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FSAFEDS
Account Statement
Customer service: 1-877-FSAFEDS (372-3337) www.FSAFEDS.com
DONALD W HADLEY
5 GAINFORD COURT
OLNEY, MD 20832
Statement Issued: 1/27/2014
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FSAFEDS Program
PO Box 36880
Louisville, KY 40233
For Benefit Period 1/1/2013 - 3/15/2014000677
The summary below shows the balance remaining in your 2013 FSAFEDS account(s) as of January 27,
2014.
2013 Health Care FSA Account Summary as of 1/27/2014
Annual Election - the maximum amount you can be reimbursed $800.00
Total reimbursements $392.27
Approved claims that are awaiting payment $0.00
Remaining balance $407.73
Amount you have contributed - your allotments $800.00
You can send us claims for eligible expenses incurred between 1/1/2013 - 3/15/2014
Your claims must be postmarked on or before 4/30/2014
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