, and the IRS does not impose timing or frequency restrictions on transfers. You may be required to complete a transfer authorization form prior to transferring your HSA assets.

b. Archer MSA-to-HSA Transfers. A transfer of Archer MSA assets to an HSA is permitted. However, HSA assets cannot be transferred to an Archer MSA.

c. HSA-to-HSA Rollovers. An HSA rollover is another way to move assets tax-free between HSAs. You may roll over all or a portion of your HSA assets by taking a distribution from an HSA and recontributing it as a rollover


contribution into the same or another HSA. Rollovers to HSAs are not allowed from traditional or Roth IRAs, health flexible spending arrangements (FSAs), and employer-sponsored retirement plans. You must report your HSA rollover to the IRS on your federal income tax return. Your contribution may only be designated as a rollover if the HSA distribution is deposited within 60 calendar days following the date you receive the distributed assets. You are limited to one rollover per 1-year (12-month) period. You may only roll over one HSA distribution per 1-year period aggregated between all your HSAs. For example, if you have HSA 1, HSA 2, and HSA 3, and take a distribution from HSA 1 and roll it over into a new HSA 4, you will have to wait 1 year from the date of that distribution to take another distribution from any of your HSAs and subsequently roll it over into an HSA.

d. Archer MSA-to-HSA Rollovers. Rollovers from an Archer MSA to an HSA are permitted according to the same rules as HSA-to-HSA distributions and rollovers. However, HSA assets cannot be rolled over to an Archer MSA.

19. HSA Distributions. You or, after your death, your beneficiary may take an HSA distribution, in cash or in kind based on our policies, at any time. However, depending on the timing and amount of your distribution you may be subject to income taxes and/or penalty taxes. HSA custodians/trustees are not responsible for determining whether HSA distributions are used for qualified medical expenses. a. Removal of Excess Contributions. You may withdraw all or a portion of your excess contribution and attributable

earnings by your federal income tax return due date, including extensions, for the taxable year for which you made the contribution. The excess contribution amount distributed will generally not be taxable, but the attributable earnings on the contribution will be taxable in the year in which the distribution is received. If you timely file your federal income tax return, you may still remove your excess contribution, plus attributable earnings, as late as October 15 for calendar year filers.

b. Qualified Medical Expenses. Qualified medical expenses are expenses paid by you, your spouse, or your dependents for medical care as defined in IRC Section 213(d) or as otherwise permitted by law, but only to the extent the expenses are not covered by insurance or otherwise. The qualified medical expenses must be incurred only after the HSA has been established.

c. Death. Upon your death, any balance remaining in your HSA becomes the property of the beneficiaries you have named. i. Spouse. If your spouse is the beneficiary of your HSA, the HSA becomes his/her HSA as of the date of your

death. We may require your spouse to transfer the assets to an HSA of his/her own. Your spouse is subject to income tax only to the extent distributions from the HSA are not used for qualified medical expenses.

ii. Non-spouse. If your beneficiary is not your spouse, the HSA ceases to be an HSA as of the date of your death. If your beneficiary is your estate, the fair market value of your HSA as of the date of your death is taxable on your final return. For other beneficiaries, the fair market value of your HSA is taxable to them in the tax year that includes such date. For such a person (except your estate), this amount is reduced by any payments from the HSA made for your qualified medical expenses, if paid within one year after your death.

d. Removal of Employer Contributions. If your employer contributes an amount in excess of the maximum annual contribution amount, or if your employer makes a contribution to your HSA but you were never an eligible individual, your employer may request a distribution from your HSA to correct the error.

20. Federal Income Tax Status of Distributions. a. Taxation. Distributions from your HSA used exclusively to pay for or reimburse qualified medical expenses of you,

your spouse, or your dependents are excludable from gross income. In general, amounts in an HSA can be used for qualified medical expenses and will be excludable from gross income even if you are not currently eligible for contributions to the HSA. However, any amount of the distribution not used exclusively to pay for or reimburse qualified medical expenses of you, your spouse, or your dependents is includable in your gross income and is subject to an additional 20 percent tax penalty on the amount includable, except in the case of distributions made after your death, your disability, or your attainment of age 65. HSA distributions which are not rolled over will be taxed as income in the year distributed unless they are used for qualified medical expenses. You may also be subject to state or local taxes and state withholding on your HSA distributions.

b. Earnings. Earnings, including gains and losses, on your HSA will not be subject to federal income taxes until they are considered distributed.

c. Ordinary Income Taxation. Your taxable HSA distribution is usually included in gross income in the distribution year.


21. Estate and Gift Tax. The designation of a beneficiary to receive HSA distributions upon your death will not be considered a transfer of property for federal gift tax purposes. Upon your death, the value of all assets remaining in your HSA will usually be included in your gross estate for estate tax purposes, regardless of the named beneficiary or manner of distribution. There is no specific estate tax exclusion for assets held within an HSA. Annual Statements. Each year we will furnish you and the IRS with IRS-required statements reflecting the activity in your HSA. Federal Tax Penalties and IRS Forms 5329 or 8889. Several tax penalties may apply to your various HSA transactions, and are in addition to any federal, state, or local taxes. Federal penalties and excise taxes are reported and remitted to the IRS by completing either IRS Form 5329 or Form 8889 and attaching the applicable form(s) to your federal income tax return. The penalties may include any of the following taxes: a. Additional Tax. Any amount of a distribution not used exclusively to pay for or reimburse qualified medical

expenses of you, your spouse, or your dependents is subject to an additional 20 percent tax on the amount includable in your gross income, except in the case of distributions made after your death, your disability, or your attainment of age 65. Separately, any failure to meet a required testing period resulting in amounts includable in gross income will make such amounts subject to an additional 10 percent tax.

b. Excess Contribution Penalty Tax. If a contribution to your HSA exceeds the amount you are eligible for, you have an excess contribution, which is subject to a 6 percent excise tax. The excise tax applies each year that the excess contribution remains in your HSA.


Health Savings Account Deposit Agreement This Health Savings Account Deposit Agreement (the “Agreement”), along with any other documents we give you pertaining to your health savings account (the “Account”) with First American Bank (the “Bank”, “we” or “us”), is a contract that establishes terms and conditions which control your account with us. Please read this Agreement carefully and retain it for future reference. 1. Establishing Your Account. Opening your Account. By instructing us to open an Account either directly or through your employer, depositing funds in an Account, or contacting us about an Account set up in your name, you agree to be bound by the terms and conditions of this Agreement. If you do not agree to these terms, please contact us promptly at: 1 + (866) 449-1150 to close your Account. Accuracy of Information. You agree that any information you supply to us or that is supplied to us by your employer is complete and correct. You must certify the accuracy of your social security number when requested. If you are currently subject or in the future become subject to backup withholding, we can withhold amounts from your Account as instructed by the Internal Revenue Service (“IRS”). Notices. You must inform us of all address changes, physical and electronic, to be assured that all necessary account notices and, if/when applicable, periodic statements, reach you. For purposes of this Agreement, notices to us should be mailed to:

First American Bank Health Account Services P.O. Box 2843 Fargo, ND 58108-2843

or emailed to [email protected]. Any notice given to you will be effective when we post it on the Health Account Services Consumer Portal at https://firstambankparticipant.lh1ondemand.com or mailed to the last known email address we have on file for you. If you have not consented to receive electronic communications, or have revoked a prior election to receive electronic communications, any notice to be given to you about your Account will be considered effective when we mail or send it to the last address that we have for you in our records. Any notice to be given to us will be considered effective when we receive it and have had reasonable time to act upon it. When we communicate with you, we may use automated telephone dialing devices, text messaging systems and electronic mail to provide messages to you about scheduled payments, missed payments and other important information about a future, current or previous Account relationship. Telephone messages may be played by a machine when the telephone is answered whether answered by you or someone else. These messages may also be recorded by your answering machine. You give us your permission to call or send a text message to any mobile telephone number you give us and to play pre-recorded messages or send text messages with information about this Agreement or your Account. You understand that, when you receive such calls, texts, or e-mails, you may incur a charge from the company that provides you with telecommunications or internet services. You agree that we will not be liable to you for any fees, inconvenience, annoyance, or loss of privacy in connection with such calls, texts, or emails. You understand that anyone with access to your telephone or email account may listen to or read the messages notwithstanding our efforts to communicate only with you. If a telephone number you have provided to us changes, or if you cease to be the owner, subscriber or primary user of such telephone number, you agree to immediately give us notice of such facts so that we may update our records. Telephone recording. You understand and agree that subject to applicable law, we may monitor and or record any of your phone conversations with any of our representatives for training, quality control, evidentiary, and any other purposes. However, we are not under any obligation to monitor record, retain, or reproduce such recordings, unless required by applicable law. Privacy, The USA Patriot Act and Opening an Account. We respect and protect the confidentiality of customer information. We only request information that is necessary to open and service your Account. Some of the information we request is required by a federal law called the USA Patriot Act and the regulations adopted by governmental agencies to implement it. This law requires us to obtain, verify, and record information that identifies each person or entity that opens an Account. This information helps the government fight the funding of terrorism and money laundering activities. When you open your Account, we will ask you for your name, street address, and date of birth. We also will ask you for an identification number, such as your social security number. This information allows us to identify you. In some instances, we also may ask to see your driver's license or other identifying documents. If your employer is facilitating your enrollment you authorize your employer to provide us a copy of your U.S. Citizenship and Immigration Services Form I-9 employment eligibility document. If your identity cannot be authenticated, or your application for your Account is incomplete, your Account may be opened in a restricted status or closed at our sole discretion. This means that we may restrict access to your Account until we can verify your identity, or we receive the necessary information to process your application. Any funds we receive while an account is restricted may be returned to the sender at any time at our sole discretion.

https://firstambankparticipant.lh1ondemand.com/


Confidentiality. Information about your Account and transactions in your Account are confidential. We will not disclose such information to third parties except: (1) when it is necessary to complete transfers or to collect a check or other item; (2) in order to verify the existence and condition of your Account for a third party such as a credit bureau or payee, or in order to tell a third party who has one of your checks that we would be able to pay that check if that party presented it to us at that time for payment; (3) if you provide express permission, which may be required in writing; (4) in order to comply with government agency regulations or court orders; (5) in order to collect money you owe us, or in connection with a claim by us or against us concerning a deposit or withdrawal involving your Account; (6) if we are presented with a legally enforceable instrument or court order, or in response to a proper governmental request under the USA Patriot Act; (7) if our officers, employees, or agents including accountants, auditors, service providers, attorneys, or collection agents need information about your Account or transactions in the course of their duties or as part of their review of our business affairs; (8) in order to collect information for our internal use, the use of our service providers, and our servicing agents and contractors about our electronic fund transfers services; or (9) where otherwise required or permitted under applicable law or our Privacy Notice. We work with several parties to provide Account services to you. These may include your employer, your employers payroll processor, health insurance carrier, third party administrator for your employer, multi purse health benefits debit card processors, or other payment service providers to enable you to pay for health care related expenses using your Account. In order for those parties to provide transaction-related services to your Account and information to you concerning your Account, we will provide nonpublic personal information concerning your Account to such parties, as appropriate to the type of Account program to which you belong and the services provided through this Account. Please rest assured that all customer information is kept in the strictest confidence, unless required or permitted by law to be disclosed. For additional information, please refer to our Privacy Notice. 2. Depositing Money in Your Account. Making Contributions. You can make contributions into your Account using the various methods outlined below. Contributions may be made to your Account by third parties, including your employer. We have the right to limit, refuse, or return any deposit. Please refer to the section of this Agreement entitled “Withdrawals” and to the sections of this Agreement following the heading “Funds Availability” for details concerning how and when we will make funds available to you, including when funds are considered to be deposited. Online Contributions. You can transfer funds between eligible accounts using the Health Account Services Consumer Portal. A transfer request may not result in immediate funds availability because of the time required to process the transaction. Online contributions between eligible accounts generally debit from your personal bank account and will generally credit to your Account at First American Bank within two (2) Business Days, depending upon the timing of your transaction and your requested transaction settlement date. If you schedule a transfer between eligible accounts on a day that is not a Business Day, the transfer will not be initiated until the next Business Day. A “Business Day" is every day except Saturdays, Sundays and legal banking holidays observed by the Federal Reserve Bank. If there are insufficient funds in an eligible account from which you are requesting a transfer, the transfer will not be processed. We reserve the right to limit the frequency and dollar amount of transactions from your eligible accounts for security reasons, or to prevent you or us from incurring a loss. Direct Deposit. If you have arranged with a third party to have payments directly deposited into your Account, there may be special conditions concerning the deposited funds. If you have authorized direct deposit into an Account that is closed or otherwise unavailable to receive any deposit, we may elect, at our sole discretion, to return the deposit to the source. Deposit by Mail. To make a deposit by mail, you will need to use a deposit ticket or contribution form to avoid processing delays. Mail your deposit to: First American Bank, Health Account Services, P.O. Box 2843, Fargo, ND 58108-2843. Please contact us for specific instructions related to making a deposit into your Account. Checks must be deposited into the Account of the party to whom the check is properly payable. Claim Against Deposited Item. If a claim is made with respect to any draft or check you deposit into your Account (an “Item”), after final credit is given to your Account on the grounds that the Item was altered, had a forged or unauthorized signature or indorsement, or was not properly payable for some reason, we can withhold the amount of that Item from your Account until the claim is finally resolved. If we sustain any loss or damage as a result of relying on your representations or instructions regarding the Item, you will be responsible for the costs and fees described in the section of this Agreement entitled "What Happens If You Owe Us Money or Cause Us to Sustain a Loss.” Returned Items. If an Item you deposit into your Account or otherwise negotiate is found to have been drawn on an account with insufficient funds to pay it or is returned unpaid for any other reason, we may, at our discretion, do one of two things. First, we may deduct the amount of the returned Item from your Account, return the Item to you, and charge a fee, if applicable. Second, we may redeposit it and charge a fee, if applicable. If we choose the latter option, you expressly agree that you have consented to this action and further agree that we have not waived or forfeited our right to chargeback your Account by exercising the option to redeposit.


Agent. You authorize us to act as your agent for the processing and collection of Items to deposit or otherwise negotiate. We are not responsible for losses which happen during collection of an Item that are not caused by circumstances under our direct control. We will not be liable for the negligence of our correspondents or loss in transit of Items deposited with us. You agree that we are legally entitled to supply any indorsement for you on any Item you deposit or cash with us. If there is a qualified indorsement on any Item, you agree that we may place your unqualified indorsement on the Item. You are responsible for reconstruction and proof of loss of any Items, including checks and other negotiable instruments, included in deposits that are lost or stolen in transit before we have received and accepted them. You also agree to cooperate fully and to assist in the reconstruction and proof of loss of any Items, including checks and other negotiable instruments, included in deposits that are lost or stolen in transit after we have received and accepted them. Deposit Insurance. Our deposit accounts are insured by the Federal Deposit Insurance Corporation. All Account deposits held by the Bank are combined with other deposits held by the Bank to determine the amount of deposit insurance that is available to depositors for all deposits they hold in a particular capacity. Deposits held by the Bank are insured to the maximum amount permissible under federal law. Any non-deposit investment products that you purchase using funds in your Account, including mutual funds, stocks, and bonds, are not FDIC-insured, are not deposits or other obligations of the Bank and are not guaranteed by the Bank or any of its affiliates, are not insured by any federal government agency, and are subject to investment risk, including the possible loss of the principal amount invested. 3. Funds Availability. Our policy regarding funds availability is designed to make funds available as soon as possible and to protect our customers’ deposits. When a deposit is received, the availability of funds may be delayed consistent with funds availability laws. During the delay, we will not use the funds to pay checks that you have written or fund transfers you have authorized, and you may not withdraw the funds in cash. If you need immediate availability from a deposit, please ask us when the funds will be available for withdrawal. Not all checks will clear during the applicable check hold period. You are responsible for returned items that have been credited to and withdrawn from your Account Checks drawn on foreign banks will be handled on a collection basis only and will be available when we receive final payment (less any applicable collection and currency exchange fees that may be imposed by us and by other financial institutions in connection with such checks). We do not accept foreign currency deposits to the Account (i.e., deposits that are not denominated in U.S. dollars). Determining the Availability of a Deposit. The length of the delay is counted in Business Days from the day of your deposit. Every day is a Business Day except Saturdays, Sundays, and legal banking holidays observed by the Federal Reserve Bank. Same Day Availability. Funds from electronic transfers received from another financial institution are available on the day we receive the deposit: Next Day Availability. Checks drawn on U.S. banks, including checks drawn on us. Delayed Availability. Checks drawn on foreign banks will be handled on a collection basis and will be available when we receive payment. Funds You Deposit by Check May Be Delayed for a Longer Period under the Following Circumstances.

1. We believe a check you deposit will not be paid. 2. You deposit checks totaling more than $5,525 on any one day. 3. You redeposit a check that has been returned unpaid 4. You have overdrawn your Account repeatedly in the last 6 months. 5. There is an emergency, such as failure of communications or computer equipment.

We will notify you in writing if your ability to withdraw funds is delayed for any of these reasons, and we will tell you when the funds will be available. Funds will generally be available no later than the fifth (5th) Business Day after the day of your deposit. Automated Teller Machine Deposits. Deposits may not be made at an ATM. 4. Withdrawing Money from Your Account. Withdrawals. You can make withdrawals from your Account by various methods made available to you in conjunction with your Account. For your own protection, withdrawals from your Account will not be allowed if we are not satisfied that the withdrawal is authorized. We are not obligated to honor any withdrawal in an amount in excess of the Available Balance in your Account. Your “Available Balance" is the amount of money available for withdrawal from your Account, consistent with the Funds Availability section above. Federal regulations give us the right to require you to give notice in writing not less than seven (7) calendar days before you intend to withdraw all or a part of your Account. Longer notification periods may be enforced under certain circumstances. Withdrawals made from your Account will be reported to the IRS as normal distributions and should be made only for qualified medical expenses under the applicable federal law. Checks. You may not use paper checks as payment orders drawn on the Account. Preauthorized Drafts. You agree that by giving your Account number information to a creditor, you authorize the debits made to your Account by that creditor including debits that take the form of preauthorized drafts submitted to us for payment.


If there are duplicate or improper debits or other errors in the preauthorized drafts, you need to advise the creditor of the error and seek a re-credit or other adjustment by the creditor. Transactions involving electronic fund transfers may be subject to other rules and regulations. See our Electronic Fund Transfers Disclosure provided below. Postdated Check. We may charge against your Account a check dated after the date it is presented unless you give us enough advanced notice of the check. This notice must provide certain information and be given to us with sufficient time for us to act according to the notice. Stale Checks. Under applicable law, we have no obligation to pay a check over 6 months old. We may choose, at our discretion and absent contrary instr

health savings account - first american bank · 2020. 8. 12. · first american bank is pleased to...

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