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D44 · 2025 Form 1099-SA - HSA (Ngozi Okafor)
Lakeside HSA Bank · 1099-SA · belongs to taxpayer · tax year 2025 · received 2026-02-15 13:08 from client · 1099SA.pdf · 1 page
landed on the return
Lakeside HSA BankD44 · page 1 / 1
Form 1099-SA 2025. Box 1 gross distribution 2,150.00. Box 3 distribution code 1. HSA checked.
Where this document landed
Extraction: extracted · 2 values
Used by engine: v1 ✓ · v2 ✓ · v3 ✓
2 extracted values
ev-0995 · p1 · box1
Box 1 gross distribution
F8889.14a
2,150
99%
ev-0996 · p1 · box3
Box 3 distribution code
F8889.15
1
99%
Verify ev-0996