HSA Forms

Download the forms and print them out. Follow the check list and instructions. Please contact us with any questions you may have.

New HSA Application Form

Rollover Form

Employer Contribution Form

1st Kentucky Bank Brochure 

If you're 55 and older don't forget you can fund your account with an extra $900 for 2008.

1st Kentucky Bank will only accept accounts from the following areas.
1) The State of Kentucky , and 2) a 250 mile radius of Mayfield for the contiguous states of Tennessee , Missouri , and Illinois .

If you have had your HDHP and are now just setting up your HSA, you may not reimburse yourself for any prior qualified health care expenses.