Common Contracts
8 similar Health Savings Account Custodial Agreement contracts
UMB BANK, N.A. HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENT (RETAIN FOR YOUR RECORDS)Health Savings Account Custodial Agreement • September 23rd, 2022 • Missouri
This agreement is made between UMB Bank, n.a. (referred to herein as “we,” “us” or the “Custodian”) and the individual person (referred to herein as “you” or the “Customer”) who completes our HSA enrollment process and satisfies the other requirements we establish in order to open a Health Savings Account (“HSA”) with us. We comply with Section 326 of the USA Patriot Act, which requires us to collect and verify certain information about you when processing your account application. We collect your personal information from you and other sources, such as credit bureaus, affiliates or other companies. You are establishing this Health Savings Account under Section 223(a) of the Internal Revenue Code (the “Code”) exclusively for the purpose of paying or reimbursing your qualified medical expenses or those of your spouse and dependents. You represent that, unless this account is used solely to make rollover contributions, you are eligible to contribute to this HSA; specifically, that: (1) y
UMB BANK, N.A. HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENT (RETAIN FOR YOUR RECORDS)Health Savings Account Custodial Agreement • May 26th, 2020 • Missouri
This agreement is made between UMB Bank, n.a. (referred to herein as “we,” “us” or the “Custodian”) and the individual person (referred to herein as “you” or the “Customer”) who completes our HSA enrollment process and satisfies the other requirements we establish in order to open a Health Savings Account (“HSA”) with us. We comply with Section 326 of the USA Patriot Act, which requires us to collect and verify certain information about you when processing your account application. We collect your personal information from you and other sources, such as credit bureaus, affiliates or other companies. You are establishing this Health Savings Account under Section 223(a) of the Internal Revenue Code (the “Code”) exclusively for the purpose of paying or reimbursing your qualified medical expenses or those of your spouse and dependents. You represent that, unless this account is used solely to make rollover contributions, you are eligible to contribute to this HSA; specifically, that: (1) y
U M B B A N K , N . A . H E A L T H S A V I N G S A C C O U N T C U S T O D I A L A G R E E M E N T ( R E T A I N F O R Y O U R R E C O R D S )Health Savings Account Custodial Agreement • September 17th, 2015 • Missouri
This agreement is made between UMB Bank, n.a. (referred to herein as “we,” “us” or the “Custodian”) and the individual person (referred to herein as “you” or the “Customer”) who completes our HSA enrollment process and satisfies the other requirements we establish in order to open a Health Savings Account (“HSA”) with us. We comply with Section 326 of the USA Patriot Act, which requires us to collect and verify certain information about you when processing your account application. We collect your personal information from you and other sources, such as credit bureaus, affiliates or other companies. You are establishing this Health Savings Account under Section 223(a) of the Internal Revenue Code (the “Code”) exclusively for the purpose of paying or reimbursing your qualified medical expenses or those of your spouse and dependents. You represent that, unless this account is used solely to make rollover contributions, you are eligible to contribute to this HSA; specifically, that : (1)
U M B B A N K , N . A . H E A L T H S A V I N G S A C C O U N T C U S T O D I A L A G R E E M E N T ( R E T A I N F O R Y O U R R E C O R D S )Health Savings Account Custodial Agreement • September 8th, 2015 • Missouri
This agreement is made between UMB Bank, n.a. (referred to herein as “we,” “us” or the “Custodian”) and the individual person (referred to herein as “you” or the “Customer”) who completes our HSA enrollment process and satisfies the other requirements we establish in order to open a Health Savings Account (“HSA”) with us. We comply with Section 326 of the USA Patriot Act, which requires us to collect and verify certain information about you when processing your account application. We collect your personal information from you and other sources, such as credit bureaus, affiliates or other companies. You are establishing this Health Savings Account under Section 223(a) of the Internal Revenue Code (the “Code”) exclusively for the purpose of paying or reimbursing your qualified medical expenses or those of your spouse and dependents. You represent that, unless this account is used solely to make rollover contributions, you are eligible to contribute to this HSA; specifically, that : (1)
U M B B A N K , N . A . H E A L T H S A V I N G S A C C O U N T C U S T O D I A L A G R E E M E N T ( R E T A I N F O R Y O U R R E C O R D S )Health Savings Account Custodial Agreement • June 11th, 2014 • Missouri
This agreement is made between UMB Bank, n.a. (referred to herein as “we,” “us” or the “Custodian”) and the individual person (referred to herein as “you” or the “Customer”) who completes our HSA enrollment process and satisfies the other requirements we establish in order to open a Health Savings Account (“HSA”) with us. We comply with Section 326 of the USA Patriot Act, which requires us to collect and verify certain information about you when processing your account application. We collect your personal information from you and other sources, such as credit bureaus, affiliates or other companies. You are establishing this Health Savings Account under Section 223(a) of the Internal Revenue Code (the “Code”) exclusively for the purpose of paying or reimbursing your qualified medical expenses or those of your spouse and dependents. You represent that, unless this account is used solely to make rollover contributions, you are eligible to contribute to this HSA; specifically, that : (1)
U M B B A N K , N . A . H E A L T H S A V I N G S A C C O U N T C U S T O D I A L A G R E E M E N T ( R E T A I N F O R Y O U R R E C O R D S )Health Savings Account Custodial Agreement • January 8th, 2014 • Missouri
This agreement is made between UMB Bank, n.a. (referred to herein as “we,” “us” or the “Custodian”) and the individual person (referred to herein as “you” or the “Customer”) who completes our HSA enrollment process and satisfies the other requirements we establish in order to open a Health Savings Account (“HSA”) with us. We comply with Section 326 of the USA Patriot Act, which requires us to collect and verify certain information about you when processing your account application. We collect your personal information from you and other sources, such as credit bureaus, affiliates or other companies. You are establishing this Health Savings Account under Section 223(a) of the Internal Revenue Code (the “Code”) exclusively for the purpose of paying or reimbursing your qualified medical expenses or those of your spouse and dependents. You represent that, unless this account is used solely to make rollover contributions, you are eligible to contribute to this HSA; specifically, that : (1)
UMB BANK, N.A. HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENT (RETAIN FOR YOUR RECORDS)Health Savings Account Custodial Agreement • September 18th, 2013 • Missouri
This agreement is made between UMB Bank, n.a. (referred to herein as “we,” “us” or the “Custodian”) and the individual person (referred to herein as “you” or the “Customer”) who completes our HSA enrollment process and satisfies the other requirements we establish in order to open a Health Savings Account (“HSA”) with us. You are establishing this Health Savings Account under Section 223(a) of the Internal Revenue Code (the “Code”) exclusively for the purpose of paying or reimbursing your qualified medical expenses or those of your spouse and dependents. You represent that, unless this account is used solely to make rollover contributions, you are eligible to contribute to this HSA; specifically, that : (1) you are covered under a High Deductible Health Plan (HDHP); (2) you are not also covered by any other health plan that is not an HDHP (with certain exceptions for plans providing preventive care and limited types of permitted insurance and permitted coverage); (3) you are not enroll
U M B B A N K , N . A . H E A L T H S A V I N G S A C C O U N T C U S T O D I A L A G R E E M E N T ( R E T A I N F O R Y O U R R E C O R D S )Health Savings Account Custodial Agreement • March 17th, 2011 • Missouri
This agreement is made between UMB Bank, n.a. (referred to herein as “we,” “us” or the “Custodian”) and the individual person (referred to herein as “you” or the “Customer”) who completes our HSA enrollment process and satisfies the other requirements we establish in order to open a Health Savings Account (“HSA”) with us. You are establishing this Health Savings Account under Section 223(a) of the Internal Revenue Code (the “Code”) exclusively for the purpose of paying or reimbursing your qualified medical expenses or those of your spouse and dependents. You represent that, unless this account is used solely to make rollover contributions, you are eligible to contribute to this HSA; specifically, that : (1) you are covered under a High Deductible Health Plan (HDHP); (2) you are not also covered by any other health plan that is not an HDHP (with certain exceptions for plans providing preventive care and limited types of permitted insurance and permitted coverage); (3) you are not enroll
