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D45 · 2025 Form 5498-SA - HSA (Ngozi Okafor)

Lakeside HSA Bank · 5498-SA · belongs to taxpayer · tax year 2025 · received 2026-02-15 13:09 from client · 5498SA.pdf · 1 page

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Lakeside HSA BankD45 · page 1 / 1

Form 5498-SA 2025. Box 2 total contributions made in 2025: 6,000.00 (all employer, through payroll). Box 5 FMV 12/31/2025 14,820.00. Coverage: family HDHP.

Where this document landed

2 return lines: F8889.3, F8889.9

Extraction: extracted · 1 values

Used by engine: v1 ✓ · v2 ✓ · v3 ✓

1 extracted value

ev-0997 · p1 · box2

Box 2 total contributions

F8889.3 F8889.9

6,000

99%